Ptsd

[N.E.wguy]

Acknowledgments
All coauthors of the article have extensive contemporary battlefield experience and mutually participated in the conceptualization, development, and implementation of the joint theater trauma system.

Discussion
Dr. Donald D. Trunkey (Portland, Oregon): I think this article is very encouraging, because I think there has been a major change since Desert Storm. I believe, though, there are still some unsolved problems. I would like to have your comments. Has the military looked at how effective the civilian trauma training is for those who are in the active military?

My sense is it has been very positive. However, there may be another problem. At least a majority of the surgeons and anesthesiologists that come into the military from the reserve are not getting the same type of training, and their skills may not be equal to what you’re being able to maintain in the active duty.

This becomes a further problem if you look at the other needs within the United States. Not only do we have to provide training for the reserves but then we have the DMAT (Disaster Medical Assistance Teams) and we have Homeland Security needs.

It seems to me that if we had the vision, we could put together a system that integrates all of these needs. I think we should have a pool of highly trained surgeons, anesthesiologists, and nurses who could solve all of these needs. By increasing by one-third the manpower in Level I trauma centers, we would create a “reserve pool.”

Who pays for this? Well, I would argue that the military is already wasting some money with STRAP programs in order to attract people into the military. If you pooled these dollars and you got Health and Human Services and Homeland Security to put in some dollars, we could then have this reserve pool. It would be very similar to what the airline pilots do. They can get called back into active duty at any time. The airlines cooperate with this program. Similarly, if you had surgeons and anesthesiologists and nurses working in civilian trauma centers, you could pull out maybe up to a third at any given time to solve some of these needs.

The other thing that I identified, at least after Desert Storm, is that in military hospitals, critical care was being done by nonsurgeons. Maybe that’s the model we should adopt; I, personally, don’t think so, but I’d like your opinion about that, as well.

I was very encouraged by some of the things that you’re doing from a system standpoint, and it is so logical to use the American College of Surgeons system’s approach in the military.

Finally, I’m going to ask you a question you won’t probably want to answer, but is this now the time that we should reconsider the purple suit? It seems to me the Surgeons General are now cooperating, and should we have a pool of surgeons who belong to really no branch but could be dispatched or placed anywhere in the world and fulfill what the military sees as their role.

Dr. Donald Jenkins (San Antonio, Texas): I think that the judgment would be that the civilian trauma center experience has been effective. Certainly, the opinion polls taken of those surgeons who have been through that site, the nurses and the medics, have gained tremendous amounts of hands-on experience they didn’t otherwise get the opportunity to have.

They felt much more confident. I think that there is some clinical success that you see there in the first engagements that we have data for. As far as critical care, that’s what we see as being the difference. I wasn’t in Vietnam, but I judge that the ward that we have in that field hospital doesn’t look a lot different. The difference in lives saved, I think, is over in the critical care end of that.

What can’t be overlooked is the Air Force role in critical care air transport, where you could take a fellow with a damage control operation, triple amputation arriving with a blood pressure of 60, have a lifesaving damage control operation, three times in less than 40 hours: once in Iraq, once in Germany, and once in Walter Reed, and that kid then, 6 months later, is getting married, and walking without assistance on his prostheses. It is a tremendous success story.

So, I think critical care is definitely the way to go. As far as the purple suit idea goes, that would sort of be a Department of Defense level question that you know I’m not going to answer. But I will tell you this, I worked side-by-side with my Army colleagues at this hospital. That team up there was made of Australian neurosurgeons and Air Force general surgeons and Army nurses and British nurses, and we were about as close to a purple suit operation, I think, as you can get there in some of those facilities. So, I think there is merit to that, Sir.

Dr. Sheldon Brotman (Pittsfield, Massachusetts): You say that you have a PI program. I’d like to know how you’re closing loops. Let’s say you’ve got a triage problem with a certain unit. How do you get back to these people and how are you able to effectively monitor your problems?

Dr. Donald Jenkins (San Antonio, Texas): That is a 24/7 endeavor. We have one trauma nurse at each one of those Level III facilities. Their responsibility is to provide feedback down to those Level II institutions, as well as forward to the Level IV institutions.

We just held, for the first time, a three-continent performance improvement conference out of Iraq last week via the telephone with folks in San Antonio, folks in Germany, folks in Washington, DC, and folks down in Iraq, all on the phone together talking about some of those patients. So, it’s old fashioned hard work, stubby pencil, see the problem, come up with a solution set for that problem, call those folks forward. It’s done on a regular basis. Lowell Chambers, down at Level II, I think, would be the first to say that it’s in evolution, but it does work. Captain DeNobile (USN) and Colonel Flaherty are in Iraq actually working on this today.

Dr. David G. Burris (Bethesda, Maryland): For Don Trunkey’s question, it was very interesting a year and a half ago, when a Tri-Service trauma surgeon group sat down and said, “What we need in theater is this kind of a guy” (a Theater Trauma Consultant). For that group to suggest that a “blue guy” (Air Force) suddenly go into a “green slot” (Army) in theater to make this happen shows that we are functioning as a purple suit, but maybe are not wearing a purple suit.

Don, some people ask me, “What does purple suit mean?” So, if you would define that, and second, you mentioned the levels of care, and you mentioned “The Gold Book.” Please discuss that a little bit because there is not a one-to-one correlation between Gold Book levels of care and military levels of care. I think that might be confusing for people, so I appreciate your discussion of that.

Dr. Donald Jenkins (San Antonio, Texas): The purple suit idea is that instead of each of the services having their own medical corps (with the Navy serving not only the Navy but also the Marine Corps), you had one medical service that was joint, you could tap into that pool and they would go to any kind of engagement regardless of the troops that would be involved. I’m currently wearing pretty close to a purple suit. I’ve got this little Army medical department badge up here that was put on me by the Army Surgeon General; I speak a lot of Army now.

To answer the Army levels of care question, those ordinals are inverse from what we would consider in the United States. A Level I trauma center in the United States is a Level V facility for the U.S. military. That’s the burn center in San Antonio or Walter Reed Army Medical Center. These Level III facilities that we’re talking about are more robust than Level III facilities, I think, that you would find here in the U.S. system of things. It’s somewhere between a II and a III with, again, 6 or 8 operating beds, 40 to 100 ward beds, half a dozen to 25 ICU beds at those places, with all the surgical capabilities.

Dr. Gregory Beilman (Minneapolis, Minnesota): Just a quick question. I noticed in my experience there that 70% to 80% of the patients we’re caring for are Iraqis, Iraqi soldiers, MOI, and so on. How are you tracking outcomes with those patients compared to our soldiers?

Dr. Donald Jenkins (San Antonio, Texas): Yes, the local Iraqi population is a difficult endeavor to track down those outcomes. Things change over time, and we had the great luxury of being able to keep our patients for as long as they needed to be kept and see them back in follow-up.

Some of that is changing today, so it does represent a significant challenge for us. If those patients are transferred out of that hospital today, you lose that follow-up on those individuals. The JTTR has the charts and will be entering the data of these Iraqi patients. Across the theater, 60% or more of all admitted casualties are non-U.S. casualties; these patients will all eventually be captured in the JTTR.

Dr. Erwin F. Hirsch (Boston, Massachusetts): After the debriefings that occurred in the aftermath of Operation Desert Shield/Desert Storm, many questioned the ability of the Armed Forces to prepare its Medical Services in the care of combat casualties. I stand here to congratulate the authors of this article plus everybody else involved since the beginning of this operation, not only for the excellence in patient care, but in addition for the development of this system, which we in the civilian community should look at very seriously. I think very soon the paradigm that the civilians are training the military is going to change and that military lessons learned will apply to the care of nonmilitary patients.

 

[4u2sm0ke]

:48:

 

[happydaze]

yeah brother, props for the thoughfulness and length of your input regarding ptsd.

 

[N.E.wguy]

Thanks guys!

 

[N.E.wguy]

WORST things to say to someone who is depressed

Some people trivialize depression (often unintentionally) by dropping a platitude on a depressed person as if that is the one thing they needed to hear.Some people trivialize depression (often unintentionally) by dropping a platitude on a depressed person as if that is the one thing they needed to hear. While some of these thoughts have been helpful to some people (for example, some find that praying is very helpful), the context in which they are often said mitigates any intended benefit to the hearer. Platitudes don't cure depression.

Here is the list from contributors to ask:

0. "What's your problem?"

1. "Will you stop that constant whining? What makes you think that anyone cares?"

2. "Have you gotten tired yet of all this me-me-me stuff?"

3. "You just need to give yourself a kick in the rear."

4. "But it's all in your mind."

5. "I thought you were stronger than that."

6. "No one ever said life was fair."

7. "As you get stronger you won't have to wallow in it as much."

8. "Pull yourself up by your bootstraps."

9. "Do you feel better now?" (Usually said following a five minute conversation in which the speaker has asked me "what's wrong?" and "would you like to talk about it?" with the best of intentions, but absolutely no understanding of depression as anything but an irrational sadness.)

10. "Why don't you just grow up?"

11. "Stop feeling sorry for yourself."

12. "There are a lot of people worse off than you."

13. "You have it so good, why aren't you happy?"

14. "It's a beautiful day!"

15. "You have so many things to be thankful for, why are you depressed?"

16. "What do you have to be depressed about."

17. "Happiness is a choice."

18. "You think you've got problems..."

19. "Well at least it's not that bad."

20. "Maybe you should take vitamins for your stress."

21. "There is always somebody worse off than you are."

22. "Lighten up!"

23. "You should get off all those pills."

24. "You are what you think."

25. "Cheer up!"

26. "You're always feeling sorry for yourself."

27. "Why can't you just be normal?"

28. "Things aren't *that* bad, are they?"

29. "Have you been praying/reading the Bible?"

30. "You need to get out more."

31. "We have to get together some time." [Yeah, right!]

32. "Get a grip!"

33. "Most folks are about as happy as they make up their minds to be."

34. "Take a hot bath. That's what I always do when I'm upset."

35. "Well, everyone gets depressed sometimes!"

36. "Get a job!"

37. "Smile and the world smiles with you, cry and you cry alone."

38. "You don't look depressed!"

39. "You're so selfish!"

40. "You never think of anyone but yourself."

41. "You're just looking for attention."

42. "Have you got PMS?"

43. "You'll be a better person because of it!"

44. "Everybody has a bad day now and then."

45. "You should buy nicer clothes to wear."

46. "You catch more flies with honey than with vinegar."

47. "Why don't you smile more?"

48. "A person your age should be having the time of your life."

49. "The only one you're hurting is yourself."

50. "You can do anything you want if you just set your mind to it."

51. "This is a place of business, not a hospital." (after confiding to supervisor about my depression)

52. "Depression is a symptom of your sin against God."

53. "You brought it on yourself"

54. "You can make the choice for depression and its effects, or against depression, it's all in your hands."

55. "Get off your rear and do something." -or- "Just do it!"

56. "Why should I care?"

57. "Snap out of it, will you?"

58. "You want to feel this way."

59. "You have no reason to feel this way."

60. "Its your own fault."

61. "That which does not kill us makes us stronger."

62. "You're always worried about *your* problems."

63. "Your problems aren't that big."

64. "What are you worried about? You should be fine."

65. "Just don't think about it."

66. "Go Away."

67. "You don't have the ability to do it."

68. "Just wait a few weeks, it'll be over soon."

69. "Go out and have some fun!"

70. "You're making me depressed as well..."

71. "I just want to help you."

72. "The world out there is not that bad..."

73. "Just try a little harder!"

74. "Believe me, I know how you feel. I was depressed once for several days."

75. "You need a boy/girl-friend."

76. "You need a hobby."

77. "Just pull yourself together"

78. "You'd feel better if you went to church"

79. "I think your depression is a way of punishing us." &emdash;My mother

80. "Shut up or get off the pot."

81. "So, you're depressed. Aren't you always?"

82. "What you need is some real tragedy in your life to give you perspective."

83. "You're a writer, aren't you? Just think of all the good material you're getting out of this."

84. This one is best executed with an evangelical-style handshake, i.e., one of my hands is imprisoned by two belonging to a beefy person who thinks he has a lot more charisma than I do: "Our thoughts and prayers are with you." This has actually happened to me. Bitten-back response: "Who are 'our'? And don't do me any favors, schmuck."

85. "Have you tried chamomile tea?"

86. "So, you're depressed. Aren't you always?"

87. "You will be ok, just hang in there, it will pass." "This too shall pass." --Ann Landers

88. "Oh, perk up!"

89. "Try not being so depressed."

90. "Quit whining. Go out and help people and you won't have time to brood..."

91. "Go out and get some fresh air... that always makes me feel better."

92. "You have to take up your bed and carry on."

93. "Why don't you give up going to these quacks (i.e., doctors) and throw out those pills, then you'll feel better."

94. "Well, we all have our cross to bear."

95. "You should join band or chorus or something. That way you won't be thinking about yourself so much."

96. "You change your mind."

97. "You're useless."

98. "Nobody is responsible for your depression."

99. "You don't like feeling that way? So, change it."

Compiled by [email protected]*com.

 

[N.E.wguy]

Best Things to Say to Someone Who Is Depressed

It is most tempting, when you find out someone is depressed, to attempt to immediately fix the problem. However, until the depressed person has given you permission to be their therapist (as a friend or professional), the following responses are more likely to help the depressed.

The things that didn't make me feel worse are words which 1) acknowledge my depression for what it is (Not 'it's just a phase') 2) give me permission to feel depressed (Not 'but why should you be sad?')

1. "I love you!"

2. "I care"

3. "You're not alone in this"

4. "I'm not going to leave/abandon you"

5. "Do you want a hug?"

6. "I love you (if you mean it)."

7. "It will pass, we can ride it out together."

8. "When all this is over, I'll still be here (if you mean it) and so will you."

9. "Don't say anything, just hold my hand and listen while I cry."

10. "All I want to do know is give you a hug and a shoulder to cry on.."

11. "Hey, you're not crazy!"

12. "May the strength of the past reflect in your future."

13. "God does not play dice with the universe." --A. Einstein

14. "A miracle is simply a do-it-yourself project." --S. Leek

15. "We are not primarily on earth to see through one another, but to see one another through" - (from someone's sig.)

16. "If the human brain were simple enough to understand, we'd be too simple to understand it." --a codeveloper of Prozac, quoted from "Listening to Prozac"

17. "You have so many extraordinary gifts; how can you expect to live an ordinary life?" --from the movie "Little Women" (Marmee to Jo)

18. "I understand your pain and I empathize."

19. "I'm sorry you're in so much pain. I am not going to leave you. I am going to take care of myself so you don't need to worry that your pain might hurt me."

20. "I listen to you talk about it, and I can't imagine what it's like for you. I just can't imagine how hard it must be."

21. "I can't really fully understand what you are feeling, but I can offer my compassion."

22. "You are important to me."

23. "If you need a friend..... (and mean it)"

Compiled by [email protected].

 

[N.E.wguy]

got a new set of xrays today

 

[Dr. Green Fang]

Bah crazy! There's nothing they can do to get that out then obviously, eh?

 

[N.E.wguy]

at the time saving my life was all they cared about, leaving them in was the last thing they cared about 1 in a 100k for surgey alone would of lived.. they called me a miricale walked out of the hospital in 10 days on my own... was up off life support walking in 4 days ripped my feeder tube out threw my nose i wanted out so bad they had to pput it back in was like when arnold removed that tumor thing in total recal

don't know in process of diagnosing chronic chest pains at heart location obviously one of these could be the culprit, lots of tests coming up hoping for a solution even if it means surgery...

 

[N.E.wguy]

here are a few more

 

[Hushpuppy]

I have a close friend that has high anxiety disorder that is genetic on his father's side of the family. It turned all of the men and several of the women in his father's family and 2 of his kids(one being my friend) into alcoholics. I helped him work through the worst of it a few years ago when he was suffering with severe panic attacks.

He was so afraid that he was going in circles and pulling me down with him. I told him that this was an ailement like any disease(rather than just "being crazy") and that we could get him through it. He told me that he kept rehashing stuff to me, so I told him as long as he had an itch, we would keep scratching it until we could make it smaller and lesser of an itch. It took 2 years of "talk therapy" as that was all I could offer to get him through it.

I watched this guy go for as many as 4-5 days without more than a couple hours of sleep over the whole period of what we called "episodes" of panic attack. I discovered that I could actually help him sleep by talking to him so that he could focus on my voice rather than the voices of panic and distress in his head. That would allow him to fall asleep for a few more hours. I now supply him with free smoke as that helps him to destress in the evenings and not drink as much. I wish I was growing back then, it would have made such a difference for him.

 

[N.E.wguy]

Your a good guy to do all that! that's all it can take is as little as an ear and some smoke to save a life people just gotta know what to look for and not to say to help prevent it.

I have the same issues, it at time feels like you are insane and no one can understand the things in your head it's unimaginable tbh...
He told me that very few people confront PTSD, most hide from it and the ones that do try to confront it last no more then 10 weeks. That he is surprised I have done all I have for treatment and am doing so long after this tragic event.. PTSD is a terrible thing and any thing can cause/ trigger it, lots of people live unhappy lives due to not knowing the facts or just hiding from it. The fact there may be a cure some day from MMJ is amazing!

So my doctor today knew of my heart surgeon that saved me,
apparently he had a book published will dig (ask the Dr. as I can;t find it.) up the name. but guy really was world known.



Also told me that i need some heart scans done (pet&ekg I think) and a breathing test. (smoke may come to an end)


but i have to say the right strain is better then all pharma combos they try

 

[N.E.wguy]

Gratitude
by Carol Bailey Floyd

Integrating gratitude into your WRAP is a very effective way of empowering it. Most people know that gratitude is a good thing, but not too many people realize how extremely powerful it is.

Studies conducted by Michael McCullough, PhD and Robert A. Emmons PhD uncovered many benefits of gratitude. They found that grateful people are more optimistic, energetic, determined, interested, joyful, and enthusiastic. Those are reasons enough to cultivate gratitude in our lives! But here are even more benefits:

Grateful people feel stronger about handling challenges, have fewer illnesses, get more sleep, and exercise more. They are more likely to help other people, are less envious, have more clear thinking, and have better resilience. People who are grateful experience less stress, have a higher immune response, are less possessive, have closer family ties, make more progress towards goals, and have longer lives!!

These benefits of gratitude can make your WRAP stronger and even more effective. Practicing gratitude is a terrific wellness tool, and when it is turned into an action plan, it can be quite amazing.

Here are some of the ways that I use gratitude in my WRAP:

If I have had Triggers, Early Warning Signs, or am having a tough day, I count 10 good things. For example: getting a friendly phone call, seeing a sweet baby, finding a lucky penny on the ground, having a fun snack. Even the worst days include good things happening. I start by just noting them in my mind, but if the day is really terrible, I will count 20 good things. If my day is beyond awful, I write down the 20 things so they become even more noticeable throughout the day. This seems like a simple Wellness Tool/Action Plan, but it is one of the very most reliable things I can do to get out of a funk, and back into feeling more empowered.

I often make a gratitude list at night right before I go to sleep. Just listing 5 things that were positive in my day makes me feel more peaceful and ready to have a good night's sleep, and I really believe I wake up in a happier mood. I also often post on xww.welovegratitude.com, which is a gratitude community where people from all over the country post gratitude lists. Both of these gratitude ideas surface often in my Daily Maintenance section.

One thing I do is called "Emergency Thank You" therapy. I usually do this when I am feeling really sad, upset, or off balance. I just stop whatever I am doing and start saying (either to myself or out loud), "thank you for this . . ." For example, if I were to do it right now, I would say, "thank you for this computer, thank you for this table, thank you for my shoes, thank you for this glass of ice water, thank you for my notes, thank you for my chair, thank you for this light, etc." I keep that up until I know I am done. The idea is to just let gratitude wash over me until the uneasy feelings are gone. This may seem a little silly, but it has worked every single time I have done it, and I have been doing it for years!

List making is a powerful Wellness Tool and Action Plan. Making a gratitude list of 100 things that make me feel grateful is incredible! Making a list that long seems like a lot, but once I get rolling with it, I can do lots more than 100. I post this list where I can see it, and I remember how lucky and blessed I am every time I notice it.

Writing thank you notes, especially unexpected ones, is an interesting and thoughtful way to let people know that you are grateful. If you are feeling a little low, try writing a thank you note to someone - it can transform your mood, and make the recipient feel great, too!

One of my most powerful Wellness Tools/Action Plans is something I call "Quotation Therapy". For example, if I am feeling a little hopeless, then I do a keyword search on "hope quotations" on my computer and hundreds of quotes appear! I just pick some of my favorite ones and post them around our house. The key concepts - hope, personal responsibility, education, self-advocacy, and support, all have quotations that can strengthen them and make them come more alive. This is fun and very empowering. I collect quotes anyway, so this is one of my favorite things to do.

Here are some of my favorite quotes about gratitude:

Gratitude has the power to turn challenges into possibilities, problems into solutions, and losses into gains. - Daniel T. Peralla

Gratitude unlocks the fullness of life. It turns what we have into enough, and more. It turns denial into acceptance, chaos into order, confusion into clarity. It turns problems into gifts, failures into success, the unexpected into perfect timing, and mistakes into important events. Gratitude makes sense of our past, brings peace for today and creates a vision for tomorrow. - Melody Beattie

Let us rise up and be thankful, for if we didn't learn a lot today, at least we learned a little, and if we didn't learn a little, at least we didn't get sick, and if we got sick, at least we didn't die; so let us all be thankful. - Buddha

Feeling grateful also raises awareness levels and that can improve the quality of your life immensely. When you are feeling really low, it often feels like you have felt that way forever. So if you want to feel better, try some gratitude exercises and notice how your outlook changes. As your awareness level improves, you will be more likely to be more aware of your surroundings, people, colors, sounds, possibility, and your blessings.

There are many ways that gratitude can be used throughout WRAP. Being actively grateful costs nothing, but reaps big rewards. It is impossible to be unhappy and grateful at the same time. The next time you need to liven up your WRAP, try doing some gratitude exercises and then notice how the quality of your life improves!

 

[N.E.wguy]

Selective serotonin reuptake inhibitors (SSRIs)
SSRIs, a popular antidepressant type, can help you overcome depression. Discover how SSRIs boost mood and what side effects they may cause.
By Mayo Clinic staff

Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressants. They can ease symptoms of moderate to severe depression, are relatively safe and generally cause fewer side effects than other types of antidepressants do.
How SSRIs work

SSRIs ease depression by affecting naturally occurring chemical messengers (neurotransmitters), which are used to communicate between brain cells. SSRIs block the reabsorption (reuptake) of the neurotransmitter serotonin in the brain. Changing the balance of serotonin seems to help brain cells send and receive chemical messages, which in turn boosts mood.

Most antidepressants work by changing the levels of one or more of these neurotransmitters. SSRIs are called selective because they seem to primarily affect serotonin, not other neurotransmitters.
SSRIs approved to treat depression

SSRIs approved by the Food and Drug Administration (FDA) to treat depression, with their generic names followed by brand names in parentheses, include:

Citalopram (Celexa)
Escitalopram (Lexapro)
Fluoxetine (Prozac)
Paroxetine (Paxil, Pexeva)
Sertraline (Zoloft)

Paxil CR is an SSRI that provides controlled release of the medication throughout the day or for a week at a time with a single dose.

SSRIs also may be used to treat conditions other than depression, such as anxiety disorders.
Side effects and cautions

All SSRIs work in a similar way and generally cause similar side effects. However, each SSRI has a different chemical makeup, so one may affect you a little differently than another. Most side effects may go away after the first few weeks of treatment, but talk to your doctor if any side effects are too troublesome for you.

Side effects of SSRIs may include, among others:

Nausea
Nervousness, agitation or restlessness
Dizziness
Reduced sexual desire or difficulty reaching orgasm or inability to maintain an erection (erectile dysfunction)
Drowsiness
Insomnia
Weight gain or loss
Headache
Dry mouth
Vomiting
Diarrhea

Taking your medication with food may reduce the risk of nausea. Also, as long as your medication doesn't keep you from sleeping, you can reduce the impact of nausea by taking it at bedtime.

Read the package insert for additional side effects, and talk to your doctor or pharmacist if you have questions.
Safety concerns

SSRIs are relatively safe. However, here are some examples of safety issues to be considered:

Antidepressants and pregnancy. Some antidepressants may harm your child if you take them during pregnancy or while you're breast-feeding. Paroxetine (Paxil, Pexeva) in particular appears to increase the risk of birth defects, including heart and lung problems. If you're taking an antidepressant and you're considering getting pregnant, talk to your doctor or mental health provider about the possible dangers. Don't stop taking your medication without contacting your doctor first.
Drug interactions. When taking an antidepressant, be sure to tell your doctor about any other medications or dietary supplements you're taking. Some antidepressants can cause dangerous reactions when combined with certain medications or herbal remedies.
Abnormal bleeding. Use of some pain relievers, such as aspirin, ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve, others), or anticoagulants, such as warfarin (Coumadin), may increase the risk of bleeding when combined with SSRIs. Talk to your doctor about the risks of using these medications in combination.
Serotonin syndrome. Rarely, an SSRI can cause dangerously high levels of serotonin. This is known as serotonin syndrome. It occurs when two medications that raise serotonin are combined. These include other antidepressants, certain pain or headache medications, and the herbal supplement St. John's wort. Signs and symptoms of serotonin syndrome include anxiety, agitation, sweating, confusion, tremors, restlessness, lack of coordination and rapid heart rate. Seek immediate medical attention if you have any of these signs or symptoms.

Suicide risk and antidepressants

Most antidepressants are generally safe, but the FDA requires that all antidepressants carry black box warnings, the strictest warnings for prescriptions. In some cases, children, teenagers and young adults under 25 may have an increase in suicidal thoughts or behavior when taking antidepressants, especially in the first few weeks after starting or when the dose is changed.

Anyone taking an antidepressant should be watched closely for worsening depression or unusual behavior. If you or someone you know has suicidal thoughts when taking an antidepressant, immediately contact your doctor or get emergency help.

Keep in mind that antidepressants are more likely to reduce suicide risk in the long run by improving mood.
Stopping treatment with SSRIs

SSRIs aren't considered addictive, but sometimes physical dependence, which is different from addiction, can occur. So stopping treatment abruptly or missing several doses can cause withdrawal-like symptoms. This is sometimes called discontinuation syndrome. Work with your doctor to gradually and safely decrease your dose.

Withdrawal-like symptoms can include:

Nausea
Dizziness
Lethargy
Flu-like symptoms

Finding the right antidepressant

Each person may react differently to a particular antidepressant and may be more susceptible to certain side effects. Because of this, one antidepressant may work better for you than another, or your doctor may prescribe a combination.

When choosing an antidepressant, your doctor will take into account your particular symptoms, what health problems you have, what other medications you take, what has worked for you in the past and what has worked for a close relative with depression.

Inherited traits play a role in how antidepressants affect you. In some cases, where available, results of special blood tests may offer clues about how your body may respond to a particular antidepressant. The study of how genes affect a person's response to drugs is called pharmacogenomics. However, other variables besides genetics can affect your response to medication.

Typically, it may take several weeks or longer before an antidepressant is fully effective and for initial side effects to ease up. You may need to try several dose adjustments or different antidepressants before you find the right one, but hang in there. With patience, you and your doctor can find a medication that works well for you.

How serotonin works in the brain to help with Depression

hxxp://www.mayoclinic.com/health/antidepressants/MM00660/?utm_source=newsletter&utm_medium=email&utm_campaign=managing-depression&pubDate=07/03/2013

Transcript

The human brain has about 10 billion brain cells. Each brain cell can have as many as 25,000 connections with other cells. Messages, which direct many functions throughout your body, travel through your brain from cell to cell, through these connections.

For these signals to move from a sending cell to a receiving cell, they must cross a small gap called the synapse. Chemicals called neurotransmitters, located at the ends of the sending cells, help the signal cross this gap. Serotonin is one such neurotransmitter — a very important one that helps regulate mood, emotions and other body functions.

After the serotonin has done its job, it's reabsorbed by the sending cell and is soon back in position to help with the next nerve signal.

If you have depression, you may have a serotonin imbalance. Your overall level of serotonin may be low, and some of it may be reabsorbed too soon. As a result, communication between the brain cells is impaired.

An SSRI, or selective serotonin reuptake inhibitor, is a medication designed to help increase the amount of serotonin in the synapse by blocking its reabsorption.

As serotonin builds up, normal communication between cells can resume and your symptoms of depression may improve.


J Biol Chem. 2013 May 31;288(22):15712-24. doi: 10.1074/jbc.M113.454843. Epub 2013 Apr 16.
G-protein Receptor Kinase 5 Regulates the Cannabinoid Receptor 2-induced Up-regulation of Serotonin 2A Receptors.
Franklin JM, Carrasco GA.
Source

From the Department of Pharmacology and Toxicology, School of Pharmacy, University of Kansas, Lawrence, Kansas 66045.
hxxp://cannabinoidsociety.org/

We have recently reported that cannabinoid agonists can up-regulate and enhance the activity of serotonin 2A (5-HT2A) receptors in the prefrontal cortex (PFCx). Increased expression and activity of cortical 5-HT2A receptors has been associated with neuropsychiatric disorders, such as anxiety and schizophrenia. Here we report that repeated CP55940 exposure selectively up-regulates GRK5 proteins in rat PFCx and in a neuronal cell culture model. We sought to examine the mechanism underlying the regulation of GRK5 and to identify the role of GRK5 in the cannabinoid agonist-induced up-regulation and enhanced activity of 5-HT2A receptors. Interestingly, we found that cannabinoid agonist-induced up-regulation of GRK5 involves CB2 receptors, β-arrestin 2, and ERK1/2 signaling because treatment with CB2 shRNA lentiviral particles, β-arrestin 2 shRNA lentiviral particles, or ERK1/2 inhibitor prevented the cannabinoid agonist-induced up-regulation of GRK5.

 

[N.E.wguy]

Most importantly, we found that GRK5 shRNA lentiviral particle treatment prevented the cannabinoid agonist-induced up-regulation and enhanced 5-HT2A receptor-mediated calcium release. Repeated cannabinoid exposure was also associated with enhanced phosphorylation of CB2 receptors and increased interaction between β-arrestin 2 and ERK1/2. These latter phenomena were also significantly inhibited by GRK5 shRNA lentiviral treatment. Our results suggest that sustained activation of CB2 receptors, which up-regulates 5-HT2A receptor signaling, enhances GRK5 expression; the phosphorylation of CB2 receptors; and the β-arrestin 2/ERK interactions. These data could provide a rationale for some of the adverse effects associated with repeated cannabinoid agonist exposure.




"Flight of ideas would be the overt, visible manifestation of many disconnected ideas expressed in conversation (or a lecture, or similar discussion format with a listener).

Racing thoughts would be the subjective experience of many thoughts running through your head too fast to keep up with. (Much the way mood is the subjective inner experience of how you feel, while affect is its behavioral expression -- do you LOOK sad, happy, irritable, etc., regardless of your subjective feeling state). Some people describe the acceleration of thoughts in racing thoughts as flipping TV channels too fast to zero in on any one; or, trying to take a drink from a fire hydrant. It is the speed with which ideas run through your mind, regardless of their content, that best characterizes this phenomenon.

Rumination, by contrast, is thought to be more of an anxiety phenomenon that is not particularly accelerated but more repetitive -- the same thing over and over again, dwelling and unable to break off a particular theme or topic, as opposed to a bombardment of multiple disparate topics colliding all at once with no clear theme at all."

Joesph Goldberg, MD

 

[N.E.wguy]

Oregon Legislature Votes to Add PTSD to Medical Marijuana Program
By: Jon Walker Friday May 31, 2013 7:20 am
hxxp://justsaynow.firedoglake.com/2013/05/31/oregon-legislature-votes-to-add-ptsd-to-medical-marijuana-program/


People suffering from Post-Traumatic Stress Disorder may soon get access to medical marijuana in Oregon. On Thursday the Oregon House passed Senate Bill 281 in a vote of 36-21. The bill was previously approved by the Senate last month. It now goes to the governor for his signature.

If the bill is signed it would add PTSD to the list of eligible conditions for which someone could receive medical marijuana. A few other states, like New Mexico, have previously included PTSD in their medical marijuana programs.

There is significant anecdotal evidence and some scientific research that indicates cannabinoids could help with PTSD. Of course, it would be great if there were more research to not only prove if medical marijuana is useful for this condition but to also discover what treatment plans are most effective. Sadly, the Obama administration hass stopped this research from being performed.

The Mulitdisciplinary Association for Psychedelic Studies had been trying for years to run a study on marijuana and PTSD. Even though their study protocol was accepted by the FDA, the National Institute on Drug Abuse, which controls the production of marijuana for federally approved research, refuses to let the research take place.

To add insult to injury, while one part of the Obama administration actively works to stop research which could show marijuana has therapeutic uses, another part of the administration then uses the lack of government approved research to justify keeping marijuana as a Schedule I drug.

 

[N.E.wguy]

hxxp://www.maps.org/research/mmj/

About > Mission
Our Mission

Founded in 1986, the Multidisciplinary Association for Psychedelic Studies (MAPS) is a 501(c)(3) non-profit research and educational organization that develops medical, legal, and cultural contexts for people to benefit from the careful uses of psychedelics and marijuana.

Our Work

MAPS furthers its mission by:

Developing psychedelics and marijuana into prescription medicines
Training therapists and working to establish a network of treatment centers
Supporting scientific research into spirituality, creativity, and neuroscience
Educating the public honestly about the risks and benefits of psychedelics and marijuana.


Our Vision
MAPS envisions a world where psychedelics and marijuana are safely and legally available for beneficial uses, and where research is governed by rigorous scientific evaluation of their risks and benefits.


Our Values

Transparency — Information is shared openly and clearly. Communications are respectful, honest, and forthright.
Passion and Perseverance — We persist in the face of challenges. We have a sense of urgency about our work, and know that it's a long-term effort.
Intelligent Risk — Our decisions are informed by research. We try new things and learn from our mistakes.
Trust and Accountability — We value integrity and honesty, and embrace high standards.


MAPS is currently seeking regulatory approval to conduct a study of smoked and/or vaporized marijuana for symptoms of PTSD in veterans of war.

MAPS is the only organization working to demonstrate the safety and efficacy of botanical marijuana as a prescription medicine for specific medical uses to the satisfaction of the U.S. Food and Drug Administration.

Our efforts to initiate medical marijuana research have been hindered by the National Institute on Drug Abuse (NIDA) and the Drug Enforcement Administration (DEA) since our founding in 1986. NIDA's monopoly on the supply of marijuana for research and the DEA's refusal to allow researchers to grow their own has paralyzed medical marijuana research, and for over 12 years MAPS has been involved in legal struggles against the DEA to end this situation.

 

[N.E.wguy]

The Blame Game and Forgiveness Let’s talk about guilt.

Did you ever wonder why people feel guilt even though they have done nothing wrong? Humans have the psychological need for order. If something they experience is chaotic; blame is the easiest way to make order of it. Sometimes we blame ourselves and sometimes we blame others. But most of us go back and forth between the two.


For example, if someone who we thought loved us, hurts us, we become hurt and confused (chaos), and we try to make sense of it. Immediately we assume we must have done something wrong. It must be me, I am the common denominator. I always mess up.

But soon, we come to our own defense inside our head. Wait a minute…That wasn’t fair that they did this. That was mean.

Then, given all this, we have trouble trusting yourself, so we can’t depend on ourselves to know what to conclude, and the back and forth is perpetuated.

Now we are more confused. Is it me? Is it them? Me? Them? I call this raging conflict inside our heads the blame game.
The Blame Game

The blame game is where most of our suffering lies. Either and both blames cut right into our self identity. We don’t know if we are good or not. It’s hard to be lovable, vindicated, or validated.

Yes, the original hurt hurt. But it is expanded a thousand fold by the blame game. This is because in making order of the original chaos, we’ve created a now nu-orderable chaos. And we get stuck in it with no place to stand. There is no innocence for us (maybe we don’t deserve it), no justice (because what if it is us), no forgiveness (because who should we forgive?), no love (because how can you be lovable?). No understanding (so how could anyone else understand?).

Does this strike a cord?
How Do We Get Out of the Blame Game?

Forgiveness.

Forgiveness doesn’t mean you conclude that you did something wrong and then forgive yourself. It is not like the ancient Christian idea of forgiving a “sin.”

Self forgiveness means you decide you did nothing wrong. You lift the veil of the blame and you can see your own beauty. I use the word to mean having compassion for yourself. It is a way of letting go of the blame game by not letting it define you anymore. It is letting go of the guilt of it all (knowing you don’t deserve the guilt). Knowing you are lovable, because you are a good person. This means that you love yourself and see good in yourself no matter what happened to you. You lay down the weapons of the blame war, and surrender that it doesn’t matter who did what and why, because you decide that you did the best you could at the time. Recognize that you survived with skills and those skills say something about what you hold precious. And holding that precious makes you beautiful.

It may also help to understand that the other person acted out of his or her own hurt, or bad self image. Not that this condones what he or she did, but it helps you see your identity separately.

“People aren’t mean to you because they don’t like you, they are mean to you because they don’t like themselves.” -Jodi

*Sometimes you are still in relationship with the person who hurt you. Don’t worry. This practice will not take you away from them. The blame game probably has done a good job of putting distance in that relationship anyhow, or at least having you desperately seeking their approval, or isolating yourself since you feel unworthy.

Self forgiveness, or deciding you are innocent will only help all relationships you are in. You will begin to trust yourself and this will allow you to open to people who treat you well, and compassionately set limits with those who don’t, (outwardly or inwardly).

Self forgiveness is a decision to trust yourself. -Jodi

 

[N.E.wguy]

little off topic but related---


Can MDMA Cure PTSD?

hxxp://mdmaptsd.org/news/134-can-mdma-cure-ptsd.html
Vice examines the merits of using MDMA-assisted psychotherapy as a treatment for PTSD by summarizing past, current, and upcoming research. The article dedicates much of its length to the imminent research that will take place in Canada, noting that the necessary MDMA to be used in the study has been exported from Switzerland to Canada
Read at Vice
Studies have shown that an occasional dose of Methylenedioxymethamphetamine (MDMA, stupid) in tandem with psychotherapy can dramatically improve the mental health and wellness of patients suffering from Post Traumatic Stress Disorder. A paper published last year by Michael and Ann Mithoefer (a psychiatrist and nurse respectively, who are also married) in the Journal of Psychopharmacology has produced some eye-opening results.
It’s important to note that this study doesn’t suggest simply prescribing MDMA pills for the popping. Rather, throughout the course of therapy, patients are given two doses of MDMA over two eight-hour sessions held three to five weeks apart. This only happens once, and for some patients it will be the first and last time they ever take MDMA, but those three or four pills taken over an eight-week period could change their lives for the better.
What the study has shown is that MDMA works like a therapeutic catalyst. Patients’ scores when measuring common PTSD symptoms such as anxiety, paranoia, nightmares and depression, consistently dropped by over 75 percent. That’s more than a twofold decrease compared to patients who went through the same therapy without the drug, or had only been given a placebo.
More importantly, when following up with patients two months after they had received the treatment, 83% were no longer even diagnosed with PTSD, and three to five years later the benefits were still maintained with no signs of long-term health effects associated with MDMA at all.
Consider that standard, government approved drugs like Zoloft or Paxil are only effective in 20% of PTSD patients, and therapy assisted MDMA is looking more and more like a breakthrough. Even Oprah is getting her name behind it.
Due to the success of the Mithoefer’s study, similar trials are underway in Switzerland, England, Australia, Israel and—just last week, after two and a half years of regulatory inspections and political red tape—nine grams of pure MDMA arrived in Canada.
Vancouver psychologist, Dr. Andrew Feldmar, will begin trials on a relatively small (12 people in total) group of soldiers, police officers, and sexual assault victims suffering the effects of PTSD who have found no relief in a variety of prior treatments.
The hoops that Dr. Feldmar has had to jump through to get his hands on nine grams of MDMA (which he acknowledges would have been easier to just find on the streets of Vancouver) are almost comical. Two-and-a-half years after the study was approved, officials were still flying back and forth from Ottawa to inspect the pharmacy where the MDMA will be stored, behind shatterproof glass, in a safe nailed to the floor. As Feldmar described it to the CBC, “It’s as if the whole of Vancouver was waiting to see this drug arrive and would rob the pharmacy to get it… It’s like Fort Knox has been waiting for this drug.”
When working with patients suffering from PTSD, he defines three crucial connections that must be made: First, the patient must be made to feel safe within the present moment. Second, in that moment, patients need to feel comfortable enough to acknowledge painful memories and to freely grieve. And third is that, through these first two steps, patients reconnect with the world, establishing an empathy and trust with the therapist they are communicating with.
He says that MDMA addresses the progress of all three stages of therapy in parallel with the drugs own three perceptible influences: “MDMA, has three major effects if it is taken in the right setting. One is to open your heart. Another one is to make yourself present, so that the future and past don’t matter, you really arrive into the here and now. And the third one is, for some people, for the very first time you feel no shame. So you’re shameless.”
The trials will follow the Mithoefer’s method, and Feldmar describes what this looks and feels like in the context of a psychotherapy session, “Ecstasy has been developed as an empathogen, it increases the person’s empathy. If you’re my therapist, I might think that behind your face there is the person who has hurt me. I basically don’t trust any person because of past events. Now if I take ecstasy, I forget what happened, I don’t worry about the future, my heart opens and suddenly, if indeed you are a well meaning person, I will intuit that, and maybe for the first time since I’ve been traumatized, I will form a connection with you that I feel safe in.”
Stereotypically, Post Traumatic Stress Disorder is perceived as Shell Shock, designated to veterans or those who have been through violent combat. But what is being brought further into the greater public consciousness—and this study has the potential to shine even more of a light on that—is that PTSD doesn’t just touch those who have lived through war, terrorism, or random violent accidents. It also affects those who have suffered in silence: victims of family violence, sexual assaults, or other stressful events that occur while living life in an arbitrary and often unforgiving world.
If these studies continue to show positive results, one would hope that the drug would become more accessible and more studies would receive funding from militaries, ministries of health, and private-sector donors. Regardless of how taboo it might seem at the moment, if MDMA can be used responsibly to aid PTSD, making this unforgiving world a little less harsh on those who have suffered it, then, by all means, Molly needs to go to therapy.

 

[7greeneyes]

god bless ya for putting so much effort into this thread newguy.

Resplendently informative as well as personally inciteful.