psychiatry

The issues of antidepressant-associated suicide has become front-page news, the result of an analysis suggesting a link between medication use and suicidal ideation among children, adolescents, a link between medication use and suicidal ideation among children, adolescents, and adults up to age 24 in short term (4 to 16 weeks), placebo-controlled trials of nine newer antidepressant drugs. The data from trials involving more than 4.4(K) patients suggested that the average risk of suicidal thinking or behavior (suicidality) during the first few months of treatment in those receiving antidepressants was 4 percent, twice the placebo risk of 2 percent. No suicides occured in these trials. The analysis also showed no increase in suicide risk among the 25 to 65 age group. Antidepressants reduced suicidality among those over age 65. Following public hearings on the subject, in October 2004, the FDA requested the addition of __lack box_ warnings__he most serious warning placed on the labeling of a prescription medication__o all antidepressant drugs, old and new.

Psychotropic drugs have also been organized according to structure (e.g., tricyclic), mechanism (e.g., monoamine, oxidase inhibitor [MAOI]), history (first generation, traditional), uniqueness (e.g., atypical), or indication (e.g., antidepressant). A further problem is that many drugs used to treat medical and neurological conditions are routinely used to treat psychiatric disorders.

I can't see the logic in medicating a grieving person like there was something wrong with her, and yet it happens all the time... you go to the doctor with symptoms of profound grief and they push an antidepressant at you. We need to walk through our grief, not medicate it and shove it under the carpet like it wasn't there.

What I do know is that when a person is first asked to explain what is wrong, they may find it almost impossible to articulate exactly what the problem is. They may not yet have matched words to the feelings they can sense in the hidden rooms of their mind. They may still have no clear ideas about the "what", "why" or "how" relating to the origins of their difficulties. Instead of words, their angst may be expressed in behaviour which may be hard for them, or anyone else, to make sense of and can manifest itself as irritability, anger or withdrawal. Sometimes they will delay seeking help until they are in a state of crisis. It's not easy to ask; I struggled at first, too.

Perhaps my depression coincided with the start of every academic year and the subsequent increase in my workload. Or maybe there was a more biological explanation linked to the fact that I, like many people with depressed mood, find the absence of light at these latitudes intolerable in the winter months. I didn't know the answer - I still don't. This is who I am. I cope most of the time; I am well for months, sometimes even for more than a year; but there are recurring periods in my life when the world seems a darker, more hostile and unforgiving place. I am a person who gets depressed.

Yet, I believe that my experience of depression has helped me to be a more humane and understanding therapist. Psychiatrists get depressed too, more often than other doctors. Being an expert in depression doesn't confer any immunity from it and I am aware that I don't have all the answers.

Macbeth: How does your patient, doctor?Doctor: Not so sick, my lord, as she is troubled with thick-coming fancies that keep her from rest.Macbeth: Cure her of that! Canst thou not minister to a mind diseased, pluck from the memory a rooted sorrow, raze out the written troubles of the brain, and with some sweet oblivious antidote cleanse the stuffed bosom of that perilous stuff which weighs upon her heart.Doctor: Therein the patient must minister to himself.

You see, people in the depressive position are often stigmatised as __ailures' or __osers'. Of course, nothing could be further from the truth. If these people are in the depressive position, it is most probably because they have tried too hard or taken on too much, so hard and so much that they have made themselves __ll with depression'. In other words, if these people are in the depressive position, it is because their world was simply not good enough for them. They wanted more, they wanted better, and they wanted different, not just for themselves, but for all those around them. So if they are failures or losers, this is only because they set the bar far too high. They could have swept everything under the carpet and pretended, as many people do, that all is for the best in the best of possible worlds. But unlike many people, they had the honesty and the strength to admit that something was amiss, that something was not quite right. So rather than being failures or losers, they are just the opposite: they are ambitious, they are truthful, and they are courageous. And that is precisely why they got __ll'. To make them believe that they are suffering from some chemical imbalance in the brain and that their recovery depends solely or even mostly on popping pills is to do them a great disfavour: it is to deny them the precious opportunity not only to identify and address important life problems, but also to develop a deeper and more refined appreciation of themselves and of the world around them__nd therefore to deny them the opportunity to fulfil their highest potential as human beings.

Talking about one's feelings defeats the purpose of having those feelings. Once you try to put the human experience into words, it becomes little more than a spectator sport. Everything must have a cause, and a name. Every random thought must have a root in something else.

I don't hold with shamans, witch doctors, or psychiatrists. Shakespeare, Tolstoy, or even Dickens, understood more about the human condition than ever occurred to any of you. You overrated bunch of charlatans deal with the grammar of human problems, and the writers I've mentioned with the essence.

Of course. A new consciousness - I that that is the word,' said the old man after he had thought a moment. 'That is what I hope it is. You and your African and Colombian, you are speaking the same language now, you know the same ideas. You are conscious that life on earth is flux. Men are better educated. They are more disciplined than in the past - their schedules are harder, their lives move faster, efficiency digs into them. Men are more sophisticated -every day they have more alternatives to choose among than they can possibly exhaust. Through psychiatry they know their strengths and weaknesses. They know the risks of every choice. This is what I mean by consciousness. Men know so much about everything they do. It was much simpler when they didn't know, when they simply acted out of instinct, believed from instinct, loved from instinct, brought up children by their instincts. Perhaps people were even happier. But now we are more conscious. We have got to live with our greater knowledge. We have got to live with our greater freedom.

In 1949, neurologist Egas Moniz (1874-1955) received a Nobel Prize for his discovery of __he therapeutic value of leucotomy in certain psychoses_. Today, prefrontal leucotomy is derided as a barbaric treatment from a much darker age, and it is to be hoped that, one day, so too might antipsychotic drugs.

Rather than being medicalized or romanticized, mental disorders, or mental dis-eases, should be understood as nothing less or more than what they are, an expression of our deepest human nature. By recognizing their traits in ourselves and reflecting upon them, we may be able both to contain them and to put them to good use. This is, no doubt, the highest form of genius.

You want to be happy? You want to be well? Then put your boots on.

It takes two to tango_ isn__ even true on the dance floor. One person can do a lot of evil all on his or her own. But the Theory of Mutual Blame arose sometime before Doc was even born. Perhaps it was a takeoff on Freud__ seduction theory or the more generic practice of blaming victims for being alive. Its origins were unclear, but no one had ever had to take full responsibility for their own actions since.

Philosophy is to religion as psychoanalysis is to pseudoscience

You tell them one real thing and then the doctor thinks he knows you. He starts getting arrogant and overfamiliar, making insulting suggestions left and right. You have to protest constantly just to set the record straight. Finally he makes offensive assumptions and throws them in your face. A stranger in a bar could do the same_

The old joke is that psychiatrists are doctors who can't stand the sight of blood. Maybe they can't stand it, but if they work where I work, they damn well better get used to it.At least surgeons and prizefighters get to wear gloves