It’s been known for a long time that when people with depression are treated with antidepressants, their risks of committing suicide can actually increase, at least initially.
It’s thought that one of the causes of this is because highly suicidal people are often so depressed that they don’t have the energy to go through with attempting suicide. However, when they start taking antidepressants, sometimes they will start to feel more energy before they actually start to feel less depressed, therefore they now have both the thought to commit suicide and the energy to do it.
Recently, a study published in JAMA Internal Medicine explored the effects of antidepressants on children and young adults and found that they too have an increased risk of suicide when they first start on antidepressants, perhaps even more so than older people, especially when given selective serotonin reuptake inhibitors (SSRIs).
SSRI antidepressants can increase suicidal thinking and behavior in children, teenagers and young adults which is why the Food and Drug Administration issued a warning about the risk in 2004 after various independent studies showed a higher rate of suicides and suicide attempts among children and teenagers taking SSRI antidepressants .
The risk of suicide was most severe for those young people who started taking antidepressants at higher than average doses. They were twice as likely to attempt suicide when compared to those taking an average dose.
Than why are SSRI antidepressants being used? It’s because many think the benefits of them far outweigh the risk since the medication eventually lessens the risk of anxiety, depression and suicidal thoughts and behaviors. In most cases, SSRI antidepressants work really well and can be life savers, but there are risks that every parent should know about including the risk of increased suicidal thoughts.
People under 25 who were started on a higher than recommended dose of SSRI antidepressants were twice as likely to attempt suicide, especially in the first three months of starting them.
You may be asking, why then do doctors prescribe a higher dose than necessary?
In the study, almost 20 percent of the people had been given an initial prescription for higher than recommended doses. Part of the reason why is often times doctors including psychiatrist, play a guessing game when prescribing medication. They often don’t know what doses will be effective for a person and often don’t follow guidelines. They start people off with a dose that may be too much or too little and count on them to come back and let them know if it’s working or if they are having too many side effects. Then they will decide if they should increase the dose, decrease it or change the medication all together.
I’ve worked in the mental health field long enough to know that psychiatry is often a guessing game and anyone who has been on psych medications before can attest to this. Many patients often tell me they feel like the psychiatrist is using them as a Guinea pig because they keep trying different medications and doses of medications out on them. In all fairness, usually psychiatrist do this to see what works best for the patient, but often time the patient is left feeling an experiment and may even stop seeking help.
I’ve included a great Ted Talk video on psychiatry that talks about the importance of looking at individual brains instead of playing guessing games when it comes to treating people. Not everyone who has depression or anxiety or any other mental illness should be treated in the same way with the same drugs or with the same therapy, but in psychiatry and the mental health field in general, that is often the case.
If you or your child is depressed and thinking about getting on an anti-depressant, make sure you talk to your doctor, read the black box warnings and ask the important questions so that you will be informed and also know what warning signs to look for. antidepressants have worked wonders for many, but for some they have also been tragically bad.
This week is Mental Health Awareness Week which was established by the U.S. congress in 1990 to recognize the National Alliance of Mental Illness’ efforts to raise the awareness of mental illness. It just so happens that last week’s police chase and subsequent shooting and killing of Miriam Carey has brought mental illness and postpartum psychosis into the spotlight.
What Is Postpartum Psychosis?
Many people have heard of postpartum depression, but not many people have heard of it’s evil sister, postpartum psychosis. When I was in graduate school I was so fascinated by postpartum psychosis that I actually did a 20 page research paper on the phenomenon.
It isn’t uncommon for women, after giving birth to feel down, sad or even somewhat depressed. This is what is known as “baby blues” and approximately 70-80% of mothers feel this contradicting negative thoughts and sadness after experiencing the joy of giving birth.
Many women don’t talk about it because they feel guilty or “bad” because of these feelings, but it’s important that they talk about the way they feel so that the “baby blues” don’t progress into something deeper like postpartum depression.
Postpartum depression basically is a much more intense and prolonged feeling of negativity, depression and mood swings when compared to the “baby blues”. This can last weeks, months or even longer.
Postpartum psychosis is the most severe and extreme form of postpartum depression and not only does it typically include the intense sadness, negativity and mood swings of postpartum depression, but it also includes the onset of psychotic symptoms after childbirth.
An example taken from a personal experience I had dealing with a client I diagnosed with postpartum psychosis is that she was extremely depressed at times and then highly erratic and impulsive other times. She was extremely irritable and was having hallucinations which included voices and delusions that her newborn was evil and needed to be killed.
Like a lot of women who deal with the “baby blues”, postpartum depression and postpartum psychosis, she tried to hide the way she was feeling and mask her psychotic symptoms until it got to the point that she was about to drown her child in the bathtub. It was then she went to her family for help and was taken to the psychiatric hospital.
This particular young lady ended up being okay after treatment which included therapy and a brief period of taking lithium. Her child was subsequently raised by the maternal grandparents although legally this young woman still has full custody and spends time with her daughter often.
Postpartum psychosis is extremely rare which is one reason it is not often talked about and another reason many people who suffer from it try to hide it because they are struggling to try to understand exactly what it is they are going through and may feel alone.
Symptoms of postpartum psychosis Include, but are not limited to:
flight of ideas
grandiose thinking or behavior
Other Famous Examples of Postpartum Psychosis
Although postpartum psychosis is rare, some popular cases include Melanie Blocker-Stokes, a successful pharmaceutical sales manager happily married to a physician.
On June 11, 2001 she gave birth to a baby girl and soon developed severe depression, stopped eating and drinking and no longer could swallow just four weeks after giving birth.
She became paranoid and thought her neighbors closed their blinds because they thought she was a bad mother and although she was in and out of several hospitals, was on several medications and even received electroconvulsive therapy, she killed herself by jumping off of the roof top of a Chicago hotel. Her daughter was only 3 and a half months old.
Melanie always wanted to become a mother and it’s a tragedy that becoming a mother ultimately took her life. She had written in her journal before her death: “How can I explain to anybody how something has, literally, come inside my body…I’m no good to anyone. No good to myself.”
She called some her friends and family and left what they now know were her final goodbyes and to her husband she left a note that simply read: “Sam, I adore you, Sommer and Andy, Mel.” Andy was her husband Sam’s son and her stepson and Sommer (Sommer Skyy) was her newborn child.
Her battle with postpartum psychosis helped congress pass the Melanie Blocker-Stokes Postpartum Depression Research and Care Act in 2010 aimed at increasing research, education and screening of postpartum depression and postpartum psychosis. Sadly not much has been done since it was passed, but this is the story that sparked me to write my research paper in graduate school and got me interested in postpartum psychosis.
Perhaps most famously there was Andrea Yates whose mental health seemed to deteriorate with each child she gave birth to. She had attempted suicide twice and was urged against not having any more children after being hospitalized in a psychiatric hospital after her fourth child. Never-the-least she gave birth to a fifth child and three months later she was hospitalized again twice and warned not to be left alone with her children.
However, one day she was left alone for only an hour and tragically drowned all five of her children. She’s currently committed to a high-security psychiatric hospital.
Miriam Carey was a 34 year old mother of a one year old little girl. She was a dental hygienist with plans on going to dental school. Last week she made the decision to drive from her home in Conneticut to Washington, D.C. Some reports say that she was mad with President Obama for listening to her phone conversations.
In any case, with her young daughter in tow, she drove to Capitol Hill, crashing into barricades around the White House, police cars and speeding recklessly down Pennsylvania Avenue before she was shot and killed by law enforcement after attempting to use her car as a weapon.
It’s unfortunate that Miriam Carey was shot and killed, especially with her one year old daughter in the car. After listening to her family talk on CNN last week talk about her struggles with postpartum psychosis and a family history of mental illness including schizophrenia, I wish something could have been done sooner although she was apparently taking medication for an unknown mental illness.
It’s possible that although her family knew she was having some mental problems, they didn’t know how severe they were or even what they were because she was most likely keeping them in the dark and the Health Insurance Portability and Accountability Act (HIPPA) keeps doctors and mental health professionals from being able to discuss a persons medical and mental issues with family members which helps explain why her family members and friends where all shocked that she was behaving so erratically and reckless especially with her daughter in the car. They were all shocked to learn that she had even driving to Washington, D.C. out of the blue.
They may have known she had issues, but never suspected that they were as severe as they turned out to be.
According to everything I have read as reported by her family members and her boyfriend, her main symptoms were paranoia and delusions. It’s a good chance that her mental health problems existed before she was pregnant and that her pregnancy exacerbated the condition and developed into postpartum psychosis.
For example, she could have been suffering from bipolar disorder or a mood disorder previously and possibly stopped taking her medication to prevent them from having side effects on the baby and then everything just snow balled out of control with the natural hormonal and mood changes that occur with pregnancy.
Many women who develop postpartum psychosis already have other underlying mental health issues
Her death however is not in vain as it helps bring attention to postpartum complications like “baby blues”, postpartum depression and postpartum psychosis so that maybe more women who are suffering silently will speak out and reach out for help.
If you or someone you know is suffering from postpartum depression of any kind, have them speak with their doctor. For more information visit http://www.postpartum.net/ or call 1-800-944-4PDD.
I love working in a psychiatric hospital because it’s rarely boring. The type of people who come through the door are everyday people, no different from you or me, it’s just that what they are dealing with at the time is more than they or most likely any of us can handle.
I remember when I first started working here, a senior co-worker said that the only thing separating us from the patients is that we have the keys that let us in and out.
That’s one reason customer service, even in a mental hospital is so important. We strive on treating everyone, no matter what their circumstances or mental state, fairly and therapeutically because you never know when we or one of our family members or friends will end up in a place like this and it’s fairly easy.
Say the “magic words” to the right person and you may find yourself involuntarily hospitalized. Have an over exaggerated emotional or behavioral reaction and you may end up placed in a mental hospital to help you calm down.
Since I’ve been here I’ve seen correction officers, police officers, teachers, college students, professional athletes, lawyers, daughters of politicians, doctors, nurses and business owners come through our doors under involuntary hospitalization statuses.
People are placed here everyday who feel like they shouldn’t be and some may very well not be, but the majority at least need a cool down period.
For example, last week a college student got into a fight with his girlfriend and someone reported he threatened to kill himself. He denied does accusations, but he was emotionally upset enough that law enforcement thought it was best that he was brought here for his safety and the safety of those around him.
Now that he was here he didn’t want to be here and wanted to leave. He kept trying to convince me and everyone that he didn’t need to be here, but in doing so, he was getting more and more upset and therefore appearing more and more like he needed to be here for his safety and those around him.
I kept trying to talk to him and tell him that if he truly didn’t think he should be hospitalized then he needed to be calm and relaxed, otherwise he was risking looking like every other patient in the hospital who truly needed to be there.
However, he was so agitated and insistent on leaving that we had to place him on an elopement risk which lessened the chance of him being released sooner than he would have been otherwise.
When people think of the patients in a mental hospital, they almost automatically get an image in their head as if mental illness has a face. Those of us who work in the field or know someone or are ourselves suffering from a mental illness know that this couldn’t be further from the truth.
This morning I spoke with the mother of one of our patients who just graduated with an advanced degree and has an extremely high IQ, but has a long history of bipolar disorder and hasn’t been on her medication in over a year.
This is a beautiful young lady who was found sitting outside naked, stating that her old self had died and given birth to her new self with a new name she was calling herself by and a new age. She also believed she had God like powers.
Here at the hospital, for the most part, this young lady was selectively mute and at times appeared catatonic. We even had to carry and pose her limp body at one point when we had to transport her to another part of our facility.
She was definitely in need of some medication to help her start getting back to her “normal” self.
I was really hoping to speak with her, I throughly enjoy talking to people who both have a long history of mental illness and the ability and awareness to really talk about it and analyze their experiences, but she wasn’t speaking to anyone, so I spoke with her mother for a while about her history of treatment and tried to help calm her mother’s fears about her daughter’s recent deterioration.
This young lady reminds me that mental illness is all around us and it’s nothing to be ashamed of or to run from. Sometimes it’s in your face like the guy talking to himself while begging for change or it’s wrapped in the package of a pretty grad school graduate who on most days could hold the most intellectual conversations, but today she’s just staring into out of space unresponsive to the world around her.
The other day I was reading a very interesting article about how mentally ill people are treated in Somalia where they have one of the highest numbers of mentally ill people in the world.
Somalia is a country that’s been plagued by war, famine and disease for decades. As a result, at least 1 out of 3 of their 10 million citizens are affected with a mental illness, including many former soldiers, some who joined various armies and fractions at as early as 7 years old and are suffering from post traumatic stress disorder (PTSD).
On top of all this, a very large number of the population uses a drug called Khat, which is a plant that you can chew and it causes psychedelic effects. It’s legal and addicting although it can cause both health and mental damage.
Things are further complicated for the mentally ill in Somalia because of the lack of qualified mental health professionals. Many of the mental health workers in Somalia have only received 3 months of training through the World Health Organization (WHO), which is advocating for the humane and proper treatment of the mentally ill in Somalia and worldwide.
WHO officials have rescued mentally ill people from some very poor conditions. Families who have mentally ill family members in Somalia often don’t know what to do or where to turn for help so they chain them to beds in the house or to trees in the yard, including one lady who was chained by her husband to a tree for eight years and gave birth to three children.
Faith and folklore also play a role in treating the mentally ill in Somalia, with individuals sometimes being flogged to get rid of the “evil spirits”, locked in a room with a hyena for three day stretches in hopes that the hyena would eat away the “evil spirits”, or simply just beaten to death by villagers.
The streets of Mogadishu, Somalia’s capital, are littered with the mentally ill sleeping under bridges or wandering around aimlessly chewing on Khat. Most of these individuals are suffering from some sort of mental trauma and are receiving no help.
Something that makes this story even sadder is that Somalia’s only trained psychiatrist died last year in a car crash. It’s one thing to have one psychiatrist in a country of 10 million people, but when that person dies and there is no one else to take their place, the fate of the mentally ill seems that much dimmer.
A lot of money is going into rebuilding Somalia and helping with diseases like HIV, TB and diarrhea, but not enough funding is going into helping the mentally ill.
I can only imagine that it will be nearly impossible to build a stronger country, economically, educationally and health wise, if such a large portion of the population is suffering from mental trauma.
Where will these workers come from? How can they function if they are suffering from a mental illness without being treated? How will the children who are suffering learn and grow up to be productive citizens?
This is only a snap shot about mental illness in a third world, war torn country and similar terrible conditions are played out everyday around the world.
Hearing about these deplorable conditions initially made me wish I could go to Somalia to help out, but I realized that it also makes me want to advocate even stronger for the rights and proper treatment of the mentally ill here in the United States and across the world through education, information and community service.
After the tragedy at Sandy Hook Elementary School, there was a lot of talk about our broken mental health system. As a mental health counselor, I have worked in the mental health system since 2006 and could go on and on about why I think the mental health system fails many of those who need it the most.
It basically boils down to politics and money.
When I worked at the psychiatric hospital, I would see severely mentally ill people come in, but because they had no insurance, they were generally released back onto the streets within 24 hours without any medication or follow up appointments. At the same time, patients with insurance, regardless of the severity of their mental state at the time, were almost always hospitalized for at least 72 hours and released with medication, prescriptions, and/or follow up appointments.
Needless to say, the patients without insurance returned on a regular basis, to the point that I got to know them all pretty personally and could even predict when they would return. These clients were considered indigent clients or “regulars” as some of the hospital staff would call them.
They never got better, not necessarily because they didn’t want to, but many of them never really got the chance to get better.
Sure, many of them were homeless, some of them drug and alcohol abusers, and some even used the hospital like a hotel knowing that if they said the right words they would at least have a place to stay for several hours, but the large majority of them never really got the chance to get the help they needed because they didn’t have the money or insurance.
So, they would be back out on the street, most harmless, some committing petty crimes and a few were pretty scary as far as what they were capable of doing to an innocent person unaware that this person was in the midst of a psychological breakdown.
It was sad and frustrating which is one reason I left the psychiatric hospital and started working with juveniles, but even now I see how the system fails many people.
Now things are much more billing and money driven. They don’t care much about clients, giving quality therapy, making sure that counselors are well trained and given opportunities to stay well-trained and updated. All they care about is how many clients you can see and bill for in a day.
We are given three times as many clients as we can properly manage and give quality therapy to, but agencies don’t care about that because they are under pressure and in competition with other agencies and what’s called a “Managing Entity” that holds all the funds given to mental health and substance abuse facilities and can decide which facilities get and lose funding.
It’s frustrating and sometimes makes me want to quit my job because I can’t effectively do my job to the standard I feel like I’m obligated to by my own ethics and the ethics of the American Counseling Association.
On top of all that, my frustrations with the mental health system include a time when I had to have a young woman hospitalized after she had growing paranoia, anxiety and delusions that she was being controlled by other people who were raping her and turning her into a dog. She even crawled around on all fours and urinated on her mom’s carpet.
She was released from the hospital without any diagnosis and was only given a prescription for anxiety. This did not stop or even decrease her paranoia and delusions and I had to have her hospitalized again when her paranoia was so bad she started having thoughts of killing herself.
The reason I had her sent to the mental hospital the first time was because they had the resources and staff needed to truly help her better than I did working out of a school based program. Yet, they basically put a patch on a wound and sent her on her way.
In another situation I had a client stab himself in the neck during an argument with his girlfriend. Sure, this was impulsive and maybe he didn’t need to be hospitalized for an extended amount of time or given medication, but he didn’t even spend the night in the mental hospital before they released him without a diagnoses or any follow up.
If this same guy decides next time to stab his girlfriend in the neck, she may try to sue the hospital, or if she dies, her family may want to try to sue the hospital and everyone will be talking about how the mental health system failed her.
This reminds me of another aspect of working in the mental health hospital.
Almost twice weekly we would get handfuls of inmates being released from jail, inmates the jail didn’t feel were mentally stable enough to be released back onto the streets. Most of these inmates didn’t have any insurance so we would take them in and release them in the morning.
How scary and sad is that? The jail didn’t feel safe letting this inmates free to roam the streets, but they couldn’t legal hold them beyond their sentences, so they entrusted the psychiatric hospital to stabilize these inmates before releasing them, and all we did the majority of the time was give them a place to sleep and then let them out the next day.
In defense of the psychiatric hospital, a lot of it came down to funding and unfortunately, not much funding is given for those without insurance. We would have what were called indigent beds, beds paid for by the state for those without insurance, but there weren’t many and they didn’t pay as much as insurance beds did.
I believe most of the people who work in the mental health field, those who haven’t been tainted or sold their soul so that they can become program managers, directors and supervisors who are more concerned about funding and stats than actually quality of care, really do love and care so much for those who suffer from a mental illness that we go far and beyond what is expected of us and definitely far and beyond what we are paid to do.
Places I’ve worked typically don’t pay their therapists/counselors what they deserve. Those who are licensed could make more as program directors or supervisors who don’t see clients. Positions that once required masters degrees are starting to only require bachelors degrees so that agencies can lower the salary, which usually lowers the education, experience and dedication of those being hired for a lesser salary.
Quality of patient care is sure to suffer.
The mental health system is so broken and so politically and funding driven, that if things don’t change drastically and soon, I can only see much darker days ahead for all of us.
A co-morbid psychiatric disorder is any disorder that co-occurs with another psychiatric disorder. Often times we see people as having one issue, when often the truth is they have more than one problem which complicates treatment and recovery.
Recently I started seeing a young man who has both attention deficit/hyperactivity disorder and oppositional defiant disorder. This complicates treatment slightly because both issues have to be taken into consideration at all times sincetotally ignoring one while focusing on the other is seldom successful.
When I worked in the adult unit of a psychiatric hospital, it wasn’t uncommon to see people with depression and alcoholism, or schizophrenia and chronic marijuana use. Often these people use drugs to try to self-medicate and lessen the symptoms of their psychiatric disorders and other times the substances help create or amplify the psychiatric disorder. As a matter of fact, substance abuse and mental health disorders often co-occur in individuals and it’s often hard to tell what came first. Did the alcoholic become depressed the more the disease took over him, or did the depression drive him to drink?People with anxiety disorders for example often turn to illegal substances or prescription pills in attempts to relieve their anxiety. One of my clients who became depressed after losing her baby quickly became addicted to the Xanax given to her by her doctor to help cope with her depression and anxiety.
Definitely some disorders are more likely to co-occur with other disorders. As an example, people with bi-polar disorder are highly susceptible to substance abuse, ADHD, obesity and anxiety disorders.
In the high school setting I generally see teenagers who have depression and an eating disorder, so I work with them to solve both, usually paying more attention to what problem seems to be the most present and severe. With the 15 year old I recently started seeing, he is already receiving medication for his ADHD and while I definitely believe that his ADHD plays a role in his oppositional defiant behavior, I’ll focus on that later since the main reason he was referred for counseling is because of his bad attitude, refusing to follow simple rules, and anger towards his parents and teachers.
Often times teachers and parents are only aware of what condition is rearing it’s ugly head the most and aren’t aware that their are other factors contributing to the behavior. Teenagers rarely drink and smoke just because. Sure there are many who do, but usually once I sit down with them there is more to their substance abuse than peer pressure, usually if it’s not problems at home or self-esteem issues there are signs of a psychiatric disorder such as depression, anxiety or bipolar disorder.
That’s what makes treating and dealing with co-morbidity so difficult. If a patient goes to his family doctor complaining of not being able to sleep at night, he may be prescribed a sleep aid. If he doesn’t tell his doctor that the reason he can’t sleep at night is because he’s worried about his job, the economy, his elderly mother, his doctor in college, etc., then his anxiety will not go away and worse yet, he may become dependent on sleep aids.
It’s isn’t to ignore co-morbidity by focusing on just the problem that we see, but it’s important that we ask, what else may be going on. This will not only help us understand the people we care about, people that we deal with on a regular basis, but also ourselves.