Wearing green for May is Mental Health Month

To the editor:

As we finally emerge from the cold dark winter our thoughts turn to spring – and green. Not the green from our grass or the leaves on the tree, but to mental health. May is Mental Health Awareness Month and green is the color being used to symbolize awareness.

Mental health is a continuum, from having very good mental health to having a serious mental illness. Good mental health means being able to learn, express a range of emotions, form and maintain good relationships and cope with change and uncertainty.

Like any health care condition, it’s good to identify symptoms early and seek treatment. Mental illnesses disrupt a person’s thinking, feeling, mood, ability to relate to others, and daily functioning. One in four adults and one in five children live with a mental illness.

Promoting good mental health, learning how to deal with stress can help, but making sure a mental illness is identified and treated early may prevent it from becoming more serious. It is also important to recognize that mental illnesses are treatable medical conditions, and with proper treatment people can and do recover.

Unfortunately, people aren’t comfortable talking about mental health or mental illnesses. There is a cloak of silence around it. During the month of May we encourage people to talk about it. You can help raise awareness by wearing green – paint your nails, wear green clothing, put on a green ribbon – and then when people ask why, share information with them about mental health. You can direct people to the Make It OK campaign or the NAMI Minnesota website to learn more about mental illnesses, how to talk about them and how to request a speaker.

Every time someone talks about mental illnesses we take another brick off that wall of silence. So celebrate May this year by promoting mental health and talking about mental illnesses. It’s OK to talk about it! Help end the silence that discourages people from seeking help.

Sue Abderholden
Executive director of the National Alliance on Mental Illness of Minnesota

  • I’m somewhat concerned about treatment options. I’m of the opinion that psychotropic drugs are over-prescribed. I believe their efficacy is overstated, and the risks understated.

    It’s especially challenging to track and record the cases that medication has done more harm than good. For instance, on NAMI’s web site, under Medications -> Paxil -> common side effects:

    – Feeling nervous, restless, fatigued, sleepy or having trouble sleeping (insomnia)

    Those symptoms can cause depression, or are symptoms of depression. I believe that doctors who are qualified to prescribe SSRI or SNRI class medications do not have the tools necessary to, in many cases, make a clear, science-based distinction between cause and effect. This isn’t their fault of course. The technology, medical or otherwise, simply isn’t available. This isn’t true for all situations of course, if a doctor does a thorough job of documenting case history and listens carefully, there are sometimes obvious signals that help define and distinguish how a medication might be negatively impacting an individual

    on NAMI’s web site, under Medications -> Paxil -> serious side effects:

    Serotonin syndrome (symptoms may include shivering, diarrhea, confusion,
    severe muscle tightness, fever, seizures, and death), seizure

    If death is included as a side effect, how do the risks outweigh the benefits? Would there be sufficient warning signs before that happened? One big problem, for both patients and their doctors, is that many people who suffer from mental illness don’t have a good support system, and the suggestion that people who start on any new medication should be monitored closely is a very unrealistic expectation.

    Again, from NAMI’s web site, under Medications -> Paxil -> summary of black box warning.

    Summary of Black Box Warnings

    Suicidal Thoughts or Actions in Children and Adults

    – Depression and certain other psychiatric disorders are themselves associated with increases in the risk of suicide.

    – Patients with major depressive disorder (MDD), both adult and
    pediatric, may experience worsening of their depression and/or the
    emergence of suicidal
    ideation and behavior (suicidality) or unusual changes in behavior,
    whether or not they are taking antidepressant medications. This risk may
    persist until
    significant remission occurs.

    – In short-term studies, antidepressants increased the risk of
    suicidality in children, adolescents, and young adults when compared to
    placebo. Short-term
    studies did not show an increase in the risk of suicidality with antidepressants compared to placebo in adults beyond age 24. Adults age 65 and
    older taking antidepressants have a decreased risk of suicidality.

    – Patients, their families, and caregivers should be alert to the
    emergence of anxiety, restlessness, irritability, aggressiveness and
    insomnia. If these
    symptoms emerge, they should be reported to the patient’s prescriber or
    healthcare professional.

    – All patients being treated with antidepressants for any indication
    should watch for and notify their healthcare provider for worsening
    suicidality and unusual changes in behavior, especially during the
    first few months of treatment.

    Now this goes back to my previous point about the challenge of tracking and recording the number of people harmed. If someone who is being treated for severe depression and suicial thoughts starts a medication and it causes him to commit suicide, will there ever be an investigation to determine how much the medication played a role? Is it even possible to make that determination through available scientific means?

    There are many sites and blogs of people talking about both positive and negative experiences they’ve had with treatment involving medication. However, it seems that anecdotal “evidence” is often dismissed; but if doctors aren’t required to document every relevant piece of data, and then submitted to a “centralized-database” where it can be comprehensively analyzed, then it becomes very easy to dismiss the anecdotal evidence and say there’s no scientific evidence.

    I first sought treatment when I was about 20 years old, circa 1992. I first had thoughts of suicide 3 years after my father committed suicide when I was 11. At the time when I went to get treatment, it was because my employer suggested it, and I wasn’t against the idea. I’d been having problems getting to work on time. I was doing a great job while I was at work, but my attendance was suffering. I was giving a 566 question test, and after two session I was prescribed Prozac and Stelazine and Cogentin.

    I’d never had any suicide attempts, and I really believe I could have benefitted from CBT, DBT, and meditation as a first line defense. I understand that doctors base their treatment plans on the available information at the time, so I don’t always “blame” the doctors, but that type of quick-script is still going on, as far as I can tell from what I read, and my most recent experience with someone from the mental health field.

    I did have my first suicide attempt within two years after getting treatment. Of course I can’t say whether or not it would have happened if I’d never been on an SSRI. I only know prior to getting treatment I felt better.

    The NAMI site does have a mindfulness page, which I think is great. But near the top:

    While the combination of therapy and medication is crucial to recovery,
    the addition of self-awareness tools and skills can also be beneficial.
    Whether you are just beginning your recovery or are further along on
    your journey, the holistic practices discussed on this page can be an
    excellent compliment to therapy and medication.

    Medication is crucial to recovery? Isn’t that statement a bit general? People get depressed and stressed and anxious and those are natural human reactions, but often these days it seems that if one has those “symptoms” one is quickly diagnosed with having a mental illness.

    I’ll concede that some people don’t deal with those problems as well as others. But I also think many people never learned coping skills and stress management as well as others, and therefore are more “susceptible” to not being able to deal with problems as efficiently as others. But people are able to learn those tools, though it may be harder if one didn’t learn them during their formative years or their adolescence, the risks of learning outweigh the benefits.

    My father committed suicide in 1981. He didn’t have any history of suicide attempts. Shortly before he shot himself, he saw a doctor because he was had some pretty bad insomnia. Some extra life stressors were going on at the time. He was prescribed Restorial, a benzodiazopene.

    From a wikipedia page about benzos:

    […] Depression and disinhibition may emerge. […]

    Paradoxical reactions, such as increased seizures in epileptics,
    aggression, violence, impulsivity, irritability and suicidal behavior
    sometimes occur. […]

    Again, no proof can ever be obtained if the medication caused negative side effects, and I’m likely to be labeled as a scientologist because I have bad things to say about medication. Sweet deal for billion-dollar corporations. I’m glad I never thought of it. I’m curious though, are there any medications that were proved to be safe, only to be recalled later, after people have died or suffered permanent physical damage?

    This article is on the LaTimes web site:

    Feb 18, 2014

    New test suggests antidepressant Paxil may promote breast cancer

    By Melissa Healy

    In a trial screening of 446 drugs in wide circulation, the new assay
    singled out the popular antidepressant paroxetine (better known by its
    commercial name, Paxil) as having a weak estrogenic effect that could
    promote the development and growth of breast tumors in women.

    This is important because as many as a quarter of women being treated for
    breast cancer suffer from depression — a condition most commonly
    treated with antidepressants known as SSRIs (selective serotonin
    reuptake inhibitors), including Paxil, which has been on the market
    since 1992. Almost a quarter of American women in their 40s and 50s are
    taking an antidepressant, mostly SSRIs.[…]

    Paxil (or Paroxetine) is a drug I’ve used for example in this comment, but many SSRI and SNRI share common side effects, serious or otherwise. There’s no reason to single out Paxil. In Alison Bass’s book, Side Effects, she focuses on Paxil but also touches on Prozac. It’s an excellent read, well-written by a former reporter with the Boston Globe.