The uninvited house guest often stays on well beyond the point of “wearing out his or her welcome.” Likewise, for many people, chronic illness/disability is not a short-term inconvenience but rather a long-term, often permanent way of life. In the early stages of adaptation, the changes that happen in our lives and families may seem tolerable—at least while we still think there is a chance that the diagnosis is wrong or the cure is in the magic pipeline offered by big pharma.

Eventually, denial and bargaining give way to anger and depression. The uninvited guest is still ever-present, and no amount of cajoling or suggestions result in change. Bouts of anger may become a way of life for a while.

Anger
Many people flow in and out of anger and depression, rather than progressing neatly through one stage and into the next. It is often said that depression is anger turned inward, which makes expression of anger in a safe and effective way very important. Getting adequate support from formal and informal support networks is critical.

It is not unusual for tempers to flare and fuses to shorten during this period of adjustment. People who are typically long-suffering seem to be constantly on edge; those with fewer coping skills may be in a chronic state of agitation and irritability, if not outright rage. It often seems as if they are pushing away those who are closest to them at the time when they need them most.

Loved ones may unconsciously spend less time with the person who seems to find fault in their best efforts. Children are often left confused and afraid. Doctors and other providers frequently find themselves being blamed for their inability to help. This is all part of the process of adaptation.

While most people understand cognitively that their loved one is struggling and coping as well as can be expected, their own feelings of inadequacy and powerlessness may lead them to retreat on some level—if not physically, then emotionally. This often feels like abandonment to the person who is already overwhelmed by disability or illness. It is very important for caregivers and loved ones to be aware of their own feelings and find support.

Coping skills: Separate the person from the behavior. Try to remain aware of the real target for your anger—the illness or disability, not the person in your midst. Remember that we often treat those we love the most with the least respect; make amends as soon as possible if you do so. Give each other a break and extend the benefit of the doubt when possible. If your loved one treats you badly, remember that everyone is under extreme stress and doing the best they can at that moment. It is also good to remember that your caregivers and medical providers are probably not inadequate, but the resources they have to work with may be.

Caregivers and loved ones should speak up if they are being treated badly. Being sick is not an excuse to mistreat people, particularly if there is a pattern of abusive behavior developing. These behaviors need to be identified and discussed in a calm, loving way (not in the heat of the moment). This may require professional help, or perhaps the assistance of a minister or family friend who is not emotionally involved.

Most of the time, the person who lashes out or treats people badly feels guilty and needs the opportunity to make amends. For those who are unaware of how their behavior comes across, specific examples of the unacceptable behavior or hurtful/abusive language helps them develop a better awareness of their inappropriate behavior. In some cases, this is a manifestation of the illness or disability. In others, it may be the result of coping skills that are maxed out. Either way, left unattended, it usually gets worse. This is not the time to let conflicts and hurt feelings stack up. If you need help addressing these issues, ask your medical provider for a referral. Providers often have therapists or chaplains they work with who may be able to help.

Depression
Depression often occurs during the adaptation process, and may happen at other times or continue. Clinical depression can be very difficult to manage. It is more than sadness or disappointment; depression is a collection of symptoms that exist most days for two weeks or longer and create some level of impairment in daily functioning. The symptoms may include many of the following:

• sadness/tearfulness
• low energy or agitation/irritability
• loss of interest in things previously enjoyed
• problems with concentration/foggy thinking or trouble making decisions
• changes in sleep or eating patterns
• feelings of guilt or worthlessness
• thoughts of death or suicide/not wanting to live
• rumination/negative thinking
• others (physical pain, changes in motor skills, etc.)

If you or someone you know have four or more of these symptoms that are present for more days than not over a two-week period, talk to your medical provider about getting help.

There is also a type of depression called situational depression that is a normal reaction to a loss or change. Almost all people with chronic illness or disabilities and their loved ones experience this. The same symptoms are involved, but the symptoms may not be present most of the time, or may not be severe enough to impair your ability to function (relationships, work, taking care of your kids, etc.).

Situational depression can linger or become more serious after a while, becoming clinical depression. If the symptoms begin to impair functioning or last longer than a few weeks, it is wise to speak with a medical provider or therapist. People with situational depression are often able to experience periods of happiness when receiving good news, or other momentary reprieves from the darkness of depression. Those with clinical depression may be unable to experience even brief moments of relief when the situation calls for it.

The best treatment for depression is believed to be a combination of talk therapy, exercise (I know—it is very hard to exercise when you are depressed), a good diet, and medication, if deemed medically necessary. The right intervention for depression depends on which type of depression you are experiencing. For those with a few symptoms that are not present all the time, self-help may be sufficient. People with four or more symptoms that are present most of the time probably need to see a therapist and possibly a psychiatrist.

Anyone who is suicidal should seek professional help immediately. This national hotline is for people struggling with depression. The crisis line is staffed 24 hours a day by trained volunteers: 1-800-273-TALK.

Coping skills: I recommend that people talk with a therapist when dealing with situational depression and try to get as much activity in as possible. This may mean simply walking outside to get the mail, sitting on the porch for 20 minutes to have a cup of coffee or juice, watering the plants, or walking the dog. Sunshine is another natural remedy that increases vitamin D, which is often deficient in people who are depressed and those who do not go outside often. Eating properly is also critical, and there are natural supplements available at your local health store that may help with situational depression. Talk to your medical provider or therapist about these options.

Support groups and self-help groups can be very helpful. Groups provide a great resource for people living with chronic illness and disabilities and their loved ones. You can find online and local resources, and most are free. Many are affiliated with local hospitals or nonprofit agencies that serve people with chronic illness or disabilities.

If depression is serious enough to impair functioning, or you/your loved one has thoughts of suicide or not wanting to live, it is important to get professional help immediately. Start with your medical provider or therapist unless the person with depression has a plan to cause self-injury or death.

In situations where someone’s safety is at risk, call 911 or the local emergency number for your area, or take the suicidal person to the closest emergency room. Your role in the situation is not to intervene, but to get professionals involved as soon as possible. If the suicidal person is unwilling to go to the ER (or medical provider’s office during business hours) or you believe it may be unsafe to transport them, simply call for the emergency medical providers to come to you.

Don’t worry about the person who is suicidal being upset by your actions—when people are in crisis, they are usually not thinking clearly, so it becomes crucial for you to make good decisions on their behalf. The medical professionals who are trained to help in these situations will make the decisions once they arrive. This will likely mean that the person who is suicidal will be transported to the hospital for an evaluation, and may need to stay there for a few days until stabilized.

Again, it is not up to you to make that decision, only to make sure the person is safe until medical professionals can take over. It is a lot of responsibility and instills fear in most of us, but in the end, when your loved one is thinking rationally again, he or she will likely be grateful. If not, you will know that you have done what you needed to during the crisis.

Ongoing thoughts of suicide or not wanting to live need to be addressed with mental health and/or medical professionals regularly. Some states (Washington, Oregon, and Montana) permit medical professionals to participate in a well-thought-out, documented plan to end life (known as rational suicide), but most do not. Discussion of a patient’s end-of-life wishes should also be considered carefully and documented in a legal document for your specific state. Legal resources such as a living will specifically identify a person’s end-of-life wishes.

It is a good idea to talk about signing a consent form that allows you to discuss your loved one’s mental health (and physical) treatment with medical providers and therapists. This will enable you to enlist their help if depression becomes unmanageable or a crisis occurs. The consent can be relinquished at any time if the patient is considered to be of sound mind, and could be a great resource. Fortunately, resources are available to assist you in being prepared for a suicidal crisis should you need them.

There are many issues to be discussed regarding suicide, including family members’ thoughts and feelings about it. It is important to remember that euthanasia is against the law in all U.S. states, and assisted suicide with the help of a physician who prescribes a lethal cocktail after careful planning and documentation is legal only in Oregon, Washington and Montana. Legal professionals should be consulted if “rational suicide” is something you or a loved one is considering.

Adaptation
Using the analogy of the uninvited house guest, this is the period when people have settled into their routines and learned to live together with whatever adjustments are necessary. The initial period of adjustment after a disability or illness almost always requires going through each of the stages in the process outlined here. It can take a long time for some to arrive at adaptation, and not everyone in a family gets there at the same time. With some luck, a lot of support, good communication, and teamwork, the process will likely resolve in time for most people.

Unfortunately, surviving the initial period of adjustment does not ensure there will not be others. As mentioned earlier, people tend to get emotionally triggered when there are relapses or new symptoms/stages of the illness or disability occur. Triggering means that some reminder of the initial trauma (usually diagnosis or the actual accident or illness) sets off the same cascade of emotions experienced at the time of the original event.

Living in fear of a relapse or a change in physical status creates a certain amount of anxiety for everyone. The unpredictability of living with a chronic illness or disability will be the focus of our next article.

In the meantime, please share below how you have effectively coped with anger and depression.

Cyber bullying has become more common with advances in technology. Messages can be posted on social networking websites, and pictures can be downloaded, altered, and made available to the world in seconds. Although there has been abundant research into the consequences of cyber bullying and traditional bullying, little has been done to determine which type may cause more psychological damage. It is well established that bullying itself—the act of terrorizing, intimidating, and ridiculing another through verbal or physical acts—can have numerous deleterious effects.

Those who endure bullying are at increased risk for internalizing problems such as anxiety, depression, and suicide ideation. Understanding how each type of bullying impacts young people is of critical importance in order to target those most vulnerable and help them deal with the ramifications. To get a better idea of the effects of cyber bullying in comparison to traditional bullying, Sheri Bauman of the University of Arizona’s College of Education recently conducted a study asking college students to rate their levels of distress based on hypothetical cyber and traditional bullying scenarios. The scenarios were similar in nature and differed only in delivery.

Bauman discovered that three main bullying themes emerged, including generalized bullying, name calling, and sexual victimization through explicit sexual images. Although the female participants reported higher levels of distress for all three types of bullying, the method of delivery did not impact emotional response. Specifically, although their responses varied by bullying scenario, all participants reported similar distress levels whether the bullying event was traditional in nature or cyber bullying.

However, Bauman found that one type of bullying was the most distressing. “We … found that bullying with sexual material, whether conventionally or by technological methods, is the most upsetting kind of incident to targets,” she said. This was especially true for female participants. Those with a history of victimization had higher distress than those without. In sum, Bauman believes that these findings demonstrate that it may not be the delivery method of bullying behavior that is most detrimental to young people, but rather the content of the message conveyed.

Reference:
Bauman, S., Newman, M. L. (2012). Testing assumptions about cyber bullying: Perceived distress associated with acts of conventional and cyber bullying. Psychology of Violence. Advance online publication. doi: 10.1037/a0029867

Dialectical behavior therapy (DBT) is a comprehensive, evidence-based treatment approach used to treat individuals with a wide variety of issues, including relationship conflict, anxiety, depression, bipolar, self-injury, eating issues, and substance abuse. Developed in the 1980s by psychologist Marsha M. Linehan for the treatment of borderline personality disorder and chronic suicidality, this method has since been adapted and utilized to help clients with much less severe issues. The therapy can help clients who exhibit extreme emotional reactions, helping them develop self-acceptance while also learning coping skills to better regulate their emotions and handle distress. DBT uses both individual therapy sessions and group skills training, as well as telephone coaching between sessions.

The DBT model combines a behavioral therapy approach with eastern mindfulness practices. In one sense, the term dialectical refers to the goal of synthesizing the extreme opposites inherent in the rigid “black and white” thinking of many clients who have trouble regulating their emotions. “Dialectical” also applies to the core DBT principle of practicing acceptance strategies while implementing change strategies, in the process of reducing and modifying self-destructive behaviors.

This type of therapy is very support-oriented; it helps clients identify their strengths, build new skills, and increase their self-esteem. DBT focuses on cognitive issues by indentifying destructive thought patterns and replacing them with more neutral and accepting internal dialogues. It is designed to be a nonjudgmental collaboration, with the therapist and client working together to increase emotional awareness and understanding, minimize negative thought patterns and behaviors, and develop new coping and problem-solving skills.

The four modules of dialectical behavior therapy:

• Core mindfulness: The first of the four primary modules of DBT, this concept involves learning to observe one’s emotions, describe those emotions, and fully participate in present experiences. This skill forms the foundation for the other three modules, and is derived largely from eastern practices of living in the moment.
• Interpersonal effectiveness: The second core component of DBT teaches clients assertiveness skills and strategies to ask for what they need, set boundaries and say no when appropriate, and deal more effectively with interpersonal conflict.
• Distress tolerance: The third module entails clients developing nonjudgmental acceptance of themselves as well as their current situation. The focus is on learning to accept the present reality and to tolerate crises, and making use of strategies such as distraction, self-soothing, and improving the moment. Practicing these skills will increase the client’s ability to tolerate challenging events and environments.
• Emotion regulation: The final module of DBT consists of three main goals: to understand one’s emotions, reduce emotional vulnerability, and decrease emotional suffering. With this in mind, some of the specific skills taught in DBT include identifying and labeling emotions as well as evaluating: events that prompt the emotion, interpretations that trigger the emotion, how the emotion is experienced, how the emotion is expressed behaviorally, and the aftereffects of the emotion.

In the case of adolescent treatment, Dr. Alec Miller has adapted Dr. Linehan’s model to incorporate parents attending skills training groups with their teens. There is an additional module, “walking the middle path,” which focuses on helping parents and their children understand each other’s viewpoints and reduce conflict and invalidation.

The five functions:

Dialectical behavioral therapy was designed to fulfill five primary functions:

• Enhance behavioral capabilities: DBT helps clients develop important life skills that help them regulate emotions, experience the present moment, improve interpersonal interactions, and better tolerate distressing situations.
• Improve motivation to changes: DBT supports clients’ motivation to change by tracking and reducing detrimental behaviors, thereby increasing quality of life.
• Generalize capabilities to other environments: In order for the client to make progress, the skills learned in therapy must transfer to a wide variety of situations. This is accomplished through homework assignments and practicing skills. Telephone consultations also can be valuable in helping clients utilize these skills in their daily lives.
• Support client and therapist capabilities: DBT aims to maintain and build the capabilities of therapists through continued training and consultation-team meetings.
• Enhance therapist motivation: The DBT model encourages the use of support, validation, feedback, and encouragement between therapists to avoid burnout and improve their effectiveness.

Stages of treatment:

The course of DBT generally flows through three stages:

• Stage 1: This stage is primarily focused on eliminating or reducing serious behaviors, including self-injury, suicidal thinking, and aggression. Behaviors that interfere with therapy also are addressed, such as missing appointments and not returning phone calls.
• Stage 2: The client strives to increase quality of life and experience emotions in a less intense manner. The client continues to eliminate or decrease destructive behaviors, and address other issues or situations that are interfering with daily life, such as past trauma.
• Stage 3: The client is experiencing increased feelings of completeness, self-respect, and love.

Who can benefit:

Though DBT originally was developed to treat more severe issues, such as borderline personality disorder, suicidal behaviors, and self-harm, the treatment has become a widely respected method for treating clients who exhibit the following, much milder traits and issues:

• Difficulty with emotional regulation
• A high level of reactivity, with a slow return to baseline
• Impulsiveness with a tendency toward self-destructive behaviors
• An inclination toward extreme thinking, unable to perceive a middle ground
• A lack of sense of self, tending to feel incomplete or empty
• A history of instability in relationships, and difficulty with interpersonal interactions
• Extreme sensitivity, accompanied by rapid mood swings, anxiety, and depression
• Fears of abandonment and trouble with intimate relationships

Dialectical behavior therapy has proven to be a very effective tool to help people manage intense emotions, change negative thought patterns, and decrease self-destructive behaviors. Individual therapy sessions focus on current detrimental behaviors in the client’s life, while group sessions involve learning skills from the four modules: mindfulness, interpersonal effectiveness, distress tolerance, and emotion regulation.

Major depressive disorder (MDD) is a mental health problem with both psychological and physical effects. Someone diagnosed with depression may have strong feelings of sadness or a loss of interest in normal activities; physical symptoms may include lethargy, body pains, insomnia, and headaches. Despite decades of research and study, fast and effective treatment for depression remains an unfulfilled goal. Currently, the preferred approach for depression treatment begins with cognitive behavioral therapy and may include one or more psychotropic medications. 

Suicide risk is a serious complicating factor in the treatment of major depressive disorder, and choosing the appropriate drug intervention remains a haphazard procedure. Because many antidepressants are potentially linked with a heightened risk of suicidal behavior, doctors must exercise caution. Response to psychotropic drugs, particularly antidepressants, is highly individual. A period of trial and error is often necessary before doctors can identify the optimum drug or drug combination. In cases of possible suicidal thoughts and behavior, the best course of action is often observation, possibly in an inpatient facility.

A recently completed study at the New York State Psychiatric Institute promises to offer some guidance in the selection of treatment for severely depressed individuals with suicidal tendencies. The study consisted of two groups, one receiving Paxil (paroxetine) and the other receiving Wellbutrin (bupropion). The choice of these specific drugs was deliberate: Paxil belongs to the selective serotonin reuptake inhibitors (SSRI) category and is among the most frequently prescribed antidepressants; Wellbutrin is a non-SSRI medication with a different mechanism of action. However, both medications still carry the “black box” warning to notify doctors and pharmacists of potentially dangerous side effects, namely the increased suicide risk. A second aspect of the study included functional MRI scanning of each participant’s brain—once at the beginning of the 8-week trial and once more at the conclusion. Participants were given a cognitive task during the scan to assess how each of them processed sensations of reward.

The initial phase of the study is complete. Data on the 125 participants is currently being compiled and analyzed. Researchers hope that one of the drugs will reveal itself as a more effective remedy for major depression, although they may find that one of the drugs leads to a higher rate of side effects. In any event, the data from this study will help attending physicians and therapists make better choices when treating their most severely depressed patients.

References:

1. Bupropion, t. c. (n.d.). WELLBUTRIN XL® (bupropionhydrochloride extended-release tablets). DailyMed. Retrieved July 18, 2012, from http://dailymed.nlm.nih.gov/dailymed/archives/fdaDrugInfo.cfm?archiveid=14812
2. Depression (major depression). (n.d.). Mayo Clinic. Retrieved July 18, 2012, from http://www.mayoclinic.com/health/depression/DS00175
3. Paroxetine/Bupropion in Suicide Attempters/Ideators With Major Depression. (n.d.). ClinicalTrials.gov. Retrieved July 18, 2012, from http://clinicaltrials.gov/ct2/show/NCT00429169?recr=Open&intr=%22Bupropion%22&rank=16

Major depression continues to be one of the most common and debilitating chronic mood problems afflicting adults. According to the Mayo Clinic, there is no quick fix for those who have this disease. Appropriate treatment includes a long process of psychotherapy, lifestyle changes, and medication. Recently, several studies have indicated that the antidepressant drug Paxil (paroxetine) may increase the risk of suicidal thoughts or even attempted suicide in certain patients. As a member of the class of drugs known as selective serotonin reuptake inhibitors (SSRIs), Paxil is one of the most frequently prescribed treatments for depression on the market. The concern over suicide has led researchers to look back at previous studies in an attempt to reassess both the effectiveness and the safety of this particular medication.

Researchers studied the results of 40 double-blind, placebo-controlled clinical trials of Paxil. As a whole, the trials included nearly 7,000 adult participants, most of whom were diagnosed with either moderate or major depression. In a typical clinical trial of a medication, participants who leave the trial early are not taken into account; their data are incomplete and inconclusive. For the present review, however, researchers considered early withdrawal to be an indicator of either ineffective treatment or adverse effects. Surprisingly, the same proportion of trial participants left their respective studies early, regardless of whether they were taking placebo or Paxil. One would expect that more of those taking Paxil would remain in the study, but the numbers tell a different story. The researchers point out another flaw in depression research in general—the dependence on rating scales rather than overt and empirical evidence. Because depression is a psychological illness with few, if any, quantifiable symptoms, gauging its severity becomes very subjective.

When researchers pooled the results from all 40 trials together, the beneficial effects of Paxil were significant but only marginally more significant than placebo. If 100 patients are treated with Paxil, then an average of 53 of them will have a positive response, compared with 42 for placebo. In essence, this medication performs only 11% better than a sugar pill. When researchers considered the potential adverse effects of Paxil, including suicidal tendencies and attempted suicides, the picture became even murkier. Of all the SSRIs, Paxil has been shown to produce the greatest spike in suicidal thoughts, especially in young adults and adolescents.

The researchers conclude that the fields of psychology and pharmacology are in need of better experimental design. They argue that current designs overstate the effectiveness of antidepressant medications while simultaneously downplaying adverse effects. For Paxil at least, a closer look at a large cross-section of data reveals that it may not be quite as effective as once thought. As always, doctors should carefully screen their patients before prescribing any antidepressant medications. Any hint of suicidal tendencies argues against its prescription.

References

1. Barbui, C., Furukawa, T.A., Cipriani, A. (2008). Effectiveness of paroxetine in the treatment of acute major depression in adults: a systematic re-examination of published and unpublished data from randomized trials. Canadian Medical Association Journal, 178(3), 296-305.
2. MayoClinic.com. (n.d.). Depression (major depression). Retrieved March 8, 2012, from http://www.mayoclinic.com/health/depression/DS00175

Research has shown that there is a genetic risk factor for suicide. However, until now, very few studies have looked at family history of suicide to determine how it affects second- and third-degree relatives and the maternal, paternal, or spousal influences. Because suicide is predicted to take nearly 1.5 million lives by the year 2020, according to the World Health Organization, being able to identify and treat those most vulnerable for suicidal ideations is vitally important. Current research has suggested the family risk factor for suicide to be anywhere between 17% and 55%. To get a more defined estimate of how suicide runs in families and how environmental factors impact the risk for suicide, D. Tidamalm of the Department of Clinical Neuroscience at Karolinska Institutet in Stockholm analyzed more than 50 years of data from the entire Swedish population. Tidamalm and colleagues assessed how many of the Swedes who had committed suicide during those years, a total of 83,951, had a relative who had also died from suicide, and they compared those rates to a control group.

The research revealed that full siblings had a higher risk for suicide than maternal half-siblings. However, maternal half-siblings were more likely to die by suicide than paternal half-siblings, perhaps because of shared environments. The study showed that identical twins were more vulnerable than fraternal twins, and even cousins were 50% more likely to commit suicide than the control group. Environment influenced the risk for suicide significantly as well. Full siblings were three times more likely to die by suicide than the children of suicide victims, whose risk was twice as high as the controls. Even spouses were more likely to commit suicide than the control groups. Tidamalm believes that degree of relation, combined with environment, is an important element for exploration in treatment. Tidamalm added, “The results confirm the importance of considering the family history of suicide when assessing suicide risk in clinical practice or when designing and administering preventive interventions.”

Reference:
Tidamalm, D., Runeson, B., Waern, M., Frisell, T., Carlstrom, E., Lichtenstein, P., Langstrom, N. Familial Clustering of Suicide Risk: A Total Population Study of 11.4 Million Individuals. Psychological Medicine 41.12 (2011): 22527-534. Print.

Depression and anxiety are among the most common mood problems, regardless of age or demographics. Children and adolescents experience anxiety and depression at a significant rate, although treatment for this population brings some complicating factors. The most frequently prescribed antidepressant medications incur a small but real risk of suicide or suicidal thoughts in young people. Known as selective serotonin reuptake inhibitors (SSRIs), this class of antidepressants is otherwise well regarded for both safety and effectiveness. When parents and physicians are cautious and attentive, SSRIs can be prescribed to children with a fair degree of safety. However, other side effects appear in younger patients that do not seem to affect adults. Hyperactivity, for example, is one such side effect of SSRIs that is confined to children and adolescent patients.

A review of previous studies revealed that so-called “activation events” might be extremely common in children taking certain antidepressants. Activation events are defined by abnormal energy, hyperactivity, and disinhibition. None of these effects reaches the level of mania, however, and sometimes it’s difficult to distinguish between “normal” activity levels and hyperactivity in young children. In a clinical trial of Luvox (fluvoxamine) prescribed to children, nearly 50% of participants experienced an activation event. Age appeared to be a significant factor—younger children were more likely to experience these side effects. Blood tests also showed that children who experienced activation events had higher concentrations of Luvox in their blood, despite lowering the dosage to mitigate side effects. This suggests that the medication is metabolized differently depending on the individual.

In the case of Luvox, hyperactivity as a side effect is not typically serious enough to require a change of medication. If the side effect is accompanied by self-injurious behavior, however, then a medication change is likely the best solution. Insomnia and aggressiveness are also signs of mania beyond simple hyperactivity. In a review of published work, researchers determined that demographic or family characteristics were not predictive of activation side effects. In addition, these side effects typically diminished and did not recur once the dosage was lowered.

In summary, because of differences in metabolism and physiology, children and adolescents react differently to medications. With Luvox and other antidepressants, there is a strong possibility of hyperactive or disinhibited behavior but not to the point of mania. Physicians and parents should always monitor children taking antidepressants for signs of worsening symptoms or suicidal tendencies. The side effect of hyperactivity by itself is generally not considered to be a cause for concern.

References

1. PubMed Health [Internet]. (n.d.). Bethesda (MD): National Library of Medicine. Fluvoxamine. National Center for Biotechnology Information. Retrieved April 4, 2012, from http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000955/
2. Reinblatt, S.P., dos Reis, S., Walkup, J.T., Riddle, M.A. (2009). Activation adverse events induced by the selective serotonin reuptake inhibitor fluvoxamine in children and adolescents. Journal of Child and Adolescent Psychopharmacology, 19(2), 119-126.

Most individuals who attempt suicide unsuccessfully will only do so once and make that decision within the hour preceding the attempt. “To kill oneself, one must have the means for doing so,” said researchers from the University of Texas Health Science Center at San Antonio and the University of Utah. “It is because of this very simple and undisputable fact that means restriction is often recommended as a risk management strategy.” Means restriction involves limiting access to items that could cause self-harm. Means restriction counseling, which differs significantly from means restriction, is a process by which a therapist educates the suicidal individual and their family members about the hazards of having access to harmful items and encourages limiting availability to them.

The researchers believe that physical means restriction, specifically as it relates to firearms, the leading method of suicide, is critical and has been proven to be effective. They said, “One particularly well-known example is the District of Columbia’s Firearms Control Regulations Act, which was associated with a 38% decrease in firearm suicide rates in the District of Columbia and a total suicide rate decrease of 22%, with no effect on neighboring counties unaffected by the law.”

Despite these facts, less than one quarter of clinicians in emergency settings offer means restriction counseling. The researchers believe this is due in part to the fact that many clinicians misinterpret the suicide attempt as an effort to kill oneself rather than an effort to decrease psychological pain. “It is therefore recommended that clinicians present means restriction as a method for maximizing environmental safety to accomplish the shared goal of pain remediation,” said the team. To avoid conflict with the client, the researchers recommend utilizing a “Means Receipt” which provides a plan for limiting the client’s access to lethal means, commitment of a supportive ally to ensure the plan is enacted, and the conditions which must be met in order to lift those restrictions.

Reference:
Bryan, C. J., Stone, S. L., & Rudd, M. D. (2011, August 29). A Practical, Evidence-Based Approach for Means-Restriction Counseling With Suicidal Patients. Professional Psychology: Research and Practice. Advance online publication. doi: 10.1037/a0025051

This article contains detailed information and accounts of suicidal ideation & behavior. If you or someone you know may be considering suicide, get help now.

To continue to discuss the very different types of experience people have with depression, this is one that most people don’t experience, but is important to address, since some do. Suicide is not in this case a tool to get people to do or feel what the suicidal person wants; it’s simply the ultimate way to make unrelenting emotional pain stop.

I believe people’s experience of the emotional pain of life varies tremendously. Some of this is due to genetically influenced brain chemistry and resilience, but much of it is due to how much trauma and emotional hurt, loss, injustice, abuse, and other painful experiences people have experienced. We have beta endorphins in our brains to numb pain and create euphoria, so we can handle both physical and emotional pain. But people are born with varying amounts and life events can influence our supply as well. For people with very little of this chemical, life is much more painful. (more…)

A new article reveals that most teens that struggle with depression do not receive treatment. Each year, almost 2 million teens report having experienced an episode of major depression. However, only 30 percent of them receive treatment for the symptoms of anxiety, sadness, guilt and irritability. The findings were revealed by the Substance Abuse and Mental Health Services Administration, in an effort to raise awareness at the severity of mental health issues in children. The study indicated that nearly 15% of teens had considered suicide in the previous twelve months, and the findings hope to help discover which children are at greater risk in order to implement the proper interventions and therapies to prevent injuries and death.

The Centers for Disease Control and Prevention report that 4,400 American adolescents and young adults commit suicide annually, and another 150,000 receive treatment for self-injuries. The Center confirms that the majority of children who take their own lives had a diagnosable and treatable mental health condition and often exhibited symptoms in the months leading up to their suicide. The study also revealed that children who reported symptoms of depression were more likely to engage in addictive and abusive behaviors involving drugs, cigarettes and alcohol. The report targets these children specifically in order so that professionals “can turn a life around and reduce the impact of mental illness and substance abuse on America’s communities,” said Pamela S. Hyde, an administrator for the agency. (more…)

Many children grow up facing distinct challenges within their family lives, though some are presented with pronounced difficulty that may have the potential to negatively impact the child’s adult life. The suicide of a parent during childhood is a markedly traumatic experience that may require special care and therapy treatment, and professionals have been interested in the effects of such an event on children for some time. In a study performed at Johns Hopkins Children’s Center, researchers recently investigated the potential impact of parental suicide on children’s own likelihood of committing the same deed later on in life.

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To carry out the study, researchers focused on statistical data that spanned over the course of thirty years for a group of people in Sweden. Parents involved in the data had either died through suicide, through an accident, or through an illness, or were still alive. The children of these parents were then analyzed for their subsequent rates of psychiatric hospitalization, convictions of violent crime, and death. The study found that children whose parent died through suicide were three times as likely as children with living parents to commit suicide themselves, though this discrepancy disappeared when the children were eighteen or older at the time of the parent’s death. Children whose parent died in an accident while the child was thirteen years of age or younger were twice as likely as kids with living parents to commit suicide, and this tendency likewise disappeared in children of older ages. The death of a parent as the result of illness did not seem to have any impact on suicide rates. (more…)