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By William M. Petrie, MD

Suicide

Suicide is a terrible but preventable loss of loss which also produces lifelong effects in the victim’s family and friends. Almost 1% of the US population will die from suicide with men out numbering women. It is estimated that 12-15 suicide attempts occur for every death. Young people 15-24 are especially vulnerable, where it is the third leading cause of death. Another group of people at high risk for suicide are those over 45 (especially men) who are widowed or divorced with recent medical problems.

Research has shown that psychiatric illness is present in most suicide deaths and that half suffer from depression. Drug abuse and alcoholism are present in almost half of suicides, as is seen in the famous suicide deaths (River Phoenix, Marilyn Monroe).

People with suicidal thoughts or impulses may communicate these feelings to others. In addition, changes in sleep, weight loss, and increase in drug and alcohol use. It is common for people with suicidal thoughts to have recently seen their physician.

Guns are the most common methods of suicide because they are available and immediate in their effect. In states in which guns are more available, suicide is more common. Drug overdoses are the second more frequent cause of suicide, but they are much slower and allow the victim to reconsider their action.

Two thirds of suicidal persons communicate their feelings to others and because of this there are opportunities for friends or family to intervene. Suicidal statements should always be taken seriously and professional help sought.

Suicide treatment includes diagnosis of psychiatric or medical problems, as well as attempting to understand suicide as a response to stress or other problems. Family support and psychiatric treatment greatly reduces suicide. Guns and other means of suicide (bottles of dangerous pills) should be secured. The presence of a gun in the household triples the risk of suicide. It is helpful for those feeling suicidal urges to talk to family or supportive friends.

Crisis call and suicide lines are available. The Jason Foundation is a Middle Tennessee organization that provides training and awareness of youth suicide, which has increased disturbingly on recent years. Call for more information to Rolling Hills Hospital at 800.832.0388.

By James R. Hart, MD

Are Antidepressants Being Overprescribed?

It is rare that someone comes to my psychiatric practice for the first time not currently taking an antidepressant or having taken one in the past. In discussions with my internal medicine colleagues, they frequently comment on the increased use of this class of medications in their patient populations. So, a frequent question is: Are antidepressants being overprescribed?

There are several reasons given for the increased use of antidepressants. There are more medications available for use, they are typically well-tolerated, and there is generally less stigma of mental illness with a growing acceptance of drug treatment by the public. There has also been a significant increase in direct-to-consumer advertising for antidepressant drugs. Additionally, the indicated use for antidepressants has expanded beyond pure depressive illness.

There is also the suggestion that prevalence of major depression may be increasing in the general population, or at least people are more willing to disclose that they have depression.

So, are antidepressants overprescribed? A more accurate question is whether individuals with depressive symptoms are getting appropriate treatment. Clearly not every individual with depressive symptoms needs an antidepressant medication. It is concerning that the use of psychotherapy is diminishing. Psychotherapy can be a very effective treatment for depressive symptoms. Exercise can also be an effective treatment for depression, but persuading a sedentary depressed person to exercise is a tall order.

(Dr. Hart is Clinical Director of Adult Services for Rolling Hills Hospital in Franklin, TN. If you or a family member are in crisis from any behavioral health issue, you may call 1-800-832-0388 for assistance.)

By E.M. Karl, MD

Could Addiction Be Ruining Your Life?

We live in a world of immediate gratification. We are bombarded with a media blitzkrieg every time we turn on the television. The take-home message is sometimes crystal clear, and sometimes a little less obvious. Regardless of the clarity of the message delivered, we are often left feeling as though something is missing in our lives. “I’m not driving the right kind of car or truck.” “I don’t have the perfect job, house, kids or even spouse.” “I don’t wear the right kind of clothes, cologne or perfume for that matter.” “I don’t eat the right kind of foods.” And perhaps the most angst provoking of all, “I don’t have that perfect body that I see on the commercials for gym membership or exercise equipment.”

Adding to the stress of all of these perceived shortcomings in ourselves is the realization that we will not likely reach these unreasonable goals. The pace of life is such that most of our energy is spent on working to support our family, taking our children to school, doctors, dentists, baseball practice, cheerleading practice or to the local park for a birthday party. The result of this conflict concerning what we “should” be in order to “look” successful and the reality of living in a real life and dealing with everyday challenges is all too often a sense of emptiness, which leaves us searching for something more, something to give us the illusion, even if for only a brief moment in time, that we “measure up.”

Unfortunately, this toxic combination of the need for immediate gratification and the yearning for that illusory feeling of being successful or “measuring up” is a perfect set-up. For persons who are genetically predisposed to addictive disorders or whose environment places them at an increased risk for addiction or compulsive behaviors, the lure of an easy, quick solution may become overpowering.

For some individuals, turning to alcohol, pills, street drugs, gambling, shopping, or even compulsive sexual activity, such as pornography or affairs, can offer a brief reprieve from the chronic daily stressors of life.

The progression of any of these behaviors, if destined to become an addiction, is usually predictable. Initially, a chemical or behavior is found to offer great relief; it takes on a certain quality of novelty. A lot of time is spent thinking about engaging in the behavior. The next stage is trying to limit one’s engagement in the activity, whether it be alcohol and drugs or compulsive behaviors, and repeatedly failing to live up to the self-imposed limitations which often take the form of promises to loved ones, co-workers or oneself. It is at this time that problems in life have begun to appear as a direct result of the addictive behaviors.

The final stage of this process is continued use of the substance despite serious, often dire, consequences in one’s life. The consequences are pervasive and involve problems with the law, work environment, marital/family setting, financial matters, as well as erosion of emotional and physical health. In fact, death, either by suicide, accident, or a wide variety of acute or chronic substance-induced diseases, is not an uncommon final result of addictive behaviors.

Now for the good news. Help is available and federal laws mandate strict confidentiality when individuals enter the healthcare system. Immediate inpatient stabilization is now common place in most hospital settings, and there are unlimited community support services to meet the needs of anyone recovering from an addiction. Help is just a telephone call away. If you feel that you or a loved one has a problem with addiction, call 1-800-832-0388 for confidential assistance in beginning the road to recovery.

(Dr. Karl is associated with Rolling Hills Hospital, Franklin, TN.)

By Kurt Klauburg, DO [November 2009]

Medicare and Mental Health

For those of us who are covered under Medicare, we are well aware that Medicare discriminates against coverage for treatment of mental illness. When you visit your family physician, Medicare demands a copay of 20% from you or your supplemental insurance policy. However, if you see a mental health physician (Psychiatrist), that copay rises to 50%. Why this disparity? It originally dates back to the 1960’s when President Lyndon B. Johnson, first proposed Medicare coverage for indigent elderly patients. The reasoning at the time was that mental illness was under the control of the patient, and if the patient paid more for their care, they would get better faster. This way of thinking quickly spread into the health insurance industry, and the “Mental Health Copay” emerged. As time progressed, insurance companies used this “disparity”as a means to lower reimbursement for mental health services.

On July 15, 2008, Congress enacted the Medicare Improvements for Patients and Providers’ Act of 2008. Among other things, this Act effectively paved the way for removal of this extra mental health charge. This has been referred to as “Parity” in the press, or an equalization of the coverage for mental health and medical health issues. Therefore, Medicare will eventually approach coverage the same, regardless of the type of care you receive. The mental health copay is scheduled to drop to 45% in 2010, and down to 20% by 2014 and thereafter. This will eventually put mental health care payment on the same level with general medical care. If the past experience is any indication, the private health insurance companies will follow suit and eliminate this “disparity” in coverage from their plans as well.

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