Noteworthy News Articles on Mental Health Topics, March 14-19, 2006

Far Out, Man. But Is It Quantum Physics?
Dennis Overbye, New York Times- 3/14/2006

Two years ago, a movie with the unpronounceable title "What the #$!%* Do We Know!?" became an underground new-age phenomenon, raking in $11 million out of midnight screenings and word of mouth, spawning an industry of books, tote bags, clothing, DVD's and "biofield" jewelry. It purported to argue, based on the insights of modern quantum physics, that reality is just a mental construct that we can rearrange and improve, if we are enlightened or determined enough. Science and spirituality have tied the knot, and the world is your infinitely deformable apple.
      This winter an expanded version, "What the Bleep, Down the Rabbit Hole," began to play to audiences who say that the movie confirms what they already thought about the cosmos, some vibe they had that it is a slippery, woo-woo-woo kind of place. The movie just finished a two-month run in New York and is to be shown in May at the Quest for Global Healing Conference, in Ubud, Bali, with luminaries like Walter Cronkite and Desmond Tutu attending.
     Like its predecessor, this film features a coterie of talking heads: physicists with real Ph.D.'s, biologists, philosophers and a woman who claims to be channeling a 35,000-year-old spirit warrior from Atlantis. It tells the story of a sourpuss photographer played by Marlee Matlin who learns to love herself and take a chance on life. Like its predecessor, the film touts the alleged power of meditation to affect the crystalline structure of water, as revealed in photographs by Masaru Emoto, a doctor of alternative medicine in Japan. Love and gratitude make for symmetrical and intricate crystals, according to the film, while hatred produces an ugly mess. If thoughts can do this to water, imagine what they can do to humans, who are, after all, mostly water — at least so runs the mantra repeated several times in the film.
     When I first heard that Marlee Matlin had made a movie about quantum theory, I was excited. (Total disclosure: Ms. Matlin once bought an option on the film rights to an essay of mine about Albert Einstein and his wife.) What could be more deserving of wide-screen cinematic treatment than the weirdness and mystery of the laws that sculpture our space-time adventures? But hours and hours spent watching the two films and navigating their splashy Web site have tempered my enthusiasm. These films and the quantum mysticism industry behind them raise a disturbing question about the muddled intersection between science and culture. Do we have to indulge in bad physics to feel good?
     The "rabbit hole" in the title refers to the philosophical muddle that the contemplation of quantum mechanics, the paradoxical laws that govern subatomic life, can lead to. And it is a legitimate and maddening one. Quantum physics proclaims, for example, that an electron (or any object, elementary particle or not) is both a particle and a wave before we look at it, a conundrum neatly illustrated by a cartoon featuring "Dr. Quantum" in the new film.
     Physicists have been at war for the last century trying to explain how it is that the fog of quantum possibilities prescribed by mathematical theory can condense into one concrete actuality, what physicists call "collapsing the wavefunction." Half a century ago the physicist and Nobel Prize winner Eugene Wigner ventured that consciousness was the key to this mysterious process. Wigner thereby, and inadvertently, launched a thousand New Age dreams. Books like "The Tao of Physics" and "The Dancing Wu Li Masters" have sought to connect quantum physics to Eastern mysticism. Deepak Chopra, the physician and author, has founded a career on the idea of "quantum healing," and a school of parapsychology has arisen based on the idea that things like telekinesis and telepathy were a result of probing minds' manipulation of the formless quantum potential. And now the movie.
     All of them promote the idea that, at some level, our minds are in control of reality. We are in charge of the holodeck, as one of the characters in "Down the Rabbit Hole" says. And if it doesn't work for you, it's probably because you don't believe. So what's wrong with that? Like everyone else, I am inspired by stories of personal change. The ideas that consciousness creates reality and that anything is possible make for terrific psychology.
     We all know that self-confidence breeds its own success. I wish I were a member of that club. But physics has moved on. The parapsychologists were booted from the American Association for the Advancement of Science 30 years ago. It has been even longer since anybody took Wigner's idea seriously, said David Albert, a professor of philosophy and physics at Columbia, who has the dubious honor of being one of the talking heads in both "What the Bleep" films and is not pleased with the results.
     Many physicists today say the waves that symbolize quantum possibilities are so fragile they collapse with the slightest encounter with their environment. Conscious observers are not needed. As Dr. Albert pointed out, Wigner framed the process in strict mathematical and probabilistic terms. "The desires and intentions of the observer had nothing to do with it," he said. In other words, reality is out of our control. It's all atoms and the void, as Democritus said so long ago. Indeed, some physicists say the most essential and independent characteristic of reality, whatever that is, is randomness. It's a casino universe.
     Not that there is anything wrong with that. There's a great story to be told about atoms and the void: how atoms evolved out of fire and bent space and grew into Homer, Chartres cathedral and "Blonde on Blonde." How those same atoms came to learn that the earth, sun, life, intelligence and the whole universe will eventually die. I can hardly blame the quantum mystics for avoiding this story, and sticking to the 1960's.
     When it comes to physics, people seem to need to kid themselves. There is a presumption, Dr. Albert said, that if you look deeply enough you will find "some reaffirmation of your own centrality to the world, a reaffirmation of your ability to take control of your own destiny." We want to know that God loves us, that we are the pinnacle of evolution. But one of the most valuable aspects of science, he said, is precisely the way it resists that temptation to find the answer we want. That is the test that quantum mysticism flunks, and on some level we all flunk.
     I'd like to believe that like Galileo, I would have the courage to see the world clearly, in all its cruelty and beauty, "without hope or fear," as the Greek writer Nikos Kazantzakis put it. Take free will. Everything I know about physics and neuroscience tells me it's a myth. But I need that illusion to get out of bed in the morning. Of all the durable and necessary creations of atoms, the evolution of the illusion of the self and of free will are perhaps the most miraculous. That belief is necessary to my survival. But I wouldn't call it good physics.


Midnight Conversations With a Two-Headed Mind
Elissa Ely, M.D., New York Times- 3/14/2006

He was studying psychology in college when he had his first break. He is familiar with all the symptoms of major mental illness, but fails to recognize any in himself. "Freud wrote that hallucinations are an indication of loneliness," he says on my voice mail. I listen to the message in the sane light of morning. He left it at the insane hour of 2:50 a.m.
      Mr. J. shares his best thoughts in the middle of his dark nights. He sleeps during the day, when his apartment is less likely to be infiltrated by government agents who have let themselves in with master keys to rifle through his papers. Strangers sniff him on the street for bad odors. Bureaucrats tap his phone. The Internal Revenue Service makes lewd suggestions through the mail. "These aren't delusions of persecution," he says, in another 2:49 a.m. message. "My paranoid management is intact."
     In the office each month, he wears wingtips and a suit, says little and sweats mightily — not happy, athletic sweat, but overwhelmed, fear-ridden sweat. The windows must be opened after he leaves. Hours later, at 2:29 a.m. or 3:46 a.m. or 5:04 a.m., he opens like a flower, becoming confessional. Through the distance of the phone receiver, Mr. J. tells me about his hateful mother and his series of unsuccessful jobs. One was reading to a blind man who he knew was watching him. Somewhere during these one-sided conversations, he always adds that he wants to die sooner rather than later. He is very certain about this. Hopes are behind him. Strangers and the I.R.S. persecute him. Medications have not helped him.
     He is at the mercy of his two-headed mind that is densely intelligent, yet unable to control its own illness. I would not dream of arguing that life is full of reasons to live. One day, he allows blood to be drawn for the first time in years. His lipids are sky-high, his sugars pre-diabetic. The C-reactive protein is horrible. Everything dangerous is soaring. A heart attack or stroke is just a matter of time. He will need treatment and follow-up. In the office, I review the lab reports with him and tell him that he has to see a primary care doctor immediately. He tells me he has no medical doctor, nor does he want one. "Listen," he says, "it's good news. High cholesterolis an easy way to go. No pain."
     I think of pulling arguments from the bottom shelf. He should live for the sake of others, hope is always possible, life can improve, and even a boy who grows up in a log cabin can become president. But for Mr. J., there are no other arguments. An easy way to go is his hope. He returns home to sleep. I open the window. The day moves along, the night arrives. When I wake up in the middle of it, I check the message machine. But the machine has nothing to say.
     Days go by. There are a few calls for prescription refills. Someone wants to change an appointment. The Social Security disability insurance people need more information before they can approve an application. All the messages come at reasonable hours. The machine is getting a full nine hours of sleep each night. Maybe a week later, there is finally a 3:24 a.m. message. "Good news, doctor!" The voice is full of exclamation points. Mr. J. sounds exuberant, even a little intoxicated. "I called a psychiatrist I saw many years ago. He took my cholesterol measurement back then and told me it was very low. I was on a diet of sardines, chili and beans at the time. I plan to return to it."
     I am unreasonably happy to hear this. The man of no hope is telling me that he wants to live. Even under the lewd gaze of the I.R.S., and in a lonely world where strangers sniff him for odors, he prefers life to its alternative. His treatment plan may not be fully evidence based. But it is a certain beginning. Maybe after all, this high cholesterol will save him.

Sleep Disorder? Wake Up and Smell the Savanna
Richard A. Friedman, M.D., New York Times- 3/14/2006

You would think the country is in the grip of an insomniaepidemic given the rising popularity of sleep drugs. Over the last five years, the use of hypnotics has increased by an astonishing 60 percent, according to IMS Health, a research company.  Is the state of sleep in America really that bad?
      Disturbed sleep has to be one of the most common complaints in medicine. Not only patients but the general public seems to have a cherished notion of what constitutes a normal night's sleep: seven to eight blissful hours of uninterrupted slumber. Many patients tell me they have a sleep problem because they wake up in the middle of the night for a time, typically 45 minutes to an hour, but fall uneventfully back to sleep. Curiously, there seems to be no consequence to this "problem." They are unaffected during the day and have plenty of energy and concentration to go about their lives.
     Being a psychiatrist, I am always on the lookout for illnesses like depression, anxiety disorders and drug or alcohol abuse that could easily produce sleep disturbance. But I often hear these complaints about interrupted sleep from patients in complete remission from their disorders, making it unlikely that this is a symptom of an untreated medical or psychiatric illness.
     The problem, it seems, is not so much with their sleep as it is with a common and mistaken notion about what constitutes a normal night's sleep. It's a question that Dr. Thomas Wehr at the National Institute of Mental Health asked himself in the early 1990's. He conducted a landmark experiment in which he placed a group of normal volunteers in 14-hour dark periods each day for a month. He let the subjects sleep as much and as long as they wanted during the experiment.
     The first night, the subjects slept an average of 11 hours a night, probably repaying a chronic sleep debt. By the fourth week, the subjects slept an average of eight hours a night — but not consecutively. Instead, sleep seemed to be concentrated in two blocks. First, subjects tended to lie awake for one to two hours and then fall quickly asleep. Dr. Wehr found that the abrupt onset of sleep was linked to a spike in the hormone melatonin. Melatonin secretion by the brain's pineal gland is switched on by darkness. After an average of three to five hours of solid sleep, the subjects would awaken and spend an hour or two of peaceful wakefulness before a second three- to five-hour sleep period. Such bimodal sleep has been observed in many other animals and also in humans who live in pre-industrial societies lacking artificial light.
     Carol Worthman, an anthropologist at Emory University in Atlanta, has studied the sleep patterns of non-Western populations. From the Kung hunter-gatherers in Africa to the Swat Pathan herders in Pakistan, Dr. Worthman documented a pattern of communal sleep in which individuals drifted in and out of sleep throughout the night. She speculates that there may even be an evolutionary advantage to interrupted sleep. "When we lived in open exposed savanna, being solidly asleep leaves us vulnerable to predators."
     With artificial light, modern humans have essentially managed to extend their daytime activities late into the night, when all other sensible creatures are busy sleeping. As a result, we have compressed our natural sleep into artificially short nighttimes, but not all people are so easily tamed by artificial light. Some people, who may just have very strong circadian rhythms, still have this primitive bimodal sleep that they confuse with a sleep disorder.
     Add these people to the rest of us who, under the pressures of modern life, often have some trouble falling or staying asleep and there is a large captive audience for drug companies. Thanks in large part to the meteoric rise in direct-to-consumer advertising, medications like Ambien and Lunesta have become household names and seductive panaceas that millions find hard to resist — even though a majority have no serious sleep problem to repair. If it's any consolation to those of you who are awake in the middle of the night for an hour or so, reading or watching television, you may simply be the most natural sleepers.

 

Study Links Ambien Use to Unconscious Food Forays
Stephanie Saul, New York Times- 3/14/2006

The sleeping pill Ambien seems to unlock a primitive desire to eat in some patients, according to emerging medical case studies that describe how the drug's users sometimes sleepwalk into their kitchens, claw through their refrigerators like animals and consume calories ranging into the thousands. The next morning, the night eaters remember nothing about their foraging. But they wake up to find telltale clues: mouthfuls of peanut butter, Tostitos in their beds, kitchen counters overflowing with flour, missing food, and even lighted ovens and stoves. Some are so embarrassed, they delay telling anyone, even as they gain weight. "These people are hell-bent to eat," said Dr. Mark Mahowald, who is director of the Minnesota Regional Sleep Disorders Center in Minneapolis and is researching the problem. He and colleagues are preparing a scientific paper based on their findings that a sleep-related eating disorder is one of the unusual side effects showing up with the widespread use of Ambien. Researchers at the Mayo Clinic in Rochester, Minn., have made similar findings.
      A woman in Salinas, Calif., whose case is to be included in the Minnesota study, said she would awaken to find candy bar wrappers next to her bed and Popsicle sticks on the floor near the refrigerator. She blamed her husband and sons before finally believing their claims that she was eating at night, unaware. Worried that she would choke, "my son was so afraid at night, he'd come sit by the bed and watch me," said the woman, Brenda Pobre, 54. Despite seeing several doctors, Ms. Pobre did not link Ambien to her nocturnal eating until after she gained 100 pounds.
     Spurred in part by consumer advertising, more than 26 million prescriptions for Ambien were dispensed in this country last year, an increase of 53 percent since 2001. Sanofi-Aventis, the French company that makes the drug, has defended its safety in 13 years of use in the United States. A company spokeswoman, Melissa Feltmann, said, "Sanofi-Aventis has received reports of people eating while sleepwalking and those reports, like all reports of adverse events, have been provided to the U.S. Food and Drug Administration." Ms. Feltmann said that the package insert for Ambien warns that a sleep-related eating disorder may occur, but she cautioned that every case reported in patients taking Ambien might not necessarily be caused by the drug.
     Most of the people who use Ambien say the drug puts them to sleep, and they wake up without incident. But several doctors and a number of patients say that sleep-eating is one of a variety of unusual reactions to the drug. The reactions range from fairly benign sleepwalking episodes to hallucinations, violent outbursts and, most troubling of all, driving while asleep, a subject explored in an article last week in The New York Times. The Food and Drug Administration has said in response to a Times reporter's query that it would monitor the drug's safety record. Dr. Carlos H. Schenck, a sleep disorders expert in Minneapolis and the lead researcher on the study, estimates that thousands of Ambien users in the United States experience sleep-related eating disorders while taking the drug.
     Ambien, the brand name used in the United States for the drug zolpidem, is sold in some countries under the brand names Stilnox and Stilnocht. In this country it is by far the biggest seller among a group of similar prescription sleeping drugs that include Lunesta and Sonata. The drug's growth into a product worth $2.2 billion in annual sales in the United States has been fueled partly by consumer advertising. Sanofi-Aventis spent $130 million to advertise the product in 2005, more than double the $61 million it spent in 2004, according to figures released by TNS Media Intelligence.
     No cause has been found for sleep-related eating disorder, but Dr. Schenck says he believed that it happened when the brain confuses two basic instincts: sleeping and eating. "Those two become linked," he said. "In the sleep stage you eat. I think two instinctual behaviors become intertwined." Along with Dr. Mahowald and other colleagues at the University of Minnesota Medical School and the Hennepin County Medical Center in Minneapolis, Dr. Schenck has identified 32 Ambien users having sleep-related eating disorder with amnesia, part of a group of case studies they are planning to publish. Often patients with sleep-related eating disorder caused by Ambien realize they have an eating problem, but do not associate it with the sleeping pill until they find a doctor who is aware of the relationship, Dr. Schenck said.
     The problem can occur spontaneously without drugs, and there have also been scattered reports linking the disorder to other medications, including Halcion. This leads some experts to question whether sleep-eating associated with Ambien is less a function of the drug itself and more a characteristic of some of the large number of people now taking it. "I think abnormal behaviors like those could be unmasked in a small minority of patients taking any medications in that class, and the most common administered medication at bedtime is Ambien at this time," said Dr. John W. Winkelman, medical director of the Sleep Health Center at Brigham and Women's Hospital in Boston.
     But Dr. Schenck said the cluster of Ambien sleep-eaters that his team discovered makes the drug the one most commonly associated with sleep-related eating disorder. He added that many of his patients' eating problems ended when they switched to other sleep medications, including Lunesta and Sonata. Sleep experts at the Mayo Clinic have come to a similar conclusion — that there is something in Ambien that causes sleep-eating in susceptible people. "In our mind, certainly in our clinical experience, zolpidem is associated with this," said Dr. Michael H. Silber, co-director of the Sleep Disorders Center at the Mayo Clinic. Dr. Silber is also president-elect of the American Academy of Sleep Medicine.
     Dr. Silber and a colleague were the first to describe sleep-related eating disorder with amnesia in Ambien users in 2002 in the journal Sleep Medicine. The five cases discussed in that paper involved patients with a condition called restless legs syndrome. Since then, Dr. Silber said he had seen other Ambien users with sleep-related eating disorder. "This is really an upsetting thing for them to see what they're doing during the night," he said. "They put on weight. I could imagine setting fire to things" while preparing food.
     Among sleep-eaters, the desire for food can be tremendously powerful. One woman in the Minneapolis area whom Dr. Schenck treated, Judie Evans, said she began taking Ambien while recovering from back surgery. At the time, she was in a full body cast and needed assistance to get out of bed. During this time, Ms. Evans, who is 59 and lives alone, began to notice that food was missing from her refrigerator. She accused two nursing aides who were caring for her of stealing food. It was not until her son came to spend several nights that Ms. Evans said she realized that despite the body cast, she was getting up to eat while she was asleep. "During the day, I couldn't even make it to the bathroom by myself," Ms. Evans said. The first night her son was there, he found her standing in the kitchen, body cast and all, frying bacon and eggs. The next night he found her eating a sandwich, Ms. Evans said, and sent her back to bed. Later that same night, her son arose to find her standing in the kitchen again. "I had turned the oven on," she recalled. "I store pots and pans in the oven and I had turned it to 500 degrees." Ms. Evans said her problems ended when Dr. Schenck diagnosed Ambien-induced sleep-related eating disorder.
     Another woman who has complained about sleep-eating was Helen Cary, a labor and delivery nurse in Dickson, Tenn., who began taking the drug so she could sleep days while working 12-hour night shifts. "I'm very ambivalent about this drug," said Ms. Cary, 57. "Without it, I would never have survived five years of night shift." But Ms. Cary said her behavior became strange while under Ambien's influence. "One day," she said, "I got up — my husband describes this in great detail — I got a package of hamburger buns and I just tore it open like a grizzly bear and just stood there and ate the whole package. He said a couple things to me and then he realized I was asleep." She has switched to working days and no longer takes Ambien.
     Two other women who said that they became sleep-eaters while under Ambien's influence were among four former Ambien users who filed suit against Sanofi-Aventis in United States District Court in Manhattan last week, contending they were harmed by the drug. A lawyer handling the case held a news conference yesterday in Manhattan. Ms. Pobre, though, says she still takes Ambien. Without it, she says she cannot sleep at all, and no other sleeping medications work for her. But Dr. Schenck, whom she consulted to find a cure for her problems, also prescribed Topamax, a drug normally used to control epilepsy, that reduces her sleep-eating behavior. "I just hope that maybe they'll come up with something that's better," Ms. Pobre said. "It's just very, very frightening."

 

Iowa's Residency Rules Drive Sex Offenders Underground
Monica Davey, New York Times- 3/15/2006

CEDAR RAPIDS, The Ced-Rel Motel in Cedar Rapids, Iowa, was home to 26 registered sex offenders by early March. Many other places either will not take them, or, under state law restricting where offenders may live, cannot. For years a layover for budget-conscious motorists and construction crews, the motel has lately become a disquieting symbol of what has gone wrong with Iowa's crackdown on sexual offenders of children. With just 24 rooms, the motel, the Ced-Rel, was home to 26 registered sex offenders by the start of March. "Nobody wants to have something associated with sex offenders right beside them," said Steve Boland, a farmer and father of two who learns about his newest neighbors every few weeks when sheriff's deputies stop by with photographs of them. "Us showing the kids some mug shots sure wasn't going to help," Mr. Boland said. "How were they going to remember that many faces?"
      The men have flocked to the Ced-Rel and other rural motels and trailer parks because no one else will, or can, have them. A new state law barring those convicted of sex crimes involving children from living within 2,000 feet of a school or day care center has brought unintended and disturbing consequences. It has rendered some offenders homeless and left others sleeping in cars or in the cabs of their trucks. And the authorities say that many have simply vanished from their sight, with nearly three times as many registered sex offenders considered missing since before the law took effect in September. "The truth is that we're starting to lose people," said Don Vrotsos, chief deputy for the Dubuque County sheriff's office and the man whose job it is to keep track of that county's 101 sex offenders.
     The statute has set off a law-making race in the cities and towns of Iowa, with each trying to be more restrictive than the next by adding parks, swimming pools, libraries and bus stops to the list of off-limits places. Fearful that Iowa's sex offenders might seek refuge across state lines, six neighboring states have joined the frenzy. "We don't want to be the dumping ground for their sex offenders," said Tom Brusch, the mayor of Galena, Ill., which passed an ordinance in January.
     But even as new bans ripple across the Midwest, the rocky start of the Iowa law — one of at least 18 state laws governing the living arrangements of those convicted of sex crimes — has led to a round of second-guessing about whether such laws really work. "Nobody wants sex offenders in their area, and on its face, it makes sense that people wouldn't want them near day cares and schools," said Scott Matson, a research associate at the Center for Sex Offender Management, a nonprofit project financed by the federal Department of Justice. "But there are consequences of removing them." While some of the Iowa's largest cities, like Des Moines, have become virtually off limits for those convicted of sex crimes involving children, the new rules have pushed many to live in groups away from their families, in places like the Ced-Rel, or the Red Carpet Inn in nearby Bouton, where nine offenders rent rooms.
     Michele Costigan, whose driveway is right across Highway 30 from the Ced-Rel in this rural stretch just outside Cedar Rapids, said she had stopped leaving any of her four children at home alone, had told them to dial 911 if anyone they did not recognize pulled into the family driveway, and was considering moving. "If the point of his law was to make us safer, we are not," Ms. Costigan said.
     Even more worrisome to law enforcement officials in Iowa, the restrictions appear to be leading some offenders to slip out of sight. Of the more than 6,000 people on Iowa's registry of sex offenders, 400 are now listed as "whereabouts unconfirmed" or living in "non-structure locations" (like tents, parking lots or rest areas). Last summer, the number was 140. "When it comes down to it, we would rather know where these people are living than to have the restriction," said Deputy Vrotsos. He said that he devoted at least 20 hours extra a week, along with the work of two clerks, to administering the new state law.
     Last fall, Deputy Vrotsos told about 30 of the offenders that they would have to move to meet the requirements of Iowa's law, which he said made about 90 percent of the city of Dubuque off limits. Some complied, he said, moving to trailer parks, across the Mississippi River into Illinois, to motels or, in the case of one man who had been living with his parents, to a truck at the Ioco Truck Stop on the outskirts of town. But at least three of the offenders have disappeared, Deputy Vrotsos said, giving false addresses or not providing any address at all. The effectiveness and fairness of the restrictions has become a matter of great debate.



Study: Genes May Cause Risk for Anorexia
Associated Press, 3/15/2006

CHARLOTTE, N.C. -- Researchers studying anorexia in twins conclude that more than half a person's risk for developing the sometimes fatal eating disorder is determined by genes. Most experts already believe there is a strong genetic component to the disorder, which mostly affects girls and women. The new study ''hammers home the fact that these are biologically based disorders,'' said Cynthia Bulik, lead author of the study who is a psychiatrist at the School of Medicine at the University of North Carolina-Chapel Hill. ''We need to stop viewing them as a choice. ... The patients feel guilty, the providers tell them things like they should just eat, parents are blamed, the insurance companies won't fund treatment because they think it's a choice. It's held us back for decades.''
       People with anorexia have a distorted body image and refuse to maintain a minimally acceptable body weight. Bulik said anorexics are about 10 times more likely to die in a given period of time than peers the same age. Anorexia's rarity -- slightly more than 1 percent of females and well under 1 percent for males -- has made it hard for scientists to gather large groups of patients for study.
     The study by researchers at UNC and Sweden's Karolinska Institute looked at a Swedish registry of 31,406 twins -- both identical and fraternal -- born between 1935 and 1958. Identical twins are genetic clones, while fraternal twins are no more similar genetically than a brother and sister born in separate pregnancies. Anorexia was more prevalent between identicals, and statistical analysis led to the scientists' conclusion that 56 percent of the liability for developing anorexia is due to genetics, with environmental factors determining the rest, Bulik said. That means not everyone with a genetic predisposition to anorexia develops it. ''A person may have genetic liability for anorexia nervosa, but they also may have -- from a different parent, for example -- genes that buffer them from expression of the disorder,'' she said. The person's environment might also provoke anorexia or prevent it.
     Michael Strober, a clinical psychologist at the University of California at Los Angeles and editor of the International Journal of Eating Disorders, said conventional wisdom is that genetic factors do play a role in susceptibility. This latest study, published in the March issue of the Archives of General Psychiatry, further confirms previous research, Strober said.
     The study also found a link between anorexia and childhood ''neuroticism,'' which Bulik describes as ''a tendency to be depressed or anxious, and also to be emotionally reactive.'' ''For some kids, insults come right off them like water off a duck's back,'' she said. ''These kids are more like emotional Velcro. Things stuck to them, get under their skin, and it influences them.''  For Strober, the new study also lends support to the belief that personality traits, including neuroticism, are important in the development of anorexia. He believes that nearly all anorexia sufferers exhibit neurotic behavior in childhood.
     Bulik and Strober are both involved in a large, federally funded multiyear study of anorexia. Headed by Dr. Walter Kaye, a psychiatry professor at the University of Pittsburgh Medical Center, that study is seeking families with two or more members with anorexia. ''This is a disorder where we haven't seen great treatments,'' Kaye said. ''At least some of us have thought there's a very powerful biology at work here. ... The next step, of course, will be to determine what the biology is, what genes are involved and what difference they make as far as how the brain works.''
     On the Web: Genetic Study of Anorexia in Families: www.angenetics.org

 

Study: Drugs Better for Elderly Depression
Associated Press, 3/15,2006

BOSTON -- For elderly people who suffer bouts of depression, drugs work surprisingly better than psychotherapy at keeping these black spells from returning, suggests the longest study ever in patients so old. The findings from the two-year study may encourage some doctors to prescribe antidepressants for longer periods, perhaps even for life, in patients who have been depressed. ''It's a good idea for you to continue to take the medication indefinitely, just as you take your blood pressure medication or diabetes medication,'' said psychiatrist Dr. Charles Reynolds at the University of Pittsburgh, who led the study. ''It's a very new approach.''
      Backed by the National Institutes of Health, the study responds to a rising trend to prescribe medicine not just to treat depression, but to keep it from coming back. Results were published Thursday in the New England Journal of Medicine. Depression is estimated to occur in 3 percent to 5 percent of elderly people and it returns more than half the time within three years. Psychotherapy -- as well as exercise and socializing -- are viewed as effective long-term shields, since they change behavior. Yet psychotherapy did little in this study.
     Many psychiatrists continue to believe in psychotherapy, even in some very old patients. Psychiatrists suggest that some patients in this study had undergone biological changes in their brains with aging and lost some mental capabilities, making them benefit more from drugs and less from talking therapy. Also, the psychotherapy in this study was given only once a month for 45 minutes.
     The two-year study monitored 116 people ages 70 and above after they recovered from an episode of depression. They were then randomly assigned to take an anti-depression drug, the drug plus psychotherapy, psychotherapy with dummy pills, or dummy pills alone. Just over a third relapsed into depression with drugs, whether they got psychotherapy or not. More than two-thirds did with psychotherapy and dummy pills, and slightly less with dummy pills alone. Though the numbers are small, experts view them as significant because it is difficult to recruit elderly volunteers for such research.
     Several psychiatrists said the findings probably apply to a range of depression drugs, not just the paroxetine used in this study. They said it's unclear just how long depressed patients may need drugs, but they should be monitored and get some form of therapy for years afterward.
     Dr. Burton Reifler, a psychiatrist at Wake Forest University who wrote an accompanying editorial, warned against the tendency to write off the serious illness of depression in the elderly by thinking ''if my wife had passed away and I had arthritis and I was 80, I'd be depressed too.''
     Many other obstacles impede extended treatment, psychiatrists cautioned. The commonly prescribed class of depression drugs, known as SSRIs, can sedate and cause weight gain or sexual problems. Some research links them to an aggravated tendency toward suicide. They may cost as little as $20 a month in generic form, but brand names can cost well over $100. Also, most old people with depression go to family doctors, who usually lack time and skill to fully monitor and treat the disorder over a long time. ''They just don't have the resources to do it, and they don't do it,'' said psychiatrist Dan Blazer at Duke University. He said this study should change practice -- but may not.



More Kids Are Getting Anti - Psychotic Drugs
Associated Press, 3/16/2006

CHICAGO -- Soaring numbers of American children are being prescribed anti-psychotic drugs -- in many cases, for attention deficit disorder or other behavioral problems for which these medications have not been proven to work, a study found. The annual number of children prescribed anti-psychotic drugs jumped fivefold between 1995 and 2002, to an estimated 2.5 million, the study said. That is an increase from 8.6 out of every 1,000 children in the mid-1990s to nearly 40 out of 1,000. But more than half of the prescriptions were for attention deficit and other non-psychotic conditions, the researchers said. The findings are worrisome ''because it looks like these medications are being used for large numbers of children in a setting where we don't know if they work,'' said lead author Dr. William Cooper, a pediatrician at Vanderbilt Children's Hospital.
      The increasing use of anti-psychotics since the mid-1990s corresponds with the introduction of costly and heavily marketed medications such as Zyprexa and Risperdal. The packaging information for both says their safety and effectiveness in children have not been established. Anti-psychotics are intended for use against schizophrenia and other psychotic illnesses. However, attention deficit disorder is sometimes accompanied by temper outbursts and other disruptive behavior. As a result, some doctors prescribe anti-psychotics to these children to calm them down -- a strategy some doctors and parents say works. The drugs, which typically cost several dollars per pill, are considered safer than older anti-psychotics -- at least in adults -- but they still can have serious side effects, including weight gain, elevated cholesterol and diabetes. Anecdotal evidence suggests similar side effects occur in children, but large-scale studies of youngsters are needed, Cooper said.
     The researchers analyzed data on youngsters age 13 on average who were involved in annual national health surveys. The surveys involved prescriptions given during 119,752 doctor visits. The researchers used that data to come up with national estimates. Cooper said some of the increases might reflect repeat prescriptions given to the same child, but he said that is unlikely and noted that his findings echo results from smaller studies. The study appears in the March-April edition of the journal Ambulatory Pediatrics.
     Heavy marketing by drug companies probably contributed to the increase in the use of anti-psychotic drugs among children, said Dr. Daniel Safer, a psychiatrist affiliated with Johns Hopkins University, who called the potential side effects a concern. Safer said a few of his child patients with behavior problems are on the drugs after they were prescribed by other doctors. Safer said he has let these children continue on the drugs, but at low doses, and he also does periodic tests for high cholesterol or warning signs of diabetes.
     Dr. David Fassler, a University of Vermont psychiatry professor, said more research is needed before anti-psychotics should be considered standard treatment for attention deficit disorders in children. ''Given the frequency with which these medications are being used, there's no question that we need additional studies on both safety and efficacy in pediatric populations,'' Fassler said.


Katrina Evacuees' Mental Health Eyed
Associated Press, 3/16/2006

CHICAGO -- When William Villavaso closes his eyes, the nightmare is waiting for him -- the one about the 15 hours he spent in water slick with diesel fuel in New Orleans, a life jacket and a chunk of wood keeping him afloat until he was rescued. Six months after losing his home and his possessions to Hurricane Katrina, the 49-year-old New Orleans native is now living in Chicago, where he has been diagnosed with post-traumatic stress disorder and wakes up from bad dreams in a cold sweat. On a scale from 1 to 10 -- 10 being well -- Villavaso says that emotionally, ''right now I'm probably a 2.'' ''I hope to have normalcy again in my life,'' says Villavaso, who is trying to battle his depression at group counseling. ''I'm just hoping for that stability.''
      As many as 500,000 Katrina evacuees around the country may need mental health counseling, according to the U.S. Substance and Mental Health Services Administration. And while Villavaso is getting help, the government says many others are not, and may not even know they need it. Several states that took in evacuees are recognizing the problem, changing their focus from providing housing and jobs to offering counseling and emotional support. In Illinois, about 20 counselors are tracking down approximately 7,000 evacuees, and officials are referring them to professionals. ''We know that there's several stages of emotional crisis that people go through,'' says Carol Adams, Illinois' human services secretary. ''Right now, people are in the stage when they realize things won't work out quite how they thought.''
     People like 46-year-old Reginald Lucien, who like Villavaso came to Chicago from New Orleans' devastated Ninth Ward. ''When I first came to Chicago I thought it was easy to cope, I never questioned it,'' he says. ''As time goes along I come to the realization that this is where I'll be for some time, it gets harder. I get anxious.''
     Dr. Anthony Ng, chair of the American Psychiatric Association's Committee on Psychiatric Dimensions of Disasters says Katrina evacuees run the risk of such problems as depression, recurring nightmares and drug and alcohol abuse. ''When people are talking about post-traumatic stress disorder, they usually talk about something like a plane crash, but this is more complicated than usual,'' Ng says. ''What makes Katrina different is the scale of the disaster and the length of time people went through it.''
     Katrina struck the Gulf Coast on Aug. 29, breaching levees and submerging 80 percent of New Orleans. It killed more than 1,300 people, most of them in Louisiana, and caused over $200 billion in damage. Hundreds of thousands of people were forced from their homes. At first, evacuees ''had sort of a honeymoon phase, when the assets, the Red Cross and volunteers are rolling in,'' says J.W. Holcomb, coordinator of mental health disaster response for the Illinois Division of Mental Health. ''But just now they're coming to grips with the fact that, `Hey, I'm no better than I was before. I'll never get back my picture of Grandma or my high school yearbook. And I'm in a strange place.'''
     To help evacuees handle the stress, the Substance Abuse and Mental Health Services Administration and the Federal Emergency Management Agency have given states more than $67 million, including a $19.2 million grant announced this month. The grant will go toward local mental health programs for Illinois, Texas, Georgia, Pennsylvania, Wisconsin, Missouri and Colorado. Texas -- which received the largest share of the evacuees -- will get most of the latest grant, about $12.1 million.
     Almaz Oko, a Miami resident who came to Chicago after Hurricane Andrew destroyed her home in 1992, says Katrina's victims face a long recovery. She says she still suffers from insomnia and flashbacks. ''You'll be in the grocery store and you'll bust out crying and you're not sure why,'' says Oko, who helped process Katrina evacuees in Chicago for the Red Cross. ''I also went through a hoarding stage when I just wanted to buy, buy, buy. I guess I was trying to buy back what I lost, to fill the hole.''
     On the Net: Illinois Department of Human Services: www.dhs.state.il.us
Substance Abuse and Mental Health Services Administration: www.mentalhealth.samhsa.gov
American Psychiatric Association: www.psych.org
Metropolitan Family Services: www.metrofamily.org



Student Gambling on Rise? You Bet
David Haugh, Chicago Tribune- 3/16/2006

Dion Lee's betting days have long since passed. So Lee did not want to hazard a guess as to when he finally would be able to watch the NCAA tournament without thinking of the gambling scandal that marred his Northwestern basketball career more than a decade ago. But odds favor later over sooner. "I still have it locked in that brain of mine," Lee said in a phone interview Wednesday on the eve of March Madness. "I took my pill and swallowed it. I paid the price, even if I know I could look at every Northwestern roster of every sport from 1993-95 and find the names of 50 people who I know for a fact were gambling. It was everywhere."
      It still is, to such an extent that gambling rings involving betting on college basketball resulted in arrests at Mt. Carmel, St. Rita and Marist high schools in Chicago in the past week. The arrests underscore that the bug has begun to afflict kids younger than ever. According to the Annenberg Public Policy Center at the University of Pennsylvania, the percentage of males between the ages of 14 and 22 who gambled each month increased from 48 percent in 2004 to 57 percent last year. Lee, 32, was sentenced to one month in prison after pleading guilty in 1998 to sports bribery. He believes the gambling epidemic is greater now on college campuses than it was famously at Boston College, Northwestern, Arizona State and other campuses in the 1990s.
     The NCAA worries about the same trend, expanding its presentations to teams that qualify for the Sweet 16 rather than limiting those talks to Final Four teams as in the past. Also, for the first time, the NCAA will send an observer to Las Vegas to work with bookmakers to monitor suspicious activity--a dramatic leap for an institution that was working with Capitol Hill to ban gambling on college sports just four years ago.
     Thursday's tipoff of the three-week-long NCAA tournament that will generate $3.5 billion in all forms of betting frightens people familiar with the ills of gambling as much as it excites those in the water-cooler crowd entering multiple brackets in the office pool. "I call it the silent addiction and it's going to be more prevalent this month than ever," said Alexander Roseborough, the president of the Illinois Council on Problem Gambling. "I still don't think there's as much publicity and awareness as there should be on this problem, maybe because colleges are concerned about the effect it could have on enrollment. But it's real and it's growing."
     Nothing has contributed to that growth more than the Internet, where more than $2 billion in online bets are expected during the NCAA tournament. The office pools many consider innocent forms of fun generate $750 million nationwide. The latest craze involves Calcutta auctions where wealthy professionals bid on teams so excessively that one pot in New York approached $200,000 last year, according to the Wall Street Journal.
     The NCAA has responded to the gambling inflation by taking a staunch anti-gaming stance, most notably cracking down on former Washington football coach Rick Neuheisel for filling out a tournament bracket to the extent it cost Neuheisel his job. The NCAA made such a strong statement in that case that a senior NCAA official criticized former gambling enforcement director Bill Saum for being overzealous in an e-mail made public during Neuheisel's trial. Last summer, Rachael Newman-Baker replaced Saum, who was transferred.
     Much of the reform attempts have come after an eye-opening survey of NCAA student-athletes released in 2004 that NCAA officials cited again this week in a teleconference. The survey of 21,000 Division I athletes revealed 17 of 388 men's basketball players (4 percent) admitted bettors had put them in a compromising position either to provide inside information or shave points. It also showed 17.2 percent of men and 5.9 percent of women wagered on college sports--including 21.2 percent of men's basketball players.
     Of the nation's nearly 16 million college students, one out of four gamble, according to the National Council on Problem Gambling. "It's a daunting task to all college administrators," Northern Illinois director of athletics Jim Phillips said. "It's a reflection of our society. For us to turn a deaf ear to it would be totally irresponsible. It's scary."
     If administrators are scared now, University of Pennsylvania economist Justin Wolfers might make the hair on the backs of their necks stand straight up. In a soon-to-be-published research paper, Wolfers contends the outcomes of as many as 500 men's college basketball games over the past 16 years have been affected by point shaving. The Australian, who used to work for bookmakers in his homeland, examined the score differentials of 44,120 games from 1989 to 2005 and concluded that teams favored by more than 12 points missed covering the spread enough to raise suspicion.
     He estimated during a phone interview Wednesday that favorites covered the spread 50 percent of the time but "heavy favorites,"--teams favored by 12 or more--covered in only 48.4 percent. Wolfers considered that 1.6 percent difference significant enough to believe players were involved in manipulating the spread. "If I'm a player, it's impossible for me to care if I win by 11 or 13 points but it matters a lot to a gambler, and that's the opening," Wolfers said. "Point shaving is so easy for the player to do." At least three of those games Wolfers studied involved Northwestern and Lee, who in February 1995 recruited former Wildcats teammates Dewey Williams and Matt Purdy to shave points after former Notre Dame kicker Kevin Pendergast had contacted Lee. The Wildcats players helped arrange for Northwestern to lose by a margin bigger than the spread in games against Wisconsin and Penn State, earning Lee $4,000 that Pendergast delivered in an Evanston alley. The scheme fell apart when Northwestern only lost by 17 when the spread was 25, losing $20,000 for Pendergast and company.
     Lee's gambling habit began two years earlier when an investigation into former NU football player Dennis Lundy's involvement revealed Lee had bet on college and pro football games. In all, 11 former Northwestern athletes either were charged or convicted at the conclusion of the investigation. University officials disputed Lee's claim that as many as four times as many athletes were involved. "Eleven years later, what is the NCAA doing different--they're still showing a video with me on it--and I know it's still going on," said Lee, who lives in his hometown of Louisville. "Why it happened then is why it's going to happen again because as much as they say they pay attention to gambling, I don't think in reality it gets through and kids like me slip through. There's too much money at stake to crack down too hard, and money makes the world go 'round."



Sane Chinese Put in Asylum, Doctors Find
Joseph Kahn, New York Times- 3/17/2006

BEIJING— Dutch psychiatrists have determined that a prominent Chinese dissident who spent 13 years in a police-run psychiatric institution in Beijing did not have mental problems that would justify his incarceration, two human rights groups said Thursday. The psychiatrists spent two days testing the dissident, Wang Wanxing, in Germany five months after China released him and sent him abroad. They said in a statement that their examination "did not reveal any form of mental disorder." The report could add fuel to charges that the Chinese police use a network of psychiatric prisons to silence political dissidents, often without trial or right of appeal.
      Mr. Wang, now 56, was confined to the psychiatric center after he was detained in 1992 for unfurling a banner that criticized the Communist Party. The authorities determined that he had "delusions of grandeur, litigation mania and conspicuously enhanced pathological will," which Western human rights groups say are diagnoses that officials have used to lock up troublesome dissidents who have not broken any laws.
     After his release in 2005, Mr. Wang described widespread abuses in the mental asylum, known as the Beijing Ankang. He said he had lived in cells with psychotically disturbed inmates convicted of murder and was forced to swallow drugs to blunt his will. He also said the staff members had used electrified acupuncture needles to punish patients while other inmates were made to watch.
     The two Dutch doctors, B. C. M. Raes, a professor of forensic psychiatry at the Free University of Amsterdam, and B. B. van der Meer, also a forensic psychiatrist, examined Mr. Wang in January. Their findings were released Thursday by the Global Initiative of Psychiatry and Human Rights Watch, two human rights groups that have been critical of China's use of psychiatric prisons. "There was no reason that Mr. Wang had to be locked up in a special forensic psychiatric hospital or to be admitted to a psychiatric facility," Dr. Raes and Dr. van der Meer said in a statement. "He was not suffering from any mental disorder that could justify his admission."
     Their diagnosis contrasts sharply with one made by doctors at the Beijing Ankang, who said when Mr. Wang was released last August that he had not been cured. "His systematic delusions have shown no conspicuous improvement since he was first admitted to the hospital," the Beijing examiners said, adding that Mr. Wang should be kept under "strict guardianship" in Germany.
     Human Rights Watch says it has documented 3,000 cases of psychiatric punishment of political dissidents since the early 1980's. The group contends that the use of penal mental asylums to confine dissidents has increased in recent years as the police have sought ways to punish followers of banned religious sects, political dissidents and persistent petitioners without channeling them through the court system.
     Robin Munro, an expert on the Chinese psychiatric system with Human Rights Watch, said Mr. Wang's examination by the Dutch psychiatrists was the first opportunity for Western specialists to directly test a diagnosis by doctors in one of China's psychiatric prisons. He said the Chinese doctors "clearly got a failing mark." "The Chinese diagnosis of Mr. Wang was based on disreputable theories inherited from the Soviet Union that claim that certain types of dissident thinking and behavior can be attributed to severe mental pathology," Mr. Munro said. "This is completely at variance with international standards today."



Prescription For an Obsession?
Shankar Vedantam, Washington Post- 3/19/2006

When Wayne Kanuch received a diagnosis of Parkinson's disease in 1993, the last thing he imagined was that the drug prescribed to treat his illness would turn him into a compulsive gambler and put his libido into overdrive. Kanuch's marriage ended in divorce, partly as a result of the sexual pressures he placed on his wife, and he began losing fortunes at the racetrack. He was fired from his job at Chevron for trolling for dates on the Internet while at work, and he quickly went bankrupt. "I contemplated suicide a couple of times," he said in an interview last week. "Everyone was blaming me, and I was looking at the mirror and blaming myself and asking why I could not stop."
     New evidence unearthed by scientists at the Food and Drug Administration, Duke University and other centers suggest the reason Kanuch could not stop is that the drug being used to treat Parkinson's boosted the level of dopamine in his brain. Researchers are looking into the possibility that dopamine, which is associated with a host of addictive behaviors, may turn some Parkinson's patients into obsessive pleasure seekers. Now, some patients are suing the manufacturers of these drugs to recover the money they lost gambling, on the grounds that the companies did not do enough to warn about these risks. Kanuch has not yet sued but plans to do so.
     So far, there is no definitive evidence on the connection between dopamine enhancers, known as agonists, and compulsive gambling. The behavioral anomalies, though dramatic, are probably rare among the thousands of Parkinson's sufferers who take the drugs. There have been no controlled studies looking into the possible link. Drug manufacturers say anecdotal reports from patients such as Kanuch do not constitute scientific evidence, but they say they have updated warning labels anyway. Valeant Pharmaceuticals, which sells Permax, a dopamine agonist, said the matter is under litigation but it has told physicians: "As with other dopamine agonists, compulsive self-rewarding behavior (e.g., pathologic gambling) and libido increase have been reported in patients."
      Boehringer Ingelheim, which makes Mirapex, another dopamine agonist, said it has toughened its warning label but said that company officials are still exploring the connection. Eli Lilly & Co, which used to sell Permax, said there is no scientific consensus on the issue and suggested that gambling problems may be linked to the increased accessibility of legalized gambling.
     Still, a recent analysis headed by FDA scientist Ana Szarfman found a strong association between pathological gambling and dopamine agonists. The statistics from a federal adverse-events database are not conclusive, but FDA officials regularly mine the data to spot red flags. "There is decent biochemical plausibility that chemical changes can lead to impulsivity and acts like pathologic gambling," said Duke University psychiatrist P. Murali Doraiswamy, co-author of the analysis, published in Archives of Neurology. "It is certainly plausible that gambling can be a side effect of a drug that excessively stimulates limbic-system dopamine," Doraiswamy said.
     The notion that brain chemicals play a powerful -- but hidden -- role in human behavior is at odds with American convictions about free will and choice. Kanuch and other patients said they spent years believing they were responsible for their actions, only to find that the impulse for self-destructive behaviors vanished once they stopped taking a drug. "I broke down in tears and cried my heart out," Kanuch said. "I could not believe a drug could cause that kind of problem. The more I read, I grew convinced and grew angrier." Several patients said the behaviors proved so destructive that they preferred the diseases that the medications were trying to treat.
     Kanuch, 52, who shuttles between living arrangements in the Texas towns of Missouri City and Katy after bankruptcy and several evictions and run-ins with the law, said he is planning to file suit against the maker of Mirapex. The man who had a 21-year career with Chevron said he lost $350,000, his marriage and numerous friends from whom he borrowed money for gambling. "I was misled by doctors," he said. "They may not know all the side effects, but as early as 1993 there was case history building. My doctor was not aware of this. When I told him there was an issue, he denied there was a problem."
     Several other patients report similar obsessions. Cindy Still of Roseburg, Ore., said that after 29 years of faithful marriage, another dopamine agonist -- a physician thought the drug might help ease her chronic depression -- caused her to start an affair, quit her religion and become a compulsive gambler. Peggy Andresen, 51, of Redmond, Wash., developed obsessions with gambling -- and painting tables and counters to look like marble. Mirapex is a great drug, she said, but "the top of every bottle needs to have a big red sticker that says 'May Cause Gambling.' "
     Barbara Hermansen, 52, of Winnetka, Ill., said she was prescribed Permax in 1996 for restless-leg syndrome, in which patients feel electrical impulses crawling under their skin when they lie down to sleep -- and causing debilitating bouts of insomnia. The drug worked like a charm, and her physician steadily increased the dose, which tends to be necessary -- by 2001, she was on 40 times her original dose. On a weekend visit to Las Vegas with her sister, Hermansen dropped $300, which surprised the Sunday-school teacher because before that she had been in a casino twice before and could not wait to get out. On returning home, the financially conservative lawyer began gambling over the Internet. She maxed out her credit cards, emptied her retirement accounts and sold jewelry to fuel the gambling. When she confessed to her husband after losing about $15,000, she said he was incredulous because she had been so staid when it came to finances. Hermansen promised she would never do it again, and she put a filter on her computer to block the gambling Web sites. She soon found herself driving to casinos. After confessing again, she got herself voluntarily banned from Illinois casinos. Then she started driving to casinos in Indiana. "I won huge amounts of money," she said. "I stood in front of a machine and won $62,000 and $28,000 in single spins."
     But, as is true for many people with gambling problems, the money proved to be almost beside the point. With one exception, she never walked out of a casino with money: "You never walk away, you always put it back in, because no amount of money is enough," she said. When a grocer gave her a bottle of champagne for being such a good customer for scratch-off lottery tickets, Hermansen said she was so humiliated and disgusted at herself that she wished "the earth would open and swallow me."
     By 2004, believing she could never stop, she resolved to drown herself by taking a sleeping pill and swimming out into Lake Michigan. But as she sat in her car with her bathing suit beside her and a sleeping pill in her pocket, she realized she could not bear to leave her husband and children. When Hermansen asked her neurologist if the drug might be the problem, he said he did not know of a connection. At a Gamblers Anonymous meeting, the theory was booed down and she was told she needed to take responsibility for her actions. A therapist suggested she was testing her husband's love because she felt she didn't deserve to be happy; a psychiatrist told her to make a list of all the reasons she was trying to sabotage her life.
     When an expert in pathological gambling finally took her off the drug, the urge to gamble vanished. The restless-leg syndrome came back with a vengeance, but Hermansen swears that she would rather "suffer from insomnia for the rest of my life rather than go through that gambling hell." Hermansen sued Eli Lilly to recover hundreds of thousands of dollars she lost gambling, and because she says the company was unresponsive to her plea for warnings.
     A move to turn the lawsuits into a class action was denied late last year, because of the diversity of the cases, and now individual lawsuits are accumulating around the country, said Daniel Kodam, a lawyer with Soheila Azizi and Associates in Rancho Cucamonga, Calif. Kodam is representing Joe Neglia of Millersville, Md., a former Defense Department intelligence analyst who turned to compulsive gambling after taking Mirapex for Parkinson's disease. Kodam dismissed the existing warnings as too little too late: "The warning label is a joke," he said. "To bury five to six words on Page 17 when the effects are so catastrophic is ridiculous. You need a clear descriptive warning label and notification to doctors to ask patients about this potential effect."



The Next Crack Cocaine?
Amit Paley, Washington Post- 3/19/2006

Jimmy Garza was freaking out. As officers handcuffed him inside his posh Fairfax County home on charges relating to a crystal meth addiction, the America Online administrator realized he was about to lose his $60,000-a-year job, his two cars and his freedom. The arresting officers seemed baffled by his drug of choice. "You know, we don't have a meth problem in this area," Garza remembers one of the officers telling him that night in 2004. "Are you kidding?" Garza, now 40, snapped back. "Wake up and look around you." The number of methamphetamine labs and addicts in the Washington area has jumped in recent years, but law enforcement and public health officials say the region is still woefully unprepared to deal with a problem that remains under the radar.
      Meth, a dangerously addictive synthetic drug that stimulates the nervous system, has infiltrated suburbs in Virginia and, to a lesser degree, Maryland; Anne Arundel County found three labs in six months last year. In the District, the drug has been used mainly by gay white men but has recently spread into the black and Latino communities and to straight teenagers as young as 15, health officials said.
     For years, officials thought the Washington region might be immune to methamphetamine, which has ravaged West Coast and midwest communities for more than a decade. Some wondered if meth was just a localized problem. But the number of seized meth labs in Maryland, Virginia and the District has increased from close to zero in 2000 to more than 80 last year. In Washington, health officials say 75 percent of patients in some clinics have abused the drug, a big increase from a few years ago. "The jurisdictions in this area just have not picked up on the exigency regarding crystal meth," said Sgt. Brett A. Parson, commanding officer of the D.C. police gay and lesbian liaison unit.
     Sounding the alarm that the meth crisis could become the next crack epidemic, some law enforcement and public health officials are pushing for a stronger response. The Drug Enforcement Adminis tration trained more Maryland officers to dismantle meth labs last month than it did in all of 2005; a District-funded public service announcement was released last week to be aired in local clubs and on television stations.
     Still, some experts said those nascent efforts are not enough to combat the spread of meth. They call for training rank-and-file police officers to detect meth labs, the passage of legislation that would restrict the sale of ingredients used to produce the drug and prevention education in schools to teach children about its dangers. "We really need to stop sitting around and just hoping that meth won't become the next crack cocaine," said Kevin Shipman, a manager with the District's Addiction Prevention and Recovery Administration. "We need to have a strong regional response before it's too late."
     When meth, which, nationally, has been a largely rural epidemic, swept east across the nation, it hit the Shenandoah Valley hard, becoming one of the most-seized drugs in that part of the region. Labs have more recently popped up in semi-rural areas of Southern Maryland and Anne Arundel, where addicts are called "methnecks." The labs require only simple equipment, such as bottles and tubing, which is easy to hide in almost any kind of building. The ingredients for the drug include medications containing ephedrine or pseudoephedrine, red phosphorous and hydrochloric acid.
     The epicenter of meth use in the region is the District's gay community, where the drug showed up about five years ago and has been spreading quickly ever since, health officials said. Known as Tina in most gay circles, the drug has become the primary drug of choice, topping even alcohol among patients admitted to the Whitman-Walker Clinic, which primarily serves gay clients in the District. "It's everywhere," Parson said. "I would defy you to find anybody in the metropolitan area who is white and gay and doesn't know one person who is using meth."
     The drug is particularly troubling to medical workers in the gay community because meth is associated with risky sexual behavior. Some gay meth addicts use the Internet to find partners to use the drug and have sex -- known as party 'n' play -- encounters that sometimes turn into multiple-day sex parties. Shipman said meth addicts are three times as likely to contract HIV as non-users because they tend to have unprotected sex and multiple partners. Health experts say the addiction is particularly hard to treat. The National Institute on Drug Abuse says there is currently no "safe and tested" medication to treat meth addiction. Programs rely on counseling and behavioral modification.
     Experts said one of the biggest problems in bringing attention to the meth problem in the area is the lack of reliable statistics on the number of users. Richard Rawson, a professor at UCLA who has been studying the drug for two decades, said public health indicators that should indicate the meth problem -- such as emergency room visits and patients in treatment -- lag five to seven years behind the emergence of the drug. "In some places, the public health people are saying, 'Well, we're not seeing it; it's not that big a problem here,' " he said. "But that's not what the data means." The best predictors of an emerging meth epidemic, Rawson said, are the presence of meth use in the gay community and the discovery of even small numbers of meth labs.
     At the DEA's meth lab training facility in Quantico, officials have identified the growing problem in the Washington area and are admitting increasing numbers of local police officers. In a recent class for 41 state and local officers held last month, seven were from the Washington area, including Annapolis and Montgomery, Prince George's, Calvert and Fauquier counties. "We know the growth in Maryland and Virginia is exponential," said John Michael Donnelly, chief of the training unit.
     But some of the officers are concerned that most rank-and-file officers won't get this training, which is expensive and in high demand. In Prince George's alone, 10 officers are on the long waiting list. "We've got to get more guys that are actually on the street certified in this," said a Calvert narcotics detective at the training in Quantico, who spoke on condition of anonymity because he works undercover. "I think a lot of guys are probably seeing meth but don't know what it is." Sgt. Shawn A. Urbas, a spokesman for the Anne Arundel police, said it would be easy for officers to miss a disassembled meth lab -- which might be just a box of tubing and some beakers -- if they had never seen one before. He said that's why the department is focusing on training.
     Health officials are also pushing for legislation that would restrict the sale of cold medications that contain pseudoephedrine, one of the ingredients used to manufacture meth. Virginia, like many states across the country, limits such sales, but Maryland and the District do not. Some drugstores are voluntarily restricting sales.
     Some former addicts, though, said the best way to stop meth is to educate the public about its dangers. Garza said he was adamantly against drugs -- "I was totally Nancy Reagan about it" -- until a friend offered him meth and he began using it at gay clubs. Soon he was hooked on the drug -- which causes users to stay up for days at a time -- and at one point partied for seven straight days without sleeping. "I had no idea that that first little bit would alter my life forever," he said. But it did. After his arrest, Garza lost his job, was evicted from his home and declared bankruptcy. He was able to get treatment, though, and now works as a limo driver. His primary mission is to tell his story so that people realize the dangers of meth. "Even though it's so obviously here, it's still very hidden. It's very hush-hush," Garza said. "But we're trying very hard to bust the secrecy off of it."