After a lifetime of profound depression, 25 years of therapy and cycling through 18 antidepressants and mood stabilisers, Mr Hartman, then 46, had settled on a date and a plan to end it all. This clinical trial would be his last stab at salvation.

For 40 minutes, he sat in a hospital room as an IV drip delivered ketamine through his system. Several more hours passed before it occurred to him that all his thoughts of suicide had evaporated.

“My life will always be divided into the time before that first infusion and the time after,” Mr Hartman says today. “That sense of suffering and pain draining away. I was bewildered by the absence of pain.”

Ketamine, popularly known as the psychedelic club drug Special K, has been around since the early 1960s. It is a staple anaesthetic in emergency rooms, regularly used for children when they come in with broken bones and dislocated shoulders.

It’s an important tool in burn centres and veterinary medicine, as well as a notorious date-rape drug, known for its power quickly to numb and render someone immobile.

Since 2006, dozens of studies have reported that it can also reverse the kind of severe depression that traditional antidepressants often don’t touch. The momentum behind the drug has now reached the American Psychiatric Association (APA), which, according to members of a ketamine taskforce, seems headed towards a tacit endorsement of the drug for treatment-resistant depression.

Experts are calling it the most significant advance in mental health in more than half a century. They point to studies showing ketamine not only produces a rapid and robust antidepressant effect; it also puts a quick end to suicidal thinking.

Traditional antidepressants and mood stabilisers, by comparison, can take weeks or months to work. In 2010, a major study published in JAMA, the journal of the American Medical Association, reported that drugs in a leading class of antidepressants were no better than placebos for most depression.

A growing number of academic medical centres, including Yale University, the University of California at San Diego, the Mayo Clinic and the Cleveland Clinic, have begun offering ketamine treatments off-label for severe depression, as has Kaiser Permanente in Northern California.

“This is the next big thing in psychiatry,” says L. Alison McInnes, a San Francisco psychiatrist who over the past year has enrolled 58 severely depressed patients in Kaiser’s San Francisco clinic.

She says her long-term success rate of 60 per cent for people with treatment-resistant depression who try the drug has persuaded Kaiser to expand treatment to two other clinics in the Bay Area.

The excitement stems from the fact that it’s working for patients who have spent years cycling through antidepressants, mood stabilisers and various therapies.

“Psychiatry has run out of gas” in trying to help depressed patients for whom nothing has worked, she says.

“There is a significant number of people who don’t respond to antidepressants, and we’ve had nothing to offer them other than cognitive behaviour therapy, electroshock therapy and transcranial stimulation.”

Dr McInnes is a member of the APA’s ketamine taskforce, assigned to codify the protocol for how and when the drug will be given. She says she expects the APA to support the use of ketamine treatment early this year.

The guidelines, which follow the protocol used in the NIMH clinical trial involving Mr Hartman, call for six IV drips over a two-week period. The dosage is very low, about a 10th of the amount used in anaesthesia. And when it works, it does so within minutes or hours.

“It’s not subtle,” says Enrique Abreu, an anaesthesiologist from Portland, Oregon, who began treating depressed patients with it in 2012.

“It’s really obvious if it’s going to be effective. And the response rate is unbelievable. This drug is 75 per cent effective, which means that three-quarters of my patients do well. Nothing in medicine has those kind of numbers.”

So far, there is no evidence of addiction at the low dose in which infusions are delivered. Ketamine does, however, have one major limitation: its relief is temporary.

Clinical trials at NIMH have found that relapse usually occurs about a week after a single infusion.

Ketamine works differently from traditional antidepressants, which target the brain’s serotonin and noradrenalin systems. It blocks N-methyl-D-aspartate (NMDA), a receptor in the brain that is activated by glutamate, a neurotransmitter.

In excessive quantities, glutamate becomes an excitotoxin, meaning that it overstimulates brain cells.

“Ketamine almost certainly modifies the function of synapses and circuits, turning certain circuits on and off,” explains Carlos Zarate, NIMH’s chief of neurobiology and treatment of mood disorders, who has led the research on ketamine.

“The result is a rapid antidepressant effect.”

A study published in the journal Science in 2010 suggested that ketamine restores brain function through a process called synaptogenesis.

Scientists at Yale University found that ketamine not only improved depression-like behaviour in rats but also promoted the growth of new synaptic connections between neurons in the brain.

Even a low-dose infusion can cause intense hallucinations. Patients often describe a kind of lucid dreaming or dissociative state in which they lose track of time and feel separated from their bodies. Many enjoy it; some don’t. But studies at NIMH and elsewhere suggest that the psychedelic experience may play a small but significant role in the drug’s efficacy.

“It’s one of the things that’s really striking,” says Steven Levine, a psychiatrist from Princeton, New Jersey, who estimates that he has treated 500 patients with ketamine since 2011.

“With depression, people often feel very isolated and disconnected. Ketamine seems to leave something indelible behind. People use remarkably similar language to describe their experience: ‘a sense of connection to other people’, ‘a greater sense of connection to the universe.’ ”

Although bladder problems and cognitive deficits have been reported among long-term ketamine abusers, none of these effects have been observed in low-dose clinical trials.

In addition to depression, the drug is being studied for its effectiveness in treating obsessive-compulsive disorder, post-traumatic stress disorder, extreme anxiety and Rett syndrome, a rare developmental disorder on the autism spectrum.

Fleeting remission effect

The drug’s fleeting remission effect has led many patients to seek booster infusions. Mr Hartman began his search before he even left his hospital room in Bethesda.

Four years ago, he couldn’t find a doctor in the Pacific Northwest willing to administer ketamine.

“At the time, psychiatrists hovered between wilful ignorance and outright opposition to it,” says Mr Hartman, whose depression began creeping back a few weeks after his return to Seattle.

It took nine months before he found an anaesthesiologist in New York who was treating patients with ketamine. Soon, he was flying back and forth across the country for bimonthly infusions.

Upon his request, he received the same dosage and routine he’d received in Bethesda: six infusions over two weeks. And with each return to New York, his relief seemed to last a little longer. These days, he says that his periods of remission between infusions often stretch to six months. He says he no longer takes any medication for depression besides ketamine.

“I don’t consider myself permanently cured, but now it’s something I can manage like diabetes or arthritis,” Mr Hartman says. “Before, it was completely unmanageable. It dominated my life and prevented me from functioning.”

In 2012, he helped found the Ketamine Advocacy Network, a group that vets ketamine clinics, advocates for insurance coverage and spreads the word about the drug.

And word has indeed spread. Ketamine clinics, typically operated by psychiatrists or anaesthesiologists, are popping up in major cities around the country.

Dr Levine, for one, is about to expand from New Jersey to Denver and Baltimore. Dr Abreu recently opened a second clinic in Seattle.

Depression is big business. An estimated 15.7 million adults in the United States experienced at least one major depressive episode in 2014, the NIMH says.

“There’s a great unmet need in depression,” says Gerard Sanacora, director of the Yale Depression Research Program.

“We think this is an extremely important treatment. The concern comes if people start using ketamine before CBT [cognitive behavioral therapy] or Prozac. Maybe someday it will be a first-line treatment. But we’re not there yet.”

‘More research needed’

Dr Sanacora says a lot more research is required. “It’s a medication that can have big changes in heart rate and blood pressure. There are so many unknowns, I’m not sure it should be used more widely until we understand its long-term benefits and risks.”

While a single dose of ketamine is cheaper than a $2 bottle of water, the cost to the consumer varies wildly, running from between $US500 and $US1500 per treatment. The drug itself is easily available in any pharmacy, and doctors are free to prescribe it – as with any medication approved by the Food and Drug Administration – for off-label use. Practitioners attribute the expense to medical monitoring of patients and IV equipment required during an infusion.

There is no registry for tracking the number of patients being treated with ketamine for depression, the frequency of those treatments, dosage levels, follow-up care and adverse effects.

“We clearly need more standardisation in its use,” Dr Zarate says. “We still don’t know what the proper dose should be. We need to do more studies. It still, in my opinion, should be used predominantly in a research setting or a highly specialised clinic.”

As a drug once known almost exclusively to anaesthesiologists, ketamine now falls into a grey zone.

“Most anaesthesiologists don’t do mental health, and there’s no way a psychiatrist feels comfortable putting an IV in someone’s arm,” Dr Abreu says.

It’s a drug, in other words, that practically demands collaboration. Instead, it has set off a turf war. As the use of ketamine looks likely to grow, many psychiatrists say that use of ketamine for depression should be left to them.

“The bottom line is you’re treating depression,” says psychiatrist David Feifel, director of the centre for Advanced Treatment of Mood and Anxiety Disorders at the University of California at San Diego.

“And this isn’t garden-variety depression. The people coming in for ketamine are people who have the toughest, potentially most dangerous depressions. I think it’s a disaster if anaesthesiologists feel competent to monitor these patients. Many of them have bipolar disorder and are in danger of becoming manic. My question [to anaesthesiologists] is: ‘Do you feel comfortable that you can pick up mania?’ ”

But ketamine has flourished from the ground up and with little or no advertising. The demand has come primarily from patients and their families; Dr Zarate, for instance, says he receives “at least 100 emails a day” from patients.

Nearly every one of them wants to know where they can get it.

This article first appeared on ‘Sydney Morning Herald’ on 2 February 2016.

People get more depressed after the age of 65, says an English study using data on older Australians.

It’s the first to show depressive symptoms continue to increase throughout old age, says lead researcher Dr Helena Chui from the University of Bradford.

“We are in a period of unprecedented success in terms of people living longer than ever and in greater numbers and we should be celebrating this but it seems that we are finding it hard to cope,” she said.

Both men and women reported increasingly more depressive symptoms as they aged, with women initially having more than men.

“However, men showed a faster rate of increase in symptoms so that the difference in the genders was reversed at around the age of 80,” the researchers said.

Levels of physical impairment, the onset of medical conditions and the approach of death all played a part in having the symptoms.

“It seems that we need to look carefully at the provision of adequate services to match these needs, particularly in the area of mental health support and pain management,” Dr Chui said.

“Social policies and ageing-friendly support structures, such as the provision of public transport and access to health care services are needed to target the ‘oldest-old’ adults as a whole.”

This article first appeared on ‘9 News’ on 16 November 2015. ]]> http://www.newsinmind.com/research/depression-increases-with-age-study/feed 0 http://www.newsinmind.com/research/more-than-a-third-of-christians-have-suffered-mental-health-issues http://www.newsinmind.com/research/more-than-a-third-of-christians-have-suffered-mental-health-issues#respond Thu, 15 Oct 2015 22:44:26 +0000 http://www.newsinmind.com/?p=7553 More than a third of Christians have suffered mental health issues, according to a survey by Christian Research to coincide with World Mental Health Day.

Over 35 per cent had experienced some form of mental health issue and more than 80 per cent knew a close friend or relative with similar experiences. Nearly three in ten said they had been discriminated against or knew someone who had, for mental health problems. And while most said they would be happy to talk about their mental health problems at church, seven in ten said their churches offered no resources to deal with it.

Previous research by ComRes showed that mental health issues account for nearly 25 per cent of the disease quota in Britain yet attracts just 11 per cent of NHS spending.

A recent BBC story stated that universities are facing a 10 per cent rise in demand for counselling services from students, with recorded mental health cases having risen from 8,000 to 18,000 between 2008 and 2012.

The online research was conducted via Christian Research’s panel of around 17,000 practising Christians across the UK, with 1,275 responding between 5 and 7 October.

“This is a clear sign that churches need to provide a more supportive space for their congregations to explore these issues,” said Maddy Fry, the researcher behind the study.

Earlier this year the UK’s largest Christian disability charity, Livability, joined forces with Premier Mind and Soul to create new resource to help churches better understand people with mental health needs in their congregations.

Christian Today reported that Katharine Welby-Roberts, an associate at Livability and the Archbishop of Canterbury’s daughter, who has spoken publicly regarding her struggles with depression, said: “As anti-stigma campaigns, such as Time to Change, begin to see societal attitudes towards mental health change, the Church has begun to recognise the need to better support people with mental health needs in their congregations.” She said that churches wanted to support people with mental health problems, but did not know how. “This can often lead to isolation or people leaving the Church because they feel misunderstood or not catered for. I believe the Church is a key untapped local resource which can support people with mental health needs.”

This article first appeared on ‘Christian Today’ on 15 October 2015.

During Mental Health Week last week, Health Minister Cameron Dick unveiled the Queensland Mental Health Promotion, Prevention and Early Intervention Plan 2015-17, which aims to improve the mental health and wellbeing of Queenslanders by taking early action.

Mr Dick also announced more than $450,000 in funding to improve mental health through greater social inclusion and community participation, particularly in regional areas.

In Parliament yesterday Ms Howard highlighted the government’s commitment to youth mental health, in light of the LNP’s closure of the Barrett Adolescent Centre, which is currently the subject of a commission of inquiry headed by the Hon. Margaret A Wilson QC.

“The Palaszczuk Government values the mental health of our youth and has committed $11.8 million over four years to rebuild mental health care for young people in Queensland after the last three years of neglect,” she said.

Ms Howard also emphasised the importance of working together as a society that values mental health.

“Mental health is an issue that touches all of our lives at some point, either personally or through the experiences of friends and family,” Ms Howard said.

“Most of us can manage these issues and get on with our lives, but others need help.

“Whether as a government, a community or individually, we must do everything we can to assist them.”

Meanwhile the Opposition today sought a bipartisan approach to mental health support services by harmonising two bills currently before Parliament.

Shadow Minister for Health Mark McArdle said it was crucial politics was left at the door when dealing with such an important issue as mental health.

“Currently there are two bills before Parliament, one introduced by the LNP in April and the other introduced by Labor in September,” Mr McArdle said.

“Both bills aim to improve and maintain the health and wellbeing of persons with a mental illness and ensure Queenslanders are supported through evidence based clinical practice.

“In the Minister’s speech introducing the government bill into the house he said, the ‘bills have many reform directions in common’.

“Given the Minister’s comments, it makes sense to present one single Mental Health bill supported by all sides of politics.

“The LNP has written to the Minister for Health and the Chair of the Parliamentary Health and Ambulance Services Committee Leanne Linard calling for one, unified bill on Mental Health.

“In the letter we have requested an extension of the reporting time to allow for this process to occur.

“We are also open to work with the government on any differences within the bills, proposing for any issue to be set aside and worked through individually to form a set of consensus clauses.”

Mr McArdle said one bill, being supported by all sides of politics sends a clear message that mental health is a clinical area where a great deal of bipartisanship exists.

“By working together we can deliver a bill that improves the lives of the nearly 20% of Queenslanders affected by a mental disorder each year,” he said.

The West Moreton Mental Health Collaborative held a number of free community events around the Ipswich region during Mental Health Week last week, including a morning walk, a community showcase at The Park Centre for Mental Health, an information night and a free breakfast in Queens Park and held a silent art auction at the Ipswich Community Art Gallery. Aftercare also hosted an early childhood mental health forum.

This article first appeared on ‘Queensland Times’ on 14 October 2015.

I remember I had asked to leave class early that day. I probably stood at the top of those stairs for about 10 minutes. I kept picturing myself wearing a cast in my arm and having to stay home for a week. I moved back and forth trying to figure out where the best place to fall from would be to cause just enough harm. Ultimately, those 10 minutes turned to seconds and the school bell rang. My chance had gone away.

I brushed off what I had tried to do. I didn’t think it was a big deal. I wanted to hurt myself to get out of having to go to school. Wanting to not go to school was not anything unusual for someone at that age. The extent to which I was was willing to go to was.

I wasn’t used to admitting I was struggling. I had always been a perfectionist who had a close group of friends, did great in school, and was truly happy with life. Having a mental illness was nothing I ever pictured having to deal with.

The thing is, mental illness is like cancer. You don’t know when it’s coming.

So when it does, you have to admit you have a problem. I would have probably been able to prevent what happened my first semester of college had I sought help for the insecurities I was having. Feelings are not a phase.

While I had forgotten about what happened my junior year of high school it ultimately came back to haunt me my first semester of college. I wasn’t used to being away from the perfect life I was used to having back home. I was diagnosed with depression after seeking help from a therapist in late September of 2011. I was advised to start taking medication but for personal beliefs refused to do so. However, the weekly sessions I began having with my therapist began to really make a difference.

While I continued to see here for about 9 months, I ultimately regret the need to hide the fact that I was seeing her. The stigma with mental illness is that if you’re dealing with it you’re either crazy. And truth be told, the people who think this way are the ones who should call themselves crazy.

One of my favorite songs says it best: “It’s ok not to be ok.” Jessie J sings this in her song “Who You Are.”

And what she goes on to say is really what I hope to show you through this personal essay. She sings “When we realize this, life is more content.”

While my family members knew I was attending therapy, my friends didn’t. Every time I was in therapy or attending group counseling I lied and said I was somewhere else. I was ashamed.

The fact that I was hiding a big part of my life became even more apparent when I was interviewing for a scholarship and came face to face with a work colleague who was part of the panel. In the essay I had discussed my battle with depression. I did the interview in peace but came out in tears.

He was the first person outside my family, more than one year after I had stopped being treated by a therapist, who had found about about my depression. I intended to keep it this way.

I finally felt the need not to so during my senior year of college. One of my best friends opened up to me about his struggle with depression not knowing about my own struggle. I was hesitant to admit it to it but finally chose to do so.

He was the first person who actually made talking about depression feel normal and continues to be the only person who makes I can have that type of conversation with. I’m happy to have found that support but am sad that there has only been one person who I can receive this type of support from.

While we may not all feel comfortable talking about depression we need to be willing to open our hearts and our minds to having the conversation about depression.

That is why I openly wrote admitted to my battle with depression on Facebook a few months before my college graduation. Soon after, four more people opened up to me about their own struggles with depression.

As a professional writer I have openly blogged about my story and have raised awareness with organizations like To Write Love on Her Arms and Mental Health America. That is not enough though.

You might think that because I worked with organizations that are in the mental health space that I should and could have treated my own depression. The thing is that even though I learned about how the things I was feeling were not OK, I couldn’t stop them.

You can have everything in the world or nothing at all and are still not be immune to facing a mental illness.

I have a mother who has survived multiple battles with cancer, a father who’s an amputee, come from a very low socioeconomic background, and have phased other health battles. But none of those experiences ever made me depressed. It was the things that I didn’t think much about in life that did.

After more and more people began to know about my own struggle, I began to feel in my own skin. While some people have looked at me differently and at times might not say things about it as respectfully as I wish they did, that’s ok. Depression is not the most easiest thing to wear, but when you’re finally able to wear it in public, life becomes 100 percent easier.

Follow Ingrid Vasquez on Twitter: www.twitter.com/ingridtweets_

This article first appeared on ‘Huffington Post’ on 13 October 2015.

You’ve taken the leap from front-line individual contributor to professional manager. How do you feel? Proud? Excited?

How about depressed?

Middle managers are the most likely people in an organisation to suffer from depression, according to a new study led by Seth Prins, a doctoral student at Columbia University’s Mailman School of Public Health, and recently published online in Sociology of Health & Illness. The researchers examined more than 20,000 full-time workers, segmented into four main categories: owners, managers, supervisors and workers.

Owners were defined as self-employed individuals who earned more than $US71,500 (the 90th income percentile). Managers were respondents who identified as an executive, administrative or managerial role and possessed more than a 4-year bachelor’s degree. Supervisors likewise identified as executive, administrative or managerial but did not possess a bachelor degree. (The bachelor’s degree was chosen as a proxy for skills in an attempt to separate higher-level management roles from lower-level supervisor positions).

 Owners and workers less depressed

This article first appeared on ‘Australian Financial Review’ on 28 September 2015.