Noteworthy News Articles on Mental Health Topics, August 1-8, 2006



Was It Alcohol or Anti-Semitism Talking? Doctors Disagree
Thomas Maugh, Los Angeles Times- 8/1/2006

Behavior experts were split Monday on whether the alleged anti-Semitic comments of Mel Gibson were a reflection of his beliefs or simply gibberish induced by intoxication — the alcohol talking, in other words. Remarks such as those Gibson is alleged to have made are "not a product of alcohol," said Dr. Samuel Barondes, Robertson professor of psychology and neurobiology at UC San Francisco. The content of any comments is in a person's head, "in his opinion structure." Others, however, argue that gross intoxication can lead to a free association of ideas that are unrelated to an individual's true character. "Basically, the person talks gibberish … and can behave in a very bizarre way," said Dr. Bankole Johnson, chairman of psychiatric medicine at the University of Virginia. "They might not even be certain of what they are saying. They don't understand what they are saying, and they don't mean what they are saying," Johnson said.
     That argument has persisted in the profession for many years and is unlikely to be resolved anytime soon, experts said. "I would imagine that both options are possible," said Dr. Steven Sussman, a professor of preventive medicine and psychology at USC. "I am not sure that anyone knows for sure."
     Psychologist Mark Fillmore of the University of Kentucky cites research that has shown that at moderate levels (the legal limit for driving is 0.08% in California), alcohol releases what are known as prepotent responses — beliefs, thoughts and actions that an individual would normally try to suppress. "Alcohol doesn't produce new behaviors," he said. "It releases things that people believe or know…. It exaggerates the personality of the individual." Gibson reportedly had a blood-alcohol level of about 0.12%, which would be well within the range at which such behaviors are manifested, Fillmore said. But behavior may change if a person is simultaneously taking prescription drugs, such as tranquilizers or benzodiazepines. Such drugs would exacerbate the effects of the alcohol, making people act as if they were grossly intoxicated.
     There is no shortage of expert opinions on the drinker who is highly intoxicated: Sussman cautioned that some drunks deliberately say things they don't believe in order to be belligerent or to produce a particular response. Barondes said that some people when drunk become very aggressive and "sensitive to the smallest slight," and added: "They want to pick a fight with somebody." At higher levels of intoxication, Fillmore said, drunks "have a breakdown of cognitive functioning. It's difficult for them even to recall what they believe."
     In trying to tease apart which behavior is which, Johnson said, it is important to consider how the person behaved previously when drunk. "If this behavior is new, if no one has witnessed it before," he said, then there is a good possibility it really is the alcohol talking. But Barondes disagrees. "Alcohol," he said, "doesn't create the ability to say things like 'Jews are controlling the world.' "



Pressure to Compete, Not Connect, Leaves Many Affluent Teens Miserable
Sandra Boodman, Washington Post- 8/1/2006

Adolescent alienation isn't a new phenomenon. But the unhappy teenagers clinical psychologist Madeline Levine sees in her practice aren't merely going through a developmental phase, she writes. In her new book, "The Price of Privilege" (Harper Collins, $24.95), Levine says that over-involved parents who pressure their children to be stars -- in school, on athletic fields, among their peers -- have created a generation that is "extremely unhappy, disconnected and passive." Unabashedly materialistic and disinterested in the wider world, they are both bored and "often boring," she writes. A large number suffer from depression, anxiety and substance abuse.
      Levine, 57, the mother of three sons, draws heavily on her 25 years of clinical experience in Marin County, Calif. Those insights are augmented by interviews with psychiatrists and psychologists around the country, as well as an emerging body of research about the psychological health of children raised in families whose average annual incomes range from $120,000 to $160,000.
     Affluent teens, she writes, are among those least likely to receive treatment for emotional problems, because many of their parents are loath to mar the public image of the perfect family. One recent study found that upper-middle-class girls appear three times more likely to suffer from clinical depression than those from other socioeconomic groups. Following are excerpts from a recent Q-and-A with the author.

What is the "culture of affluence," and why is it damaging to kids?
I think there's been a real ratcheting up of materialism, as opposed to an emphasis on making connections with people. Competition counts more than cooperation. If you can't trust your neighbor, or your best friend sitting next to you while you take the SATs because she might score 10 points higher than you and knock you out of your chance of going to the school you want, that makes people feel they have nowhere to turn except to themselves. I think it's made worse by this persistent and unreasonable fear that we are all in competition for very limited resources. The reality is that there really is a space for everybody who wants to go to college, even though it may not be at Harvard.

Affluent communities aren't new, nor is academic competition or drug abuse. In the late 1960s and early 1970s competition for college was fierce, drug use was common and, for boys, there was the added fear of being drafted to fight in Vietnam. Why would life be harder for teenagers now?
We don't really know the answer to that; there never was any research done on affluent kids 20 or 30 years ago. This may be a phenomenon that's been going on for decades, but nobody did studies of these kids. I do think the parental over-involvement and level of anxiety are new. A friend showed me the Yale alumni bulletin and said they used to write about who was appointed to the Cabinet or started a company or became head of a hospital. Now, it's whose kid made the select soccer team.
      There really is some transformative idea about the role of children's accomplishments. And I lay part of the blame for that at the feet of my own profession, which came up with the ridiculous notion that a kid's self-esteem was so fragile and so vulnerable that all efforts needed to be made to increase it. I'll give you an example: Where I live they have something called the "good-enough catch." If a little kid is playing baseball and is anywhere near the base and makes the catch, it counts as an out. Aside from the absurdity of it, it's actually horrible preparation for real life. The world simply doesn't work that way.

Are the increases in depression, anxiety disorders and substance abuse real, or do they reflect the fact that affluent kids are more likely to be diagnosed and medicated than their less privileged peers?
My best guess is that this is a real increase caused in part by the phenomenal microanalysis of everything these children do. What affluent parents tend to do is to see the child they wish they had -- not the child they have. Parents have this notion that their child is supposed to be a certain way, because performance is so highly valued in affluent communities. Parental love has become contingent on performance, which is very damaging. I just had parents who came into my office with their crying daughter and said, "We just wasted $160,000." Why did they think that? Because they sent their kid to a private school and she wants to go to the University of Colorado instead of, say, Georgetown.
      Kids aren't having the experiences that are mandatory for healthy child development -- and that's a period of time to be left alone, to figure out who you are, to experiment with different things, to fail, and to develop a repertoire of responses to challenge. They have no interior life. It's all about performance -- and performance is not real learning.

Why are many parents pathologically over-involved?
I do think there is a cultural shift. We have smaller families, we have more time to obsess about perfecting each child. Many parents can't stand to see their children unhappy or angry or disappointed, which is part of life, part of growing up. Our generation of parents is not happy themselves. A lot of women feel that their best emotional bet is their children. The divorce rate is high, friendships are hard to come by, communities are competitive.
      I'm not romanticizing the 1950s, but in those days, women had coffee klatches. I came from a working-class neighborhood, and every door was open and people felt responsible for other people's children. Now, people wouldn't think of going next door for a cup of coffee or to discuss a personal problem. You have to make a date first. There's nothing like that fluid interchange of support and help that our mothers had.

You identify three types of parents: involved, over-involved and intrusive. How do they differ?
Say the kid comes home and says he has a math test. The involved parent says, "We want you to do well on that test, so you need to study between 7 and 8 after dinner for an hour." The over-involved mother, of which I'm one, might say the same thing plus, "Before you go to sleep, I'd like to go over those math problems with you." The intrusive parent does all that and then finds a mistake and says, "I knew it. You can never be left alone. You were going to go into the test unprepared just the way you always do and you're going to fail and then you're going to be flipping burgers for the rest of your life." They get into the child's psychological space, they make judgments about the value of that child. And that's a very dangerous place for a parent to be.

What advice do you have for parents?
There are several thing parents can do: Families should eat dinner together as much as possible, and kids should be involved in rituals -- at church, the synagogue, at Meals on Wheels or wherever. Parents need to impose consistent discipline, which will help kids develop self-control, which is vital. Kids should never, ever, be paid for grades. Real learning is about effort and improvement, not performance. Your kid's C actually may be the far greater achievement than the A that comes easily. And they should have chores. A lot of kids I see don't have to do anything except shine. And if you turn out kids who aren't expected to do anything but shine, you turn out narcissistic or self-centered kids. As one girl I see told me, "If I'm so special, why do I have to clear the table?"



A Can-Do Approach to Autistic Children and Athletics
Anahad O'Connor, New York Times- 8/3/2006

The members of the swim team at Bloomington High School South in central Indiana cheer wildly every time Nathan Buffie races. In his two years on the team, Nathan has never won first place at a meet. Often, he finishes far behind. But it is the fact that Nathan even goes into the water and manages to compete at all that his teammates find so remarkable. Nathan, a trim 16-year-old with a boyish smile, has autism, the devastating developmental disorder that makes his participation in any sport or social activity a struggle. “He is probably the worst swimmer on the team, but he keeps getting better and he wants to win,” said his mother, Penny Githens. “He tells his teammates this, and they just get so excited for him.”
      For years, children with autism were left on the sidelines, a consequence of a widespread belief that they were incapable of participation in athletics. But while it is true that autistic children can be difficult to motivate and resistant to exercise, they are now being pushed to take part in physical education programs, encouraged by experts who say that certain sports can ease repetitive behaviors like pacing and head-banging as well as provide a social outlet.
     Autistic children, even those who are considered low functioning, can excel at activities like swimming, martial arts, running and surfing — sports that don’t entail having to read social cues or figure out when to pass the ball. “A lot of autistic children are never going to play on a team, but they can do really well in individual sports,” said Donna Asher, the camp director at the North East Westchester Special Recreation Program in Hawthorne, N.Y. “It’s not their physical skills that keep them from participating, it’s their social skills — not being able to interact with others or having a breakdown on the field in the middle of a game.” Athletic programs for autistic children, often called adapted sports programs, are designed to sidestep social and behavioral problems.
     Many autistic children — up to half, according to some studies — are prescribed antipsychotics and other drugs that can produce fatigue and swift weight gain. Studies show that about 17 percent of autistic children are overweight and another 35 percent are at risk, figures that mirror the rate among American children in general. Experts hope that teaching autistic children how to be active will stave off problems later in life. “What we’re trying to do is to make sure that they won’t be at high risk for obesity and coronary artery disease,” said Dawn D. Sandt, an assistant professor of adapted physical education at the University of New Mexico who has studied the activity levels and the body mass of autistic children.
     Still, for parents of autistic children, locating an adapted sports program can be a low priority. More often than not, they are consumed with struggles to find speech therapists, behavioral intervention services, special education classes and a health insurance policy that will pay for it all. “Parents of autistic kids have a lot of battles to fight,” said Georgia Frey, an associate professor of kinesiology at Indiana University in Bloomington, who founded an adapted physical education program in 2001. “So when it comes to getting their kids involved in recreation and physical activity, it can seem too exhausting. But I do think that parents see the value in these programs, because the demand for them is very high.”
     Researchers say the value of sports for autistic children is well documented but often overlooked. Studies dating back to the 1980’s have found that brisk physical activity increases attention span and reduces repetitive behaviors. But the catch is that the exercise must be moderate to vigorous. One early study of autistic children found that 15 minutes of jogging “was always followed by reductions in stereotyped behaviors” such as hand-flapping and rocking. But 15 minutes of playing alone with a ball, considered mild exercise, had “little or no influence” on behaviors.
     John O’Connor, an associate professor of adapted physical education at Montana State University-Northern, explained why. Running and swimming involve rhythmic movements that are similar to stereotypical behaviors, and may distract people with autism the same way flapping their hands or walking on their toes does. “People with autism experience levels of sensory perception that most of us wouldn’t know or understand,” Dr. O’Connor said. “It overloads them, so they engage in behaviors that distract them. Exercise gives them the same benefits but it doesn’t have the negative social connotations.”
     As many as 1 out of every 166 children born today has autism, according to the federal Centers for Disease Control. No organization tracks the number of participants in adapted physical education programs or how many such programs exist. Because the severity of the condition varies, the challenges instructors face are never the same. Some children are withdrawn, others will engage. Some speak fluently, others are mute.
     The Aqua Pros Swim School in San Diego has a program called Pool PALS (Persons with Autism Learning to Swim). There, teachers incorporate pictures and marker boards into their lessons to demonstrate proper stroke technique to children who have trouble communicating. The school also has a mechanical platform that can be lowered into a pool inch by inch to gently introduce reluctant children to watersports.
     Tammy Anderson, the private swim instructor who runs the program, started it about five years ago after she met a woman who doubted that her nonverbal, tantrum-prone 7-year-old daughter would ever swim a lap. “I saw that as a challenge,” Ms. Anderson said. Every lesson had to be broken down into small steps that were demonstrated with flash cards and other visual cues. After a month and a half, she said, the girl could swim across the pool “with a pretty decent stroke.” “Her mom came back to me in tears and said it was the first thing that anyone has ever been able to teach her daughter,” Ms. Anderson said. Pool PALS now has more than 100 students, up from 30 when it started. It spawned a surf program with 80 participants, up from 14 when it began in 2001. Both programs have waiting lists.
     Because autistic children often do better with routines, most programs are highly structured. At the Westchester camp, which serves children with developmental disabilities and emphasizes fitness, campers are provided with a detailed daily schedule. Instructors keep the campers engaged and ready to participate. “Left to their own devices, these kids will retreat into their own little worlds,” said Ms. Asher, the camp director.
     The hope of the adapted programs is that participants will pursue a sport for life. Then there are the best-case scenarios like Nathan Buffie in Indiana, who started in an adapted swim program at a Y.M.C.A., graduated to a community program and eventually proved capable of swimming for his high school team. He also participates in an adapted martial arts program at a Y.M.C.A. His mother, Ms. Githens, said that Nathan stumbles sometimes. He doesn’t always line up when he should, and he has problems controlling his voice. But the swim team has embraced him nonetheless. “When he is out in the water,” she said, “his teammates yell and scream for him in a way that they don’t for anyone else.”


When the Beard Is Too Painful to Remove
Jane Gross, New York Times- 8/3/2006

They spend decades denying their sexual confusion to themselves and others. They generally limit their encounters with men to anonymous one-night stands and tell all manner of lies if their wives suspect. They consider themselves to be devoted husbands, conscientious fathers and suburban homeowners, and what typically brings them to the point of crisis in their 40’s, 50’s and even 60’s is their first emotional connection with another man. For gay men in heterosexual marriages, even after the status quo becomes unbearable, the pull of domestic life remains powerful. Many are desperate to preserve their marriages — to continue reaping the emotional and financial support of wives, and domestic pleasures like tucking children in at night.
      The demand for support groups for gay, married men, as well as traffic in Internet chat rooms, shows that so-called “Brokeback” marriages have hardly disappeared, as many experts assumed they would, even in an age when gay couples, in certain parts of the country, live openly and raise children just like any family.
     Leaving a marriage and setting up housekeeping with a gay partner is not what most married gay men have in mind when they join a support group, according to Stephen McFadden, a clinical social worker, who runs such groups in Manhattan. Instead, Mr. McFadden and others in the field say, their clients generally start out committed to the opposite goal. Even after a pained awakening or acknowledgment of their sexual orientation, these men want to save their marriages, Mr. McFadden and others say, either by lying, promising their wives they will not have sex with men or persuading them to accept their double lives. Yet, such arrangements succeed for only “a small percentage’’ of couples, Mr. McFadden and other therapists said, but the stubborn attempt often makes these men unwelcome or uncomfortable in support groups for gay fathers, which are easy to find but largely the province of men who are long divorced.
     One support group member, Steve T., is a Long Island doctor, married to his high school sweetheart and the father of three school-age sons. He said he felt the sting of judgment when he tried a group for gay fathers. “They thought my desire to stay married was part of my denial,’’ said Dr. T., who would do almost anything to keep his family together and his suburban lifestyle intact, even after telling his wife that he is gay. She is his “best friend’’ and the “perfect co-parent,’’ said the 44-year-old doctor, who agreed to be interviewed on condition he not be fully identified and his secrets thus revealed to relatives, neighbors and patients. He enjoys the social life of a popular suburban couple, adores his in-laws and wants to live in the same home as his children. But he also wants to continue a love affair with a man like himself: married, with children, a lawn to mow and a comfortable life. And until a few weeks ago, Dr. T. said, “this was working great in terms of getting our needs met and not disrupting our families.’’
     Dr. T.’s wife had agreed she could live with his sexual orientation provided he didn’t act on it. So he lied and said his homosexual relationship did not include sex. But she wasn’t fooled and forced him to move into an in-law apartment in the family home, a way station to a more formal separation. This development has left him stunned, one moment sympathetic to his wife’s position and the next disbelieving that they can’t work it out. “I love her, but she wants me to be in love with her,” Dr. T. said. “She wants to be my one and only. Everything we have will be at risk if, God forbid, we divorce.’’
     Data on these marriages is scarce and unreliable because of the various ways of defining “gay’’ in demographic research. Studies in the 1970’s and 80’s, using inconsistent methodology, found anywhere from one-fifth to one-third of gay men were or had at one time been married. All the therapists and gay men interviewed for this article assumed that percentage would be far lower in today’s more accepting society.
     But Gary J. Gates, a demographer at the Williams Institute, a research group that studies gay issues at U.C.L.A., blended data for The New York Times from the 2000 Census and a 2002 federal survey of family configurations, and found that the percentage of gay men who had ever been married could be as high as 38 percent — or as low as 9 percent — depending on whether respondents were asked their sexual orientation, whom they had sex with or whom they found attractive.
     Of the 27 million American men currently married, Mr. Gates found, 1.6 percent, or 436,000, identify themselves as gay or bisexual. Of the 75 million men who have ever been married, 1.8 percent, or 1.3 million, identify themselves that way. But, in both cases, when the men are asked about behavior if they have ever had sex with men, not what they consider their sexual orientation, the number of men who have ever been married doubles.
     The sort of arrangement Dr. T. hoped for — a proper marriage and one or more relationships with men on the side — is not unheard of. Cole Porter pulled it off and so did James McGreevey, New Jersey’s former governor, who left office, and his wife, in 2004. Mr. McGreevey, 48, has spent the last year writing a memoir, “The Confession,’’ to be released on Sept. 19, and recently, with his new partner, Mark O’Donnell, 42, moved into a Georgian mansion in Plainfield, N.J.
     The specter of AIDS has led to a formal and presumably safe way for gay married men to have it all, known as a Closed-Loop Relationship. Instead of risky promiscuous sex, a married man has two “monogamous’’ relationships, one with his wife and one with another man, usually married. Done according to the rules, enumerated on Web sites and online support groups, all four parties agree to this setup. “It’s an approach which people hoped would be a compromise solution,’’ said Michael, the Web master of www.marriedgay.org, a site based in Manchester, England, who declined to give his last name out of deference to his wife, whom he no longer lives with. “But it’s easier said than done.’’
     Closed-Loop Relationships are anathema to Bonnie Kaye, the former wife of a gay man, who runs the Web site www.gayhusbands.com and conducts “How to Come Out to Your Wife’’ workshops. “If they’re too selfish to leave, I won’t work with them,’’ Ms. Kaye said. “If they love their wives, they need to give them their lives back.’’
     Deception remains common. An unscientific survey of visitors to www.marriedgay.org found that more than half of the married gay respondents said their wives did not know of their sexual inclinations. Of those, a slim majority were considering whether to come clean but a third said “never.’’ Men who are forthcoming with their wives, and then divorce or separate, report surprise that what happens afterward is often vastly harder than the process of ending the marriage.
     Scott W., 64, a retired school teacher and real estate agent, relieved his occasional need for homosexual sex with anonymous encounters on East Hampton Beach without quite labeling himself as gay or bisexual. Only when he fell for someone, who rejected him because he was married, did Scott conclude he had to divorce a woman he loved and had been with for 24 years. That process, as these things go, was without acrimony, said Scott, a former member of Mr. McFadden’s support group, and he remains close to her and his two grown sons.
     But looking for love in late middle age, Scott said, is a frustrating ordeal. After a brief “slut phase,’’ he had “the naïve idea I’d find someone right away.’’ Instead, he has learned he is ill-suited, or too old, for gay night life. “They want to go out at 11 o’clock,’’ Scott said, “and I want to go to sleep at 11 o’clock. Plus, in those places, there’s too much noise and confusion.’’ He eats dinner most nights at the bar of an East Side restaurant that attracts an older gay clientele. The conversation is lively, Scott said, but he hasn’t found anyone to date. Recently, a married gay man left his business card but Scott threw it away. He is not looking for a one-night stand.
     Scott’s loneliness after divorce is common among middle-aged men, according to Dr. Richard A. Isay, 69, the first openly gay member of the American Psychoanalytic Association who himself left a heterosexual marriage about 20 years ago, when he was already in a gay relationship that he remains in today. Dr. Isay said he came slowly to understand his patients’ sense of isolation during three decades of practice, and therefore has modified his advice to gay married men. “I beg them to take it slow because it’s difficult to find the substitute for the love and companionship of a longtime spouse,’’ said Dr. Isay, author of “Commitment and Healing: Gay Men and the Need for Romantic Love” (Wiley, 2006). “They must take that loss into consideration.’’
     The loss comes on top of the adolescent awkwardness of not knowing the social norms of a new world, described on the blog www.comingoutat48.blogspot.com. Its author, who identifies himself only as Chris, writes of changing his clothes many times before heading to his first gay bar, finding it empty and not realizing he had arrived too early. He writes of not understanding the sexual terminology in gay personal ads and looking for an “always gay’’ man to teach him what he needed to know. In an e-mail exchange, Chris compared the experience to “living abroad,’’ where the “thrill of a new place’’ competes with “the deep loneliness’’ of unfamiliarity. It is not, he said “the existential loneliness of not knowing who you are and where you belong, but the loneliness of ‘What am I going to do this weekend?’ ‘How am I supposed to behave?’ or ‘When will the phone start to ring?’ ’’
     Even in the security of a six-year relationship with a man, John. J., 53, resists divorcing his wife of 30 years. “I am still so in love with her,’’ he said, speaking on the condition he not be fully identified because his parents, in-laws and colleagues do not know the details of his separation. “And there’s nobody else I’d use that word for.’’ John said he had no moral choice but to leave his marriage once he “let the emotional aspect’’ of his attraction to men into his life. “That had been the realm of me and my wife,’’ he said. “So that’s the line of demarcation. The two, for me, are mutually exclusive. But divorce? I can’t imagine the finality of that. I have doubts all the time.’’



Parental Rights Upheld for Lesbian Ex-Partner
Adam Liptak, New York Times- 8/5/2006

Isabella Miller-Jenkins has two mothers, the Vermont Supreme Court ruled yesterday. The court rejected a host of arguments from Isabella’s biological mother, Lisa Miller, that her former lesbian partner, Janet Jenkins, should be denied parental rights. The decision conflicts with one from a court in Virginia, where Ms. Miller and her daughter, who is 4, now live. A lawyer for Ms. Miller predicted that the United States Supreme Court would eventually hear the case to resolve the dispute.
      After living together for several years in Virginia, Ms. Miller and Ms. Jenkins traveled to Vermont to enter into a civil union in 2000. Isabella was born in Virginia in 2002, after Ms. Miller was impregnated with sperm from an anonymous donor whom Ms. Jenkins helped select. Ms. Jenkins was present in the delivery room. When Isabella was 4 months old, the women moved to Vermont, where they lived for about a year before separating. Ms. Miller and Isabella moved back to Virginia.
     In an interview last year, Ms. Miller said she no longer considered herself a lesbian. “When I left Janet,” Ms. Miller said, “I left the homosexual lifestyle and drew closer to God.” Ms. Miller said that she was Isabella’s only mother and that she did not want Ms. Jenkins to have visitation rights.
     In a statement yesterday, Ms. Jenkins said she welcomed the Vermont Supreme Court’s ruling. “I’m relieved that today’s decision brings me closer to seeing my daughter,” she said. “I just long to hold her, and tell her and show her how much I love her.” Ms. Jenkins has not seen Isabella since June 2004.
     But yesterday’s decision may represent only a symbolic victory for Ms. Jenkins, because it is not clear that the Virginia courts will honor it. In October 2004, a judge in Winchester, Va., granted sole custody of Isabella to Ms. Miller. He relied on the state’s Marriage Affirmation Act, which makes same-sex unions from other states “void in all respects in Virginia.” That decision has been appealed, and a Virginia appellate court had deferred its decision on the appeal until the Vermont Supreme Court had a chance to rule. It will presumably render a decision soon.
     Mathew D. Staver, the founder and chairman of Liberty Counsel, a public interest law firm that defends traditional marriage and represents Ms. Miller, said the Vermont decision “tramples on parental rights and state sovereignty.” Vermont, Mr. Staver said, “does not have the right to impose its same-sex union policy on Virginia.” “The Vermont ruling,” he added, “illustrates that same-sex marriage or civil unions will inevitably clash with other states. This case will have to be resolved at the United States Supreme Court.”
     A lawyer for Ms. Jenkins, Jennifer L. Levi, said she expected Virginia to abide by yesterday’s ruling, in part because it was relatively routine. “The decision confirmed,” Ms. Levi said, “that well-established laws designed to protect children in cases of dissolution apply to children of same-sex couples.”
     Yesterday’s decision, which was unanimous, was written by Justice John A. Dooley. He said that many factors supported the conclusion that Ms. Jenkins is a parent “including, first and foremost, that Janet and Lisa were in a valid legal union at the time of the child’s birth.” Among the other factors, Justice Dooley wrote, were the women’s expectation before Isabella’s birth that Ms. Jenkins would be her mother, that they both participated in decisions concerning insemination and prenatal care, that all concerned treated Ms. Jenkins as a parent while the women and Isabella lived together, and that Ms. Miller identified Ms. Jenkins as a parent when she first moved to dissolve the civil union. Justice Dooley said yesterday’s decision did not break new ground. Courts in nine other states, he wrote, “have recognized parental rights in a same-gender partner of a person who adopts a child or conceives through artificial insemination.”

Antidepressants Prove Addictive to Some
Associated Press, 78/6/2006

When Gina O'Brien decided she no longer needed drugs to quell her anxiety and panic attacks, she followed doctor's orders by slowly tapering her dose of the antidepressant Paxil. The gradual withdrawal was supposed to prevent unpleasant symptoms that can result from stopping antidepressants cold turkey. But it didn't work. ''I felt so sick that I couldn't get off my couch,'' O'Brien said. ''I couldn't stop crying.'' Overwhelmed by nausea and uncontrollable crying, she felt she had no choice but to start taking the pills again. More than a year later the Michigan woman still takes Paxil, and expects to be on it for the rest of her life.
      In the almost two decades since Prozac -- the first of the antidepressants known as SRIs, or serotonin reuptake inhibitors -- hit the market, a number of patients have reported extreme reactions to discontinuing the drugs. Two of the best-selling antidepressants -- Effexor and Paxil -- have led to so many complaints that some doctors avoid prescribing them altogether. ''It's not that we never use it, but in the end I will tend not to prescribe Effexor or Paxil,'' said Dr. Richard C. Shelton, a psychiatrist at the Vanderbilt University School of Medicine. Shelton has received grant support from the makers of both drugs and consulted for a number of other pharmaceutical companies.
     Patients report experiencing all sorts of symptoms, sometimes within hours of stopping their medication. They can suffer from flu-like nausea, muscle aches, uncontrollable crying, dizziness and diarrhea. Many patients suffer ''brain zaps,'' bizarre and briefly overwhelming electrical sensations that propagate from the back of the head. Though not exactly painful, they are briefly disorienting and can be terrifying to patients who don't know what they are experiencing. There are case reports of people who have just quit antidepressants showing up in hospital emergency rooms, thinking they are suffering from seizures.
     Toni Wilson certainly didn't know how unpleasant going off Zoloft could be when her doctor recently switched her to Wellbutrin, telling her that the new drug would ''take the place of'' the old one. The two antidepressants actually work on entirely different neurochemical systems, so going straight from one to the other was equivalent to quitting Zoloft cold turkey. ''After about three days I felt real anxious and irritable,'' the Kansas woman said in an e-mail message. ''I would shake, not eat much, it felt like little needles in my body and head.''
     Cases like Wilson's would be virtually nonexistent if physicians took more care in weaning their patients off antidepressants, said Philip Ninan, vice president for neuroscience at Wyeth, the maker of Effexor. ''The management of discontinuation symptoms is relatively easy if you know about it,'' Ninan said, and noted that Wyeth had made efforts to educate both physicians and patients.
     Yet surprisingly few doctors know enough about SRI discontinuation to manage it effectively. A 1997 survey of English doctors found that 28 percent of psychiatrists and 70 percent of general practitioners had no idea that patients might have problems after discontinuing antidepressants. Awareness may have increased since then, but the phenomenon is so little studied that no one has done the necessary research to find out. The condition's prevalence is equally mysterious. Studies put the rate at anywhere from 17 percent to 78 percent for the most problematic drugs.
     So little is known about it that researchers aren't even exactly sure what causes the symptoms. It may be related to the fact that the brain chemical affected by most of the antidepressants on the market today, serotonin, does a lot more than regulate mood. It is also involved in sleep, balance, digestion and other physiological processes. So when you throw the brain's serotonin system out of whack, which is essentially what you're doing by either starting or discontinuing an antidepressant, virtually the whole body can be affected. Generally the drugs that are metabolized most quickly cause more severe symptoms, Shelton said. Effexor, which breaks down in a period of hours, is one of the worst SRIs in that regard; Prozac, which has a half-life of about a week, is considered the best.
     Some doctors have been able to minimize withdrawal symptoms in patients who are quitting Effexor or Paxil by gradually switching them over to Prozac, then tapering them off the more easily discontinued drug.
     Critics of the pharmaceutical industry complain that drug companies downplay the severity of drug discontinuation symptoms. The prescribing information companies provide to doctors warns that patients occasionally experience mild symptoms when they stop taking SRI antidepressants, but imply that tapering off the medication can prevent problems. Medical journals describe the ill effects of going off the drugs as ''mild and short-lived,'' and usually avoidable if the dose is tapered. ''I don't think they're difficult to go off,'' said Alan Schatzberg, chairman of the department of psychiatry and behavioral sciences at the Stanford University School of Medicine. ''The vast majority of people aren't that sensitive.'' Schatzberg recently chaired a Wyeth-sponsored panel of physicians that offered guidelines for how to manage ''antidepressant discontinuation syndrome,'' the preferred medical term for what a layperson would think of as withdrawal. He has also served as a consultant to several other pharmaceutical companies.
     Terms like ''antidepressant discontinuation syndrome'' demonstrate the pharmaceutical industry's efforts to downplay the problem, charged Karen Menzies, an attorney who has been involved in litigation over the phenomenon. ''Withdrawal is the word that is used in Europe,'' she said.
     In December 2004 Britain's drug regulatory agency issued a report that warned that all SRIs ''may be associated with withdrawal'' and noted that Paxil and Effexor ''seem to be associated with a greater frequency of withdrawal reactions.'' But drug companies insist antidepressants can't cause withdrawal because they are not technically addictive. Even so, many patients who have gone through the experience say it feels like withdrawal to them. Some can't work, drive, socialize or do other everyday things for weeks. ''You just feel awful,'' said a New York children's entertainer, who asked not to be named for professional reasons. He has taken a small dose of Effexor for eight years rather than suffer through the withdrawal experience. But he said the inconvenience is worth it for the benefits the drug provided him when he needed it.
     Taking SRIs indefinitely is not an attractive option for many patients because it means putting up with unpleasant side-effects such as weight gain and sexual dysfunction. For women who want to have children it's an especially risky choice; researchers have documented withdrawal in newborns whose mothers were taking antidepressants, and some SRIs have been linked to birth defects.
     Having to keep taking Paxil makes O'Brien angry because she feels at the mercy of GlaxoSmithKline, the company that makes it. Though a GSK spokesperson said the symptoms associated with discontinuing Paxil are generally mild and manageable, in O'Brien's eyes the company is profiting by having hooked her on one of its drugs. ''If they ever did quit making Paxil, I'd be in so much trouble,'' O'Brien said. ''What really makes me mad is if I can't get off it, why am I paying them? They should be paying me.''



Is It the Drunk or the Drink Doing the Talking?
John Schwartz, New York Times- 8/6/2006

Did he mean it when he said, according to a sheriff’s report of his arrest on suspicion of drunken driving, that “The Jews are responsible for all the wars in the world”? Or when he asked the arresting deputy, “Are you a Jew?”

In the first of his serial apologies afterward — the one that did not mention the anti-Semitic nature of his rants — Mr. Gibson called what he said “despicable” and that he made statements “that I do not believe to be true.”

In a follow-up apology that dealt directly with his comments about Jews, he said, “I am in the process of understanding where those vicious words came from during that drunken display.”

So where, exactly, did those words come from? (And not just the anti-Jewish comments, but also the less-noted crude aside about the anatomy of a female officer?) Was this alcohol-fueled soliloquy an ugly insight into Mr. Gibson’s character — in other words, in vino veritas? Or was it just the tequila talking?

Science, as it happens, has been hard at work trying to understand the how and the why of what everyone at a college mixer learns: alcohol can make people do, and say, stupid things. But does it make people say things that they do not believe at all, that are, as Mr. Gibson insisted in his statements, antithetical to one’s own views and faith?

Experts generally suggest that the answer is “Nope.”

When asked where those vicious words came from, Dr. Kevin J. Corcoran, a psychology researcher who has studied the effects of alcohol on perception and judgment, replied, simply, “his mouth.”

Dr. Corcoran said comments do not spring from nothing; for example, Dr. Corcoran said, he himself would not make anti-Semitic statements under the influence of alcohol.

“I say other outrageous things when I’m drunk,” he said.

He added that Mr. Gibson “may not fully believe” his statements about Jews, “but they were waiting to be delivered,” once his inhibitions were lowered and he was subjected to the stress of being pulled over by the police.

“We all have things that we might think or feel or even be attracted to that we know are wrong,” said Dr. Corcoran, who is also the dean of arts and sciences at Northern Kentucky University. For example, he said, people are likelier to look at pornography when they drink than when they are sober; alcohol reduces inhibitions, for good or ill.

Alcohol suppresses the prefrontal cortex and the cerebellum regions of the brain, said Dr. Nora D. Volkow, the director of the National Institute on Drug Abuse, who declined to comment specifically on the Gibson case.

The cerebellum governs motor coordination, which explains the drunk’s weaving walk and iffy driving skills. The prefrontal cortex “is normally making an assessment of the appropriateness of your acts,” she said, modulating desires and urges. After a couple of drinks, Dr. Volkow said, suppressing such impulses becomes much harder.

“Alcohol brings you back into adolescence and childhood,” she said, the time before the prefrontal cortex is fully developed.

This leads to a condition that researchers call the “alcohol myopia effect,” in which someone who has had too much to drink reacts to immediate cues without regard to consequences or the broader social context. G. Alan Marlatt, director of the Addictive Behaviors Research Center at the University of Washington, said that psychologists often focus on the difference between “traits and states.” Inebriation is a temporary state, but it might unleash one’s deeper and more permanent traits, he said.

Nonetheless, Mr. Marlatt said that he had encountered people who, under the influence of alcohol and other drugs, do completely uncharacteristic things or say things that are not true. He recalled a case of a man coming out of anesthesia — alcohol is an anesthetic, after all — and babbling about having an extramarital affair, even though he apparently had done nothing of the sort. Even in this case, however, Dr. Marlatt said that he wondered whether the patient’s words sprang from a desire to have an affair, whether there had been one or not.

In Robert Louis Stevenson’s “Strange Case of Dr. Jekyll and Mr. Hyde,” Dr. Marlatt noted, the evil Hyde was no stranger to the good Dr. Jekyll; he sprang from within.

Which is why the best explanation for Mr. Gibson’s comments may come from the exquisite Italian phrase for misspeaking. Instead of saying “oops,” they say “mi è scappato.”

It means, literally, “It escaped from me.”



Home Again After Foster Care
Ofelia Casillas, Chicago Tribune- 8/6/2006

After 15 years as a ward of the state, Shantaye Wonzer had been through 16 foster homes and two residential treatment centers. She had slept on a porch in one home and in a kitchen chair at another.

So Wonzer decided to return to the family she'd been taken from as a toddler. Now Wonzer, like dozens of other former foster children, is charting a new, still undefined relationship with her birth mother, whose drug habit years ago had made Wonzer a ward of the state.

"I never thought I would be, but I'm here," said Wonzer, 18. "And I'm trying to make the best of it."

In Illinois, foster children who reach age 18 can choose whether they want to leave the system, or remain a part of it until they are 21.

The University of Chicago Chapin Hall Center for Children recently surveyed 386 such teens. One hundred and six had left the system. And of them, more than a third had returned home to live with their biological families, sometimes to the very parents who had neglected them.

Despite entering the child-welfare system because of abuse or neglect at home, most of the youths in the study had stayed in touch with their relatives. Most reported feeling close to one or more family members, particularly grandparents, siblings and biological mothers.

"It's surprising from the standpoint of general public perception and even to people in the system," said Mark Courtney, the center's director.

Kendall Marlowe, spokesman for the Illinois Department of Children and Family Services, said his agency has not "taken a systemic look at what happens to children leaving care," but he said the Chapin Hall study is "an important first step" in helping his agency to better understand these youths.

But returning home isn't necessarily a panacea, said Cook County Public Guardian Robert Harris.

"You have nostalgia of what life was like before, or what it could have been," Harris said. "Sometimes it's a rude awakening."

Many older teens--say, those home from college--struggle to balance parental support and their desire for independence. Former foster kids find that typical awkwardness multiplied by old wounds and the distance of years apart.

Longing for family
Erik Farley, 21, found a short stint living with his mother to be much different than the dreams he harbored while they were separated.

As Farley tells it, his odyssey began when his mother was working long hours, leaving him and his brothers alone.

Farley ended up with foster parents in Geneva. After they became his legal guardians, they moved to Virginia and, later, New York. But he always longed for his family in Illinois.

"You know how you look up at the moon and wonder if they are looking at the moon too? That's what I would do," Farley said. "The nights when the moon was beautiful, I'd look up and wonder if they were looking."

One month before he turned 18, Farley drove 16 hours home to his mother. But once he arrived, he longed for independence.

"I didn't have that same love that a child has for his mother because we had grown so distant," he said.

"She was my mother, and I loved her for that. She carried me for nine months. She was really strong when I was little. I respected her and loved her that she had raised me as best she could."

Tenesha Adams, 22, felt she had no option in June but to move in with her grandmother--though she soon made an even more drastic choice.

After entering foster care at age 15 because of physical abuse by her stepfather, Adams lived in shelters, a North Chicago residential facility, then an apartment on the South Side supervised by caseworkers.
She tried to keep that apartment after she left foster care but was evicted because she couldn't pay rent. In June, the Northwestern Memorial Hospital office assistant moved in with her grandmother in Gary.

The transition was difficult because Adams also has a 3-year-old daughter.

"I feel weird right now. It's an adjustment," Adams said at the time. "I didn't have a choice because I don't have anyone else that has offered."

By July, she had grown so tired of the commuting time and costs, Adams decided to move to a shelter in Chicago. She plans to move out of the shelter in November and try to find her own apartment again.

As a DCFS ward, Shantaye Wonzer estimated she lived in about 16 foster homes and two residential treatment facilities.

This spring, when another foster mother asked Wonzer to leave after three years of mounting disagreements, Wonzer decided to return home.

In late May, Wonzer, moved into her grandmother's dim North Side apartment.

When she walked inside, Wonzer found the home filled with her childhood pottery. New chocolates had been stocked in the drawers and, on a shelf as decoration, she saw a familiar stuffed rabbit in dusty, pink ballet slippers.

The objects not only reminded her of childhood but told her that her family--who had kept in touch with her through the years--hadn't forgotten her.

On a recent evening, Wonzer sat at the kitchen table between her grandmother and her 41-year-old mother, who, with her perky brown ponytail, could pass for Wonzer's sister.

Restoring relationships
Wonzer said she has forgiven her mother, a waitress, and is attempting to forge a new relationship. "I love her, but I don't like her because of everything that has happened," Wonzer said. "She is my mother, but I don't think of her as a mother. I don't look to her for motherly advice. She is kind of like a friend. But on the other hand, I don't want her to think of herself as that. Our relationship is quite complicated, actually."

Wonzer's mother, Lisa Heath, said she is also trying to strike a balance as mother and friend to the daughter she is so proud of.

Wonzer's grandmother, Judith Heath, 67, who works for American Airlines, said the years since Wonzer left feel "almost like there has been no time at all."

The grandmother and mother are helping Wonzer prepare for college--she leaves Aug. 19 for Bradley University in Peoria, where she will get both state and private scholarships. She will be the first person in the family, her grandmother believes, to attend college.

"She's our baby right now, and that's the way it should be," said Judith Heath.

"Here's our center," she said, gesturing to Wonzer, who was sitting between her mother and grandmother, "right here, with us around it."



Domestic Abuse Web Sites Offer Escape Link
Jamie Francisco, Chicago Tribune- 8/7/2006

Along with information about emergency services and shelter, the Web site of a northwest suburban agency that helps victims of domestic abuse now offers an escape button for women worried about their safety.

The button, which appears on the Web sites of Palatine-based Women In Need Growing Stronger and other agencies across the country, is intended to help victims temporarily camouflage Internet research efforts and avoid arousing the suspicion of the abusers they are attempting to flee. Click on the "ESCAPE" button on the computer screen, and the Google search page appears, providing instant cover for a woman searching the Internet for information on how to deal with abuse.

"If somebody were to come up behind them, they're at least able to escape for that moment, to show they were working on something else," said Jennifer Djordjevic, spokeswoman for WINGS, which added the escape button to its Web site in April.

Agencies that assist domestic-violence victims began adding the escape feature on their Web sites about four years ago when staff members realized that abusers were gleaning information from computer-generated Internet search histories to stalk and harass victims, said Cindy Southworth, director of technology at the National Network to End Domestic Violence. The network's escape button redirects to The Weather Channel.

In 2000, the Washington-based organization launched a campaign to educate staff of domestic-violence agencies about spyware technology, computer programs that save Web pages visited, including e-mails, Southworth said.

If installed on a personal computer, tech-savvy abusers can track the Internet habits of their victims--from e-mails to previewing bus schedules--that could clue them in on when their victim plans to leave, she said.

"All the emerging technologies, including Internet, wireless phones, electronic mail, have required that domestic violence-prevention advocates become tech-savvy," Southworth said. "We need to understand these tools so we could help victims use them and understand how perpetrators are misusing these tools."

It is not known how many Web sites of domestic-violence agencies feature an escape button, Southworth said.

She said that it probably is safer for victims to research their plans at a public location, such as a library, so their Internet search habits can't be tracked.

At home, an escape button could briefly shield them from being found out, she said. But using the button does not erase search-history information.

"The escape button is not foolproof," Southworth said. "Anything you do on the Internet can be tracked. [The button] does help if somebody walks up to you in a coffee shop, but it does not protect you if your perpetrator has access to your computer at home or has remote access because they've installed a [spyware] product and they're monitoring you from afar."

For domestic-violence victims who have computer access only at home, Southworth warns them not to change their Internet search habits, even if they discover they are being cyber-stalked. Any sudden changes in behavior could set off an abuser, she said.

"It could be lethal if all of a sudden the computer [history of visited Web sites] is cleared," Southworth said. "It could tip off the abuser that she's aware he's been monitoring her and she's potentially making plans to leave. She's more likely to be seriously injured or killed at that time than any other time."

Southworth has heard tales of victims who were tracked via global-positioning-satellite systems and of abusers who hacked into e-mail accounts to find out more information about their victims.

"Our biggest message when we talk to [the abused] is: Trust your instincts," Southworth said. "If you think your abuser knows too much about you, it's possible they do, in this electronic age."

While it is difficult to track how many domestic-violence victims have benefited from the escape button, feedback has been positive, said Rita Smith, executive director of the National Coalition Against Domestic Violence, based in Denver. "We periodically get e-mails from people thanking us for providing that resource," Smith said.



New Depression Findings Could Alter Treatments
Benedict Carey, New York Times- 8/8/2006

The results of two new studies may signal a substantial shift in the way psychiatrists and researchers think about treatment for severely depressed patients.

In one, government researchers found that an injection of a powerful anesthetic drug dissolved feelings of despair in a small group of severely depressed patients in a matter of hours, and that the effect lasted for up to a week in some participants.

Doctors cautioned that the study was very small, and that the drug, ketamine, is a tightly controlled substance sometimes used as a club drug that can cause hallucinations, confusion and dangerous reactions, especially when ingested in unknown doses.

In the other, psychiatrists in New York found evidence that antidepressant drugs significantly increased the risk that some children and adolescents would attempt or commit suicide. Doctors have debated this risk for years, but the authors of the study were skeptical of it, and their report may sway others.

Both studies are being published in The Archives of General Psychiatry.

In the first study, Dr. Carlos A. Zarate of the National Institute of Mental Health led a team of researchers who treated 18 chronically depressed men and women with the anesthetic ketamine.

Five participants recovered from depression in the first day and were still significantly improved a week later. Most patients also received a placebo treatment during the study, an injection of saline solution, and showed no improvement.

Dr. Zarate said experimenting with novel approaches was crucial because the current crop of antidepressant drugs worked slowly and weakly, if at all, for millions of patients.

Ketamine affects the brain in a way entirely different from drugs like Prozac, and it has shown some antidepressant effects in animal studies. It had not been tried for depression in humans.

“What the study tells us is that we can break this sound barrier, in effect, and get an almost immediate response that we cannot get with other drugs,” Dr. Zarate said.

Ketamine is not approved for depression, and it has a checkered past in psychiatric research. The drug often induces hallucinations, like whispering voices and light trails, and researchers used it in the 1990’s to induce psychotic reactions in people with schizophrenia — an experiment widely criticized as unethical.

Dr. Zarate said that neither doctors nor patients should use it for depression outside of carefully controlled research settings and that the results of the current trial should be considered suggestive. “This drug should be seen as a tool for understanding what mechanisms might be involved in rapid relief,” and not as a treatment, Dr. Zarate said.

The study of suicide risk, led by Dr. Mark Olfson of Columbia University and the New York State Psychiatric Institute, was based on an analysis of Medicaid records of more than 4,400 people who were hospitalized for depression in 1999 and 2000.

The researchers found no link between the antidepressant drugs and suicidal behavior in depressed patients 19 or older. But children and adolescents in the study who were taking antidepressants were about 50 percent more likely than those not on the drugs to try to kill themselves. And they were about 15 times as likely as those not on the medications to complete the act, although the number of suicides was too small to draw definitive conclusions, the authors cautioned.

In addition, there could be differences between the two groups that the Medicaid records didn’t reveal: the children who received the drugs may have been more severely ill, skewing the results, they said.

In 2004, the Food and Drug Administration required strong warnings on the labels of antidepressant drugs alerting parents and doctors of a possible suicide risk in some children. Since then many psychiatrists have been skeptical of the suicide link.

“I was surprised by what we found,” Dr. Olfson said. “I set out thinking we’d find that the drugs” significantly reduced suicide risk.

The findings may prompt researchers to look at which children are most at risk, rather than continuing to debate whether the risk exists, he said.

Direct Ads Drove 50% Rise In Use Of Sleeping Pills
Daniel Yi, Los Angles Times- 8/8/2006

Americans' growing reliance on prescription drugs to lull themselves to sleep has reignited debate about the role of commercials in influencing medical choices of patients and doctors.

Use of prescription sleeping pills is up nearly 50 percent since 2001, and a report released Monday by Consumers Union, the publisher of Consumer Reports magazine, says at least part of the increase is because of a surge of direct-to-consumer advertising of such anti-insomnia medications as Ambien and Lunesta.

Critics have long said that aggressive advertising by drug companies has resulted in rising health care costs and overuse of drugs, some of which might have dangerous side effects.

What's different now with the new generation of prescription sleeping pills, critics say, is that their marketing may be inducing people to use medications unnecessarily. For those longing for a good night's sleep, they say, other remedies, such as over-the-counter medicines or even changes in habit, might work just as well or better.

"We've always known there are people who suffer from insomnia. But what the advertising has done is make a big noise about a problem that may not have been that big of a problem," said Marvin M. Lipman, a Scarsdale, N.Y., physician and the chief medical adviser for Consumers Union. "In a sense, they've helped create the disease."

The drug industry spent more than $4 billion in consumer advertising last year, a five-fold increase in 10 years. The U.S. is among a few countries that allow consumer advertising of prescription drugs. For years, pharmaceutical advertising was directed mainly at doctors and hospitals, but in 1997, the Food and Drug Administration issued guidelines for television advertising that helped spur a boom in commercials.

Drug manufacturers say their ads are aimed at educating patients and doctors about diseases and available treatments, not necessarily to peddle their medicines.

Chris Benecchi, the product manager at Lincolnshire, Ill.-based Takeda Pharmaceuticals North America Inc., maker of sleeping medication Rozerem, said the company goes to great lengths to educate doctors about other insomnia remedies. The drug's website lists several of them, for example. It is in a link just above the moving image of a man talking in his kitchen to Abraham Lincoln and a beaver with the tagline "Your dreams miss you."

"Surveys show [consumer] advertising brings patients into their doctors' offices and helps start important doctor-patient conversations about conditions that might otherwise go undiagnosed or untreated," Ken Johnson, a senior vice president with industry trade group Pharmaceutical Research and Manufacturers of America, said in a written statement Monday. "Ultimately, it is doctors and patients together who should be making decisions on a patient's care, and to do that, they need the best information possible."

Last year, Americans filled 43 million prescriptions for sleeping pills, up from 29 million in 2001. Sanofi-Aventis' Ambien, the best-selling sleeping pill, was the 14th most prescribed drug in the U.S., according to research firm IMS Health. Ambien, approved in 1992, grew from less than $1 billion in sales in 2001 to more than $2 billion last year.

About 50 million to 70 million Americans suffer from insomnia, according to the Institute of Medicine at the National Academy of Sciences, but the causes are varied and not always clear.

Insomnia is not a disease but a set of symptoms that is mostly triggered by other things like stress, pain or jet lag. Critics say consumer drug advertising is most questionable when hawking prescription medications that treat conditions like insomnia rather than particular ailments.

By heavily promoting drugs that treat symptoms rather than illnesses, doctors say, patients may be driven to look for quick fixes instead of finding a solution. In most cases, doctors say, sleeping pills should be the last resort. But for many insomnia sufferers, that's the first thing they ask for when they enter a doctor's office.

"When you see a commercial with the sun breaking over the hill and curtains opening and people with big grins on their faces and butterflies flying all around, sleeping pills become the treatment of first choice," said Lloyd Van Winkle, a family physician in Castroville, Texas.

By contrast, ads for cholesterol-lowering drugs such as Pfizer Inc.'s Lipitor or AstraZeneca's Crestor are unlikely to drive someone without a cholesterol problem to request a prescription from a doctor. That's because someone either has high cholesterol or not. Doctors also credit advertising about cholesterol-lowering drugs with driving many people to check their cholesterol levels.

Advertising can also promote the use of expensive prescription drugs by otherwise healthy people, critics say. Some users of Pfizer's Viagra and other drugs to treat erectile dysfunction are taking them simply to facilitate certain lifestyles.

Doctors, the ultimate gatekeepers, are often too busy to argue with forceful patients or to spend much time diagnosing conditions that aren't life-threatening such as insomnia, medical experts said.


Depressed Brain Can Be `Primed'
Susan Brink, Los Angeles Times- 8/8/2006

Before the antidepressant ever gets swallowed, before it dissolves and makes its way through the bloodstream and deep within the gray matter of the brain, some depressed patients start feeling better because they think they will. Experiments have shown that healing from depression starts in some people, called placebo responders, even when the drug given is just a sugar pill.

That, of course, is not enough to completely cure depression. But if a placebo can trick the brain into starting to get better, it's actually a pretty good predictor of who will continue to improve with antidepressant treatment. A new study released last week in the American Journal of Psychiatry shows that the placebo effect may provide a head start for actual drug treatment by beginning to change the brain pathways that antidepressants will then follow.

The finding is an important step in helping scientists further refine who might be helped by drugs and what other factors might be involved in helping depressed patients get better.

The setting most likely matters too. Feeling free to talk openly about how he felt, along with a belief that he was going to be helped, set Chuck Park, 32, of Culver City on a path to healing. He was a participant in the 51-person study and one of 26 volunteers who received a placebo for the entire nine weeks of the trial. Another 25 volunteers received antidepressants for eight of the nine weeks. "After a few weeks, I started to feel a little better," he says. "The nurse, Michelle, would ask me how I was feeling, and I knew it wasn't just a superficial question. I could really tell her."

Activity measured by electroencephalogram in an area of the brain that is especially active in depressed patients, called the dorsolateral prefrontal cortex, slows down in some people shortly after they begin getting a placebo. The slowdown is not enough to overcome depression, but those people whose brains responded to sugar pills ended up also responding to antidepressants in the new study. And Park, who improved slightly on a placebo, saw his depression lift completely after the trial ended and he started taking antidepressants.

"It's a very dramatic and clear example demonstrating that medication itself isn't the whole story," says Aimee M. Hunter, UCLA psychologist and lead author of the study. "If there is an actual formula or recipe for getting better, it may include medication, but it's very clear that it includes other factors or ingredients."

The placebo response, as the study measured it, appears to be a significant ingredient. Researchers attributed about 19% of the mood improvements measured on a depression scale after the trial to the placebo effect.

Psychiatric research is different from other kinds of medical research in that almost all depressed patients are given a placebo for about a week before the trial starts. Called the placebo lead-in, it is done to clear the body of other medications the patient might have been taking, but it is also done to get people used to filling out forms measuring their feelings and to allow them to meet the doctors and nurses who will be working with them. "Psychiatric studies are a lot more personal," says Dr. Andrew Leuchter, director of the laboratory of brain, behavior and pharmacology at UCLA.

"This is the first study to look at succession," Leuchter says. "There are brain changes due to placebo, and changes due to the medication."

But that still leaves 81% of the formula predicting treatment success yet to be sorted out. A patient's beliefs, hopes, expectations and relationship with the doctor might also play a role.

Leuchter is part of a team of researchers in 10 centers throughout the country who are beginning to further sort out the elements that go into treating depression. They will study 300 patients to see if they can use similar EEG testing to predict which patients will do well on specific antidepressants.

There are about 20 antidepressants available by prescription, and patients can fail on several before finding one that works. In fact, a National Institute of Mental Health sponsored study of 4,000 patients found that only about half of depressed patients got relief from their symptoms following a first round of treatment with either an antidepressant or talk therapy.

"Right now, trial and error is the rule, and it can take months to find the right medication," says Leuchter.

The new study he's involved with, called the Biomarkers for Rapid Identification of Treatment Effective in Major Depression trial, will look at brain changes following one week of treatment with any one of a number of antidepressants. That won't be enough time for the drugs to work clinically, but researchers will be looking for early brain changes. Volunteers will again be tested with EEGs after about three months of treatment. "We can look at early EEG changes to see if any of those changes predict how they did later," he says.

If early brain changes can alert physicians to patients who are on the right track for treatment, Leuchter says, it could cut down on the time needed to find the right drug for the right patient. "We're hoping that within three years, this might be a test available in doctors' offices," he says.

It's not just the right drug, either, that has yet to be sorted out. Depression is complicated and the NIMH is conducting a seven-year study, called the Sequenced Treatment Alternatives to Relieve Depression, to determine the effectiveness of various treatments, including drugs and psychotherapy and combinations of both.

"We know from other studies that psychotherapy also causes certain brain changes," Leuchter says. "I believe that engagement with physicians and attention is a form of supportive therapy."

It could be, he says, that just as drugs, placebo and talk therapy can change the brain's circuitry, so can wanting to get better, believing one will get better, or hearing a physician say there is great hope that you'll get better.