Recently I heard of a person being prescribed and antidepressant and Ritalin for depression. The problem is, Ritalin is a stimulant, and depression that manifests in irritation or rageful outbursts is exacerbated by it. A quick search on Ritalin and depression led me to the article, Attention Deficit Disorder and Medication: The Basics, which states:

Sometimes medication failure is due to lack of communication between patient and doctor (and sometimes school). The doctor, patient and family should be clear about exactly which symptoms they expect the medication to treat. Patients should ask questions. They should inform the doctor if there are side effects or if the medication does not seem to be working.

If medication is still not working as expected, it may be time to re-evaluate the diagnosis. Individuals with ADHD may also have other disorders at the same time. Anxiety and depression may superficially resemble ADHD. Occasionally a medical illness may masquerade as a psychiatric condition.

Medication can only take the individual part of the way to recovery. Therapy, community support, coaching and the individuals own determination are important parts of treatment.

Further searching brought me to the transcript of a t.v. interview caled Senior Depression: Healthy For Life from the Eyewitness News Newsroom. The doctor, Helen Lavretsky, M.D., (a geriatric psychiatrist at UCLA), stated:

Normally, an individual who is with geriatric depression, late life depression, responds or shows some signs of improvement in depression after weeks to months of active treatment.

In order to provide faster effect, she prescribes low doses of ritaling to “kick start the effects of anti-depressants in her patients.” She “treated 21 elderly patients with ritalin, along with their traditional anti-depressants. Many felt better in as little as 72 hours.”

However, she noted that the energizing effect of ritalin is brief. By prescribing this with antidepressants, the goal is that the efficacy of the antidepressants will have taken root when the ritalin effect wanes.

In any medical situation, it is in your best interest to be curious, ask questions, and do your research. Learn what your medicine is for and the various effects it has (including side-effects). Check with your doctor to learn what foods and medicines (over the counter or prescription) are contraindicated — that is, could cause a toxic reaction if the medicine is combined with that other substance.

People in employer-sponsored health plans are paying 48 percent more out of their own pockets for care than they did three years ago, according to an authoritative new study, and the cost will be even higher next year.

Almost two-thirds of large employers raised the amounts that employees are contributing to the cost of their health plans this year, and 79 percent say they will do so again in 2004, according to the study, by the Kaiser Family Foundation and the Health Research and Educational Trust.

It appears this trend will continue. And then, there are the millions of people without any health insurance. As costs rise, I wonder how many more will join their ranks?

You may notice that this entry is posted in the wee hours of the morning — nearly 5 a.m. It’s not that I’m an early riser, either. Far from it. I haven’t been to sleep yet. And this is because I broke some rules of good sleep hygiene.

Do you ever have insomnia? Throughout my life I have wrestled with bouts of it. I’m a very light sleeper anyhow. Much of the problem is under my control, however, and it’s when I ignore the following guidelines that I lose sleep.

1. Go to sleep at the same time every night.
2. Set up a routine of self-soothing before bed; this means no television. Instead, light a candle and ponder the day’s events, read a meditation, listen to soothing music, bathe, or whatever it is that calms you.
3. Use the bed only for sleep or sex.
4. Avoid alcohol in general.
5. Avoid caffeine after mid-day.
6. Try to get to sleep in only 15-30 minutes; otherwise, get out of bed and read or do something not overly arousing.
7. Don’t exercise 2-3 hours before sleep.
8. Talk about problems during the day; bedtime is not the moment to broach upsetting subjects.

We are creatures of habit and cycles, and our bodies respond well to consistency. In my case, the inability to sleep arises from not observing guideline numbers 1, 4, and 5 yesterday.

I have found that warm milk does help sometimes, and there are other foods for sleep if you don’t like milk. Now and then Valerian tea helps, but this must be used carefully and in small doses. Check with your doctor before taking any herbal supplements in any form.

From the New York Times: Emergency Rooms Get Eased Rules on Patient Care:

The Bush administration is relaxing rules that say hospitals have to examine and treat people who require emergency medical care, regardless of their ability to pay.

Under the new rule, which takes effect on Nov. 10, patients might find it more difficult to obtain certain types of emergency care at some hospitals or clinics that hospitals own and operate.

The new rule makes clear that hospitals need not have specialists “on call” around the clock. Some patients might have more difficulty winning damages in court for injuries caused by violations of the federal standards.

“The overall effect of this final rule will be to reduce the compliance burden for hospitals and physicians,” the administration says in a preamble to the regulation, to be published next Tuesday in The Federal Register.
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Blindness isn’t always related to malfunction in a person’s eyes. There is a condition known as “cortical blindness,” in which the optical nerves and eyes are physically intact, but the visual processing areas on both sides of the brain are damaged. There is a game you can try, the results of which might indicate the presence of blindsightedness.

There is also a condition known as Anton-Babinski syndrome, in which a person is not able to process visual images in the brain, but the psychological parts of the brain act as though the body can see. This results in the person denying the fact of blindess and acting as though they can see, and when they bump into something, explaining it by saying things like, “My glasses are dirty,” or “That wasn’t there before.”

An excerpt from Blues Busters: The Trouble with Men:

Even more men exhibit what he calls covert depression. ‘You don’t see the depression itself but the defensive maneuvers men use to evade or assuage it,’ says Real. Signs include:

• Self-medication. First and foremost is drinking, but also abuse of other drugs.
• Risk-taking, including compulsive gambling, womanizing, and acts of bravado that show up as high rates of accidental death. These are ‘desperate acts’ that both numb the pain and show the world ‘I’m a real man’ by denial of vulnerability. Says Dr. Pollack: ‘We see them as bad boys rather than sad boys.’
• Radical isolation. Men withdraw from relationships, from their wives.
• Lashing out. This can run the gamut from increased irritability to domestic violence, even homicide.

‘Women internalize depression and tend to blame themselves,’ says Real. ‘Men tend to externalize distress and blame others.’ They move into action–and distraction.

Such defenses may protect them from feeling depressed but not from being depressed. Real cites the example of author William Styron, who in Darkness Visible described how his depression revealed itself only when he stopped decades of heavy drinking. The depression was part of his character for a long time, managed with self-medication. When the self-medication stopped, the depression became visible.

The intoxicant defenses and lashing-out defenses, Real finds, represent men’s attempts to ward off the anguish of shame by inflating their own value. In short, he says, they transmute shame into grandiosity, what he calls ‘the central theme of masculinity.’ As he sees it, the inclination to bravado takes permanent hold at adolescence. Indeed, until then, boys and girls exhibit the same rates of depression.

The mental health establishment recognizes that grief and other forms of emotional pain in males may be expressed in acts as well as words throughout childhood. Drinking, substance abuse, and antisocial behavior are all cited in the psychiatric bible, the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), as signs of depression among teens. But not among men.

‘Somehow, when a boy turns 18 we split depression off from the behaviors that make it up,’ says Real. ‘We stop seeing the acting out as due to an underlying depression and instead call it a character disorder. That’s not science, it’s morality.’

Suicide rates in teens tell a truer story, observes Pollack, pointing out that adolescent boys kill themselves at four to six times the rate of adolescent girls. The conventional explanation is that girls try more often but boys use more lethal means.

‘But we have to ask why boys use more lethal means,’ he implores. ‘Girls’ actions are often not meant to end their lives. When boys pick up a gun or a rope they don’t want to come back from it. The shame and the pain are so intense but they are not allowed to talk about it.

‘We have to recognize that there are socialization and cultural dynamics at work here,’ adds University of Iowa psychologist Sam V. Cochran, Ph.D. He is pushing for the recognition that depression in men is usually a masked disorder, one hidden behind other behaviors.

Prohibiting males from expressing grief, sadness, and loss makes their depression look different, but only at a superficial level. ‘Where there’s anger, irritability, rejection followed by self-medication, or compulsive behaviors,’ he says, ‘there’s usually a mood disorder going on.’