From the article, "FDA Panel Backs Implant To Counter Depression":
The device has been used in the United States since 1997 to control epileptic seizures. The manufacturer, Cyberonics Inc. of Houston, hopes to expand its market: Fifteen to 25 percent of the 19 million Americans with depression may not respond to available treatments, Rush said.The implant involves connecting a wire to the left vagus nerve in the side of the neck; a battery is implanted high in the left chest or under the armpit, and the amount of current can be regulated externally. Typically, the implant sends a 30-second pulse of current followed by a five-minute pause, 24 hours a day.
Karmen McGuffee of Garland, Tex., told the panel she had tried virtually every antidepressant drug on the market before getting the device. Improvement came within weeks, she said.
"My mother said she wasn't looking into the eyes of a dead person anymore," she said. When people asked why she was willing to get an implant, she replied, "I had nothing to lose" …
… The panelists mostly agreed that the data presented by Cyberonics had problems but were swayed by the lack of alternative treatments and the evidence that the device is generally safe, based on its widespread use to reduce epileptic seizures.
Cyberonics' central study was a randomized trial involving 221 patients. All received implants, but the power was turned on for only half the group.
Of 111 patients getting stimulation, 17 showed an improvement of at least 50 percent on a psychiatric scale of depression after 12 weeks. Of 110 patients getting "sham" treatment, only 10 showed similar improvement. The difference between the groups was not statistically significant, however.
in the news
-Lobbyists block mental health parity
-Bush plans to screen whole US population for mental illness
on therapy
-Two Psychotherapy Types Effective For Personality Disorders
-In Treating Childhood Trauma, One Therapy Stands Out
new research
-Psychotic Depression May Be Relative of Schizophrenia
-Zinc supplements could help kids with ADHD
-Study Finds Cannabis Triggers Transient Schizophrenia-Like Symptoms
more
-Drink Enhances Mental Illness Medication
-New Technique Developed at UC San Diego for Deciphering Brain Recordings Can Capture Thinking As It Happens
-Scientists Unlock One More of Sleep's Secrets
-Room Designed to Put Customers to Sleep
—from the American Gallery of Psychiatric Art. If you've never checked it out, it's worth a visit. Also of interest: the site's list of related links.
If you're a woman in her mid-20s who's being medicated for depression -- in other words, if you're in a situation like mine -- you've probably wondered about the possibility of a healthy, drug-free pregnancy.
You'll wonder even more after reading Lauren Slater's essay, "Noontime," from Unholy Ghosts: Writers on Depression. It's one of the most harrowing, precise accounts of depression I've read in a long, long time.
I recommend buying Unholy Ghosts and reading the essay in its entirity, but an abridged version of "Noontime" is also available online, here.
A short excerpt:
Because I am a psychologist, I know all the signs. Disturbed sleep. Disturbed appetite. Neurovegetative symptoms. Psychomotor retardation. It is difficult to move; my limbs say no. I stand at the stop of the stairs, holding with one hand the newel post, looking down the slant and considering. I spend a long time weighing the pros and cons of staying put, or descending. The decision feels tricky and enormous.All the signs above are symptoms of depression. They are also, however, symptoms of pregnancy, so maybe I'm not depressed. Maybe I'm just pregnant. Maybe to be pregnant is to be depressed. Then would the converse also be true, that to be depressed is to be pregnant? Of course not!... My brain swims in my head, the questions are overwhelming, my heart flaps.
I make a decision. I get to the bottom of the stairs. Musashi [my dog] comes over and licks my knee. He keeps licking and licking my knee in one specific spot and at last I see why; I have a skinned knee, with blood and all, I don't know how this happened. Perhaps I fell down the stairs, although I highly doubt it. In any case, the hows do not matter, only the whys. Why Musashi licks my knee is because there's blood on it, I have an answer. I have an answer! His tongue looks pretty, a flickering red, but I know it's crawling with bacteria, that I should push him away from the cut, but I don't. I cannot find it in myself to care.
What I find in myself is a fatigue that flees during the night so I am wide-awake and blinking, and descends during the day, without warning, each nap a small delectable death. I nap at all the wrong times, in staff meetings, on the phone with a social worker, please God not with a patient, of course I am with a patient, she being me, napping and then jerked away, my heart's rhythm all wrong. "What's wrong?" Benjamin says each evening when he comes home from work. I say, "It's back, depression's a real mental illness you know," and he nods. He doesn't know. He brings me food, all of it very unappealing, especially the texture of toast. He brings me sliced tomatoes and I am nauseated by the way they look, like fresh peeled scabs on a white platter.
Janet, of Humanophone, just reminded me to link to this piece from the NY Times Magazine on the relationship between happiness and prejudice. If you haven't already read it, here's a quick excerpt:
Researchers found that angry people are more likely to make negative evaluations when judging members of other social groups. That, perhaps, will not come as a great surprise. But the same seems to be true of happy people, the researchers noted. The happier your mood, the more liable you are to make bigoted judgments -- like deciding that someone is guilty of a crime simply because he's a member of a minority group. Why? Nobody's sure. One interesting hypothesis, though, is that happy people have an ''everything is fine'' attitude that reduces the motivation for analytical thought. So they fall back on stereotypes -- including malicious ones.I'm interested in hearing readers' reactions.
What qualifies me for this blog might also disqualify me. Others have routines; I have my moods, and they similarly dictate my daily activities, even if to occlude them. But, like routines, my moods are, at least in retrospect, predictable; and, like a workday, they cycle me between productivity and leisure, though on a scale of weeks or months instead of days.
Two weeks ago, I kept waking at sunrise after two to three hours of restless, thin sleep. Even if the morning's sunlight made me dizzy, even if I got out of my bed by falling off it, even if my body wanted to vomit itself across my sheets to stay in bed, I viewed my insomnia as a gift.
I've always been a heavy sleeper. Usually, sleep drugs me, paralyzes my arms in the morning so I fall back into it. I can sleep twelve, fourteen, twenty hours, more — and days blur; the calendar's boxes, as if submerged in water, loosen and dissolve. I sleep through my scheduled meds, and withdrawal is instant and unforgiving; I cold-sweat through my sheets; my sweat freezes me inside my dreams. And The Dreams: before I went on my meds, they were already deformed, cruel, vivid, but the past two years they've become more real, and more thematically consistent, than my waking life. (Veins are made of blue thread that, pulled, unravel innards; moles grow into nipples; parents attack me; my brother tries to seduce me; even if I'm not depressed during the day, in my dreams I'm mourning, inexplicably desperate, devastated, hopeless.)
If I can escape sleep, I will. Insomnia's a friend. But it also gives me false confidence — I'll eventually crash, but I forget that. I might also "forget" to take my pills. (1. Last week, I remembered a time last summer when I was out of meds and didn't have a ready refill. For three days, I took half my dosage; and it was as if an overcast sky sailed in; my thoughts sombered, gained heft, and I felt grounded by their dark weight. Last week, I missed that more substantial self. 2. Habits can become so regular they turn invisible. Did I just smoke that cigarette? I don't remember. Or, each repetition of routine is an infinite return, a moment of no time in time. The pill bottle is open on my desk; did I take my pills while reading? Everyday, I take two, and I know the routine without having any memories of it.) So, I think I skipped half a dose twice last week.
If I miss my pills completely, my nerves feel like boiling water, frenetic and violent for attention. It's a bodily sensation that no other type of self-destruction achieves. But if I lower my dosage, the effect is, at first, strictly psychological. It feels like a mixed episode — my thoughts turn strange and sad, but the act of thinking feels Romantic. At the end of last week, in this very self-important mood, I sat on a bench in my town's public square and listened to music while drawing passers-by and writing down thoughts. In my notebook are things like,
Sadness pulls life to it … a forgotten realism.Angsty and cartoonishly sad as those thoughts may be, writing them energized me. I felt I was a conduit for someone else, maybe a pre-medicated self — and rather than worry me, the thoughts seemed like bright insights into the mind of a character —one more desperate than myself — I might store away for a story.
I long for people, but always turn the longing into a strict lesson: how to be consoled by, content with, my own company.
I'm always on the verge of crying. My throat is a salt lick.
I look up and a homeless man who's staring at me pantomimes a sad face to show me mine.
I can feel the sadness thumbing my face like clay — pushing my cheeks lower; firming my brows' muscles, but underneath that tensing, carving a hollow stare.
When I got off the bench, the sun was setting. By the time I got back home, it was set. My sleep schedule is usually vampiric, but only because nighttime, on some level, scares me, and I don't feel safe falling asleep until the sun's mopped up my bedroom's shadows. Or, maybe I shouldn't say night "scares" me. It traps me, sequesters me from comfort; it grows black walls over my windows. I want to be there when the walls fall, to make sure they do.
So, that night, my perverse joy in my own sadness gave way to frantic, confused, helpless depression. I call these worst nights my "episodes." Everything changes. I can't talk or read. I'll huddle in fetal positions around my apartment, sobbing with the certainty that something's deeply wrong with me. I feel like a poorly anesthetized patient who wakes up during surgery but, paralyzed, can only wait and wait and wait though a terror that feels longer, deeper, larger, than time. If I manage to distract myself, it's with plans to die. No method appeals to me, and I don't want to slash or crush or jam my body with my mind's desperation. But thinking about dying calms me, gives me direction. When I'm crying on my apartment's unvacuumed carpet, I only feel paralyzing vertigo: no energy to change positions, my thoughts not even looping but spinning.
The next day, after heavy sleep, I'll feel better but exhausted, as if I ran a marathon. My body: sore and weary. My thoughts: drab and wrung dry. But the exhaustion feels wholesome, like my body's mistaken the previous night's episode for sun-blessed, toxin-sweating labor.
I may slip downward at sunset, down into the night's drain again. But, if I'm writing, I'm hopeful. I'm not romanticizing sadness but hacking its arch into words.
I don't know if my postings will ever be regular, but if depression keeps me away, it also brings me back again.
It might even qualify as a self-help excercise.
From The New Yorker:
The reputed existence of a “suicide poem” has lurked in the background of Lincoln scholarship since shortly after the President’s death, in 1865, when his close friend Joshua Speed mentioned it to Lincoln’s law partner and biographer William Herndon. At least twice, at the ages of twenty-six and thirty-one, Lincoln had expressed thoughts of suicide seriously enough to alarm his friends. Speed was certain that Lincoln had published the poem in [the Sangamo Journal], but he wasn’t sure about the date.But, finally, it seems the poem has been found. The NYer comments,
The poem is written in the voice of a tortured, lonely soul who comes to the bank of the Sangamon River:Yes! I’ve resolved the deed to do,Even if one takes into account the appetite for melodrama in Lincoln’s day, the last two stanzas of the poem are startling:
And this the place to do it:
This heart I’ll rush a dagger through
Though I in hell should rue it!Sweet steel! Come forth from out your sheath,
And glist’ning, speak your powers;
Rip up the organs of my breath,
And draw my blood in showers!
I strike! It quivers in that heart
Which drives me to this end;
I draw and kiss the bloody dart,
My last—my only friend!
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DISCLAIMER: Names have been changed to protect the incompetent, the unpleasant, and the all-around not-terribly-effective.
Lesson One: Bedside Manner, or "bang head against wall, collect pills"
"Primum non nocere" ~ Galen, Ancient Roman physician
A prospective psychiatrist, psychologist, psychotherapist, or counselor (henceforth referred to as "mental-health professional") should begin by having an interesting psyche of her/his own, and by showing an interest in the psyches of others. Entering into the field of mental healthcare is counterindicated for those utterly without personality, those with repressed or repressive personalities, and those of the type commonly referred to as "assholes." So-called "book-learning" offers a wide range of useful tools for the prospective mental-health professional, but academic settings alone cannot infuse humanity into those deficient in it. The prospective mental-health professional should be prepared to engage the interest of clients who may be emotionally disinclined to be interested.
It's difficult to say what motivated me to walk into the office of my first psychiatrist at age 18. I had been in the same existential condition more often than not since I was 15, and would be through the present day and beyond, although my relationship to the depression has changed. The essential symptoms at the time of my entrée into the client end of the mental health profession: Listlessness. Agitation. Problems with my 16-year-old girlfriend. Problems with the shit jobs I couldn't seem to hold on to. Problems with the academic work that should have been easy but quickly became overwhelming. The dull ache of profound apathy and hopeless inertia. The cuts I made on my arms with my parents' serrated kitchen knives, carving out a sharp and visible pain to match the phantom miasma of my psychic innards. A quantum singularity in the pit of my stomach that threatened to swallow me from the inside.
I suppose there was a series of trap doors in my depression through which I fell at the time. One of them took me from Everything is hopeless, but the hopelessness at least is mine, so I'll hold on to it to Everything is hopeless, but the hopelessness is utterly beyond me, so I'm willing to try something new to crawl out of it. Another, through which I would stumble too soon, would take me to Fuck everything. I'm going to kill myself.
At any rate, falling through the first trap door, I landed in the office of my first psychiatrist -- Dr. Something-Or-Other -- in the health center at Western Michigan University. I was a college freshman who still lived at home, and he had the personality of a concrete slab. I told him a little bit about what was going on, and he prescribed me Prozac and told me not to mix the Prozac with alcohol. I would take the pills regularly, if not enthusiastically, and stay away from booze for days at a time.
(I had discovered the wonderful oblivion of alcohol the summer after I turned 17. A little more than a year later, as an English major in college, and a poet and musician to boot, it seemed ill-advised for me to be dry for longer than days at a time. More to the point, as a depressive who'd found a little temporary release and comfort in self-medication, I didn't want to go without alcohol for very long. Dr. S-O-O didn't press the issue, didn't demand that I abstain, didn't seem alarmed. In fact, I don't recall him ever changing his facial expression from his accustomed look of deep gray boredom. He may have been depressed himself. Or he may have been a robot.)
Sometime later, we switched to Norpramin (an older tricyclic antidepressant not much in use anymore, generically known as Desipramine hydrochloride). Dr. S-O-O advised me that, unlike Prozac, Norpramin afforded me the opportunity to overdose and do some serious, possibly fatal, damage to myself. (He didn't quite phrase it like that, but that's how I heard it.) This opened up whole new vistas of suicidal fantasy, and in very little time, my unfulfilled but obsessive longing for a Norpramin overdose had me doing a voluntary stint in the local psych ward.
The hospital was nice. I get nostalgic for it when I feel overwhelmed by the necessities of "real life," or when I smell poorly-made coffee and Marlboro Reds through congested sinuses. I don't remember my in-house counselor, some guy who took me through a couple of personality tests and told me I was dysthymic with episodes of major depression. I remember my psychiatrist -- Dr. Vader -- a short little Asian woman who, I was sure, hated every second she had to spend with me. To counter Dr. Vader's dark side, a feisty nurse named Marilyn became my Obi Wan. She had the radical idea that I as a patient had rights, and should stand up for them.
With encouragement from Marilyn and some of my crazy wardmates, I asked to be paired with a different psychiatrist. This only pissed off Dr. Vader even more. I remember her (I don't know how accurately) yelling at me about how I had hurt her feelings. She then put forth an intriguing theory about the root of my psychological disorder, that I was a spoiled brat who was used to getting his own way. I was much humbled by Dr. Vader's performance, and agreed to suffer her tutelage until such time as I was well enough to leave the hospital. And then she doubled my dosage.