The “American Sniper” Lesson No One is Talking About

With all the controversy surrounding the movie American Sniper, one point is not getting enough attention:  the societal effects of untreated PTSD.

Post-Traumatic Stress Disorder (PTSD) is a disabling condition resulting from severe stress or trauma.  It’s common in war veterans but also affects rape victims, survivors of domestic violence, child abuse victims and others.  Symptoms include flashbacks, nightmares, depression and difficulty concentrating.  Sufferers often turn to drugs and alcohol to cope.

A minority of patients exhibit violent or aggressive behavior as a result of the condition.  This aggression may occur without warning and can be lethal.  (The documentary Beer Is Cheaper Than Therapy offers a frightening view of soldiers struggling to adjust to civilian life after returning from war).

The fact that Chris Kyle–the most lethal sniper in U.S. history–was killed on U.S. soil by a fellow veteran is a tragic irony that deserves attention.  There’s a reason the term “cycle of violence” exists.  Whether it’s an abusive parent who was abused as a child or a violent spouse who experienced violence in a warzone, the costs of untreated PTSD are immense.  How many violent criminals have PTSD as a result of childhood abuse?  How many good people have had their psyches destroyed by unnecessary violence at home and abroad?  Unfortunately, we don’t have the statistics to answer those questions, but it’s safe to assume the number is high.

The medications used to treat PTSD leave a lot to be desired.  At best, they provide modest improvement in mood and anxiety; at worst, they could trigger a worsening of the condition.  Recent studies into the benefits of MDMA and cannabis on PTSD look promising.  There is still no cure.

When it comes to PTSD, an ounce of prevention is worth a pound of cure.  Adult trauma survivors should seek counseling to work through their problems before having children (and after).  Agencies like the VA must make treatment easily accessible to soldiers returning from war.  Teachers should learn to recognize the signs of abuse in children and report them to the proper authorities immediately.  Remember, the person suffering can’t always speak up for themselves.

PTSD is as much a social problem as an individual one.  Sufferers deserve empathy and respect, not fear and stigma.  Treatment is an ongoing process that is worth the effort.  This is one condition where burying your feelings can have deadly consequences.

 

 

 

 

 

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Depression An Allergic Reaction in the Brain? Experts Say Yes.

Psychologists are finally confirming what many of us already suspected:  depression is a physical disorder, not a mental one.  Immune messengers known as cytokines–which help fight infections like the flu–can cause depression when chronically activated.

When you’re sick with a viral or bacterial infection, you feel exhausted, socially withdrawn and mentally foggy.  This is known as “sickness behavior” and it has a biological function: to help your body reserve energy and fight infection.  But when the immune system is constantly reacting to inflammation in the body, depression can result.

So what causes this rascally inflammation?  The causes can vary from person to person, but there are many potential sources.  Junk foods like trans fat and sugar are major offenders, as are allergens like mold and pollen.  (If you have allergies, you know how miserable and cranky you feel during an attack).  Food allergens can also trigger a this sort of inflammatory response, as most of the body’s immune system is located in the gut.  Stress, lack of sleep and immune-stimulating drugs like interferon can also cause a flood of cytokines.

Depression is a complex disease with many causative factors.  Not all cases can be blamed on a faulty immune system alone.  But this finding could open the door to new treatments and a less stigmatizing view of depression sufferers.  The “chemical imbalance” theory has spawned a host of medications with an abysmal success rate.  Makes sense, as boosting serotonin or other neurotransmitters would do little for depression caused by an immune response.

But do anti-inflammatory drugs really fight depression?  Some studies say yes.  Combined with traditional antidepressants, NSAIDs like celecoxib (Celebrex) and the anti-inflammatory herbs ginger and turmeric provided more relief than antidepressants alone.  It’s too early to suggest trading your Prozac for anti-inflammatories, so talk to your doctor before changing your treatment plan.

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Harnessing the Mood-Boosting Powers of Opioids

Opioids can have miraculous effects on depression and anxiety, as many addicts will attest to.  Now that information is being put to good use.

Enter ALKS-5461, the latest antidepressant in the pipeline.

ALKS contains the opioid buprenorphine combined with the opioid blocker samidorphan.  Buprenorphine stimulates the mu-opioid receptor (the one that produces “the high”) while blocking the misery-inducing kappa opioid receptor.  Samidorphan partially blocks bupe’s effect on the mu receptor, reducing the risk for abuse.

The drug was so effective in clinical trials that it was granted fast-track designation by the FDA.  Despite its potential, ALKS-5461 is not a cure-all and could carry side effects of its own.  It is intended as a second-line (or third-line) treatment for patients whose depression is not helped by mainstream medications.

How many addicts are self-medicating without realizing it?  If an effective antidepressant was available, it could reduce the desire to use harder drugs in this population.  Not to mention the desperate need for new options for patients with treatment-resistant depression.

ALKS-5461 is slated to hit the market in 2016.

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Flashback Friday: Shocking Treatments

Today we take a trip back into psychiatry’s not-so-distant past; to a time when convulsions were believed to cure mental illness.  The crude methods used to produce these fits (insulin shock, metrazol and electroconvulsive therapy) are discussed in this “shocking” video.

By the way, one of these treatments is still in use today.  Sweet dreams.

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Brain Injury and Mental Illness: CTE

Driving into oncoming traffic.  Drinking antifreeze.  Shooting oneself in the heart.  These are just a few of the bizarre and horrifying ways ex-NFL players with the brain disease chronic traumatic encephalopathy (CTE) have ended their lives.

Traumatic brain injury is perhaps one of the most obvious, straightforward routes to brain dysfunction.  Because the brain controls virtually every function of the body, physical injury to this delicate organ can result in a wide range of problems.

Exhibit A:  dementia.

While not technically a psychiatric illness, dementia is a key feature of brain diseases that are uniformly fatal.  Alzheimer’s is the most common cause of dementia, but there are many others.  Since the 1920s, dementia has been documented in boxers in the form of dementia pugilistica, aka “Punch Drunk Syndrome”.  Brothers Mike and Jerry Quarry are two famous boxers who died from the condition, known today as chronic traumatic encephalopathy (CTE).

But CTE is not limited to professional boxers.  As the PBS documentary “League of Denial” recently showed, football players–even those still in high school–can develop CTE as a result of repeated blows to the head.

One particularly tragic CTE story is that of NFL player Justin Strzelczyk of the Pittsburgh Steelers.  Like many former NFL stars, Strzelczyk descended into a period of depression, substance abuse and suicide after his football career waned.  In his final days, Strzelczyk believed he was being chased by demons and his phone was being tapped.  He threw money from his roof as an offering to the devil.  On the day of his death, he packed $2,600 and some crucifixes into a suitcase and headed down a New York highway in the wrong direction driving 90 mph.  After a long chase, Strzelczyk hit a tanker truck that exploded into a ball of fire, killing him instantly.  Upon autopsy he was found to have no drugs or alcohol in his system.  He was only 36 years old.  (See videos below for the full story).

Sadly, Strzelczyk’s strange and dramatic death is not an aberration.  Other former NFL players like Junior Seau, “Iron Mike” Webster and Terry Long (who killed himself by drinking antifreeze) died in an equally disturbing fashion after a long battle with CTE.  Ex-Chicago Bears player Dave Duerson went so far as to shoot himself in the chest rather than the head so scientists could study his brain for the disease.

Is it possible that other former athletes like O.J. Simpson and Mike Tyson are also affected to some degree by this condition?  Since CTE can only be definitively diagnosed by brain autopsy after death, we can only speculate.  (Near the end of “League of Denial,” one researcher claims the disease is so prevalent that she doubts there are any long-time football players who don’t have it.)  Athletes in other contact sports like professional wrestling and hockey have also been diagnosed postmortem with CTE.

CTE is caused by the brain slamming against the inside of the skull repeatedly (i.e. – “sub-concussive blows”) or by multiple larger concussions.  Like Alzheimer’s disease, CTE is a progressive and fatal condition with no known treatment or cure.  Depression, psychosis and other personality changes are very prominent in CTE, perhaps more than in other forms of dementia.  Interestingly, head trauma is also a risk factor for developing Alzheimer’s later in life.

In Part II of this story, we’ll look at the link between brain injury and other mental health disorders like depression.

Part I:  Justin Strzelczyk Story on ESPN

Part II:  Justin Strzelczyk Story on ESPN

 

 

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Hemochromatosis: The Celtic Curse that Killed Hemingway

The Writer and His Shotgun

Ernest Hemingway was a swashbuckling, globetrotting, Nobel prize-winning author who died from a self-inflicted gunshot wound at the age of 61.  While many factors likely contributed to his suicide (repeated head injury, his own father’s suicide, broken marriages, alcoholism), an insidious disease known as hemochromatosis is thought to have also played a role.

Hemochromatosis–also known as “The Celtic Curse”–is a genetic condition in which the body cannot rid itself of excess iron.  As a result, the iron ingested in food accumulates in vital organs such as the liver and heart.  In its late stages, hemochromatosis can cause terrifying mental and emotional disturbances such as depression, angry outbursts and psychosis.  Not everyone who has the disease will develop symptoms; those who do often don’t experience them until later in life.  Strangely, men are more likely to develop symptoms of the disorder than are women.

For all the mysteries surrounding Hemingway’s death, we know this:  he was diagnosed with hemochromatosis at the Mayo Clinic in early 1961.  His father also suffered from the disease and developed eerily similar mental problems shortly before his death.  In his final  years, Hemingway was tormented by a total inability to write creatively.  His brother and sister also committed suicide, as did his granddaughter Margaux–sister of actress Mariel Hemingway.  In 2013, Mariel starred in a documentary called “Running From Crazy” in which she examines the unfortunate history of mental illness in her family.

Did the Celtic Curse also claim the lives of Ernest Hemingway’s kin?  Might it play a role in other cases of familial suicide?  While there’s no evidence to support the idea, it’s possible that singer Kurt Cobain might have suffered from hemochromatosis.  In addition to his suicide at age 27, Kurt had multiple uncles and grandfathers who killed themselves violently.  He suffered from undiagnosed stomach pain all his life (as did his mother), which is a common symptom of hemochromatosis.  Cobain was of English and Irish descent, putting him at greater risk for the condition than people of other ethnicities.

One thing is certain:  until psychiatry starts acknowledging alternative causes of depression beyond the “neurochemical imbalance” theory, we’ll keep missing opportunities to treat people.  All the Prozac in the world won’t save someone whose brain is overloaded with a toxic metal.

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Eye Movement and Schizophrenia

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Finally, a subjective diagnostic test for a mental illness!

According to a recent study at McGill University in Montreal, impaired reading fluency can be an indicator of schizophrenia.  The study compared the eye movements of 20 schizophrenic patients to those of 16 non-affected subjects.  The results showed that schizophrenic people generate smaller eye movements, read more slowly and spend more time processing words than their non-schizophrenic counterparts.

While eye movements alone do not provide a definitive diagnosis, they can be considered along with family history and other risk factors to draw more accurate conclusions.

If schizophrenia–which has always been viewed as a psychological disorder–can affect eye movement (a neurological function), would it not be considered a neurological disorder?  Other significant physiological differences, such as reduced temporal lobe and frontal cortex volume, have already been documented in schizophrenia patients.  Hopefully this finding will open the door to other biology-based diagnostic methods for schizophrenia and other mental health disorders.

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