Sexual side effects of medication

A shockwave went through my family the day my cousin Anna opened a chic erotic shop in town. Some people, like my aunt, tried to cover it up by saying Anna and her husband had " become franchisers ". That wasn't a lie but not exactly the whole truth either. It all became clear to everyone the day the invitations for the opening hit the doormats with a figurative loud bang.

I was pleasantly surprised, I often like it when things are a bit "different". So I took some friends and colleagues to the opening festivities and met quite a few family members there. Some shy , giggly or clearly uncomfortable. Others unexpectedly interested and curious and going through the shelving as if it were an exclusive exhibition in a trendy museum.

I observed Anna selling her products and listened to her talking in detail about sex and erotic equipment with ease as if she was Nigella Lawson in person promoting her cooking and favorite kitchen utensils.

Lots could be learned for  mental health care from the openness of my cousin. She inspired me to get the topic of sexual side effects of medication higher on the agenda.

Back at work my colleagues and I made a checklist for physical health to be used at care evaluations. Sexual side effects of medication was one of the topics and now much harder to neglect . And we encouraged colleagues to talk about it more.

There are many different types of psychotropic medications and they may cause a range of sexual side effects like decreased libido, erectile- or ejaculation dysfunction for men and decreased lubrication for women. For both men and women, the quality  of sensation may be less and the time it takes to reach an orgasm can be prolonged or completely impossible . Some medications are less likely to cause trouble. And some people may not experience any of the sexual side effects at all..

Sexual side effects can have a negative impact on lives and relationships. That makes it important to encourage and enable patients to speak about it.

People who are well informed about these side effects are often better prepared and more likely to comply with treatment. They know that side effects often decrease in time. But if not , a medication change,adjustment or additional medication can help to overcome these troubles. 

It's important that mental health professionals learn to discuss this subject more. It may take courage to overcome our own shyness. But there are many cases in which a solution can be found and lives  can be improved. That’s definitely worth the effort .

Sleep: Protecting An Essential Life Rhythm

Many college students do not sleep well.  In fact, the typical student pattern can best be described as chaotic.  In many cases these patterns exacerbate and even trigger poor mental health outcomes.  Bipolar and other mood disorders, for example, are known to be sensitive to inadequate or unhealthy sleep rhythms.  Sometimes sleep problems are caused by factors outside their direct control, such as loud roommates, a medical condition, or living near a train track.  In these circumstances vulnerable students should consider working toward changes in their health and living situations, admittedly not always an easy thing to do.  More often than not, however, a student's sleeping problem is caused by poor "sleep hygiene", or poor choices about sleep that are within their ability to alter.

Due to their youth and general level of energy and vitality, traditional-aged students may grossly underestimate their ability to cope with chaotic life rhythms.  The average 20-year old can in fact rebound from sleep deprivation better than, say, the average 40-year old.  But this subjective feeling may mask an underlying deterioration which may be occurring, even at the cellular level.  So, students can pull off all-nighters for a time, but that habit is soon to catch up with them in the form of worsening mood, impaired ability to focus and concentrate, and diminished academic or athletic performance.

One simple set of guidelines to follow: pick and stick to a regular, reasonable rise time, avoid daytime naps, and use the bed only for sleep and other relaxing activity.  Seven to nine hours of nighttime sleep may be ideal.  But there are other tips which may be helpful.

Here is a list of practices conducive to good sleep, adapted from the American Academy of Sleep Medicine (2002):

• Try to sleep only when you are drowsy.
• If you are unable to fall asleep or stay asleep, leave your bedroom and engage in a quiet activity elsewhere.  Do not permit yourself to fall asleep outside the bedroom.  Return to bed when - and only when - you are sleepy.  Repeat this process of often as necessary throughout the night.
• Maintain a regular arise time, even on days off work and on weekends.
• Use your bedroom only for sleep and relaxing activity.
• Avoid napping during the daytime.  If daytime sleepiness becomes overwhelming, limit nap time to a single nap of less than one hour, no later than 3 pm.
• Distract your mind.  Lying in bed unable to sleep and frustrated needs to be avoided.  Try reading or watching a videotape or listening to books on tape.  It may be necessary to go into another room to do these.
• Avoid caffeine within four to six hours of bedtime.
• Avoid the use of nicotine close to bedtime or during the night.
• Do not drink alcoholic beverages within four to six hours of bedtime.
• While a light snack before bedtime can help promote sound sleep, avoid large meals.
• Avoid strenuous exercise within six hours of bedtime.
• Minimize light, noise, and extremes in temperature in the bedroom.

Newtown

As we learn more about yet another unspeakable tragedy we also ponder in frustration over the state of mental health care in America.  While mass violence forever changes the landscapes of educational and community institutions, we look for courageous leaders who will take the reins and improve the accessibility, affordability and effectiveness of mental health services for the most vulnerable among us.


In higher education settings, the lives of every member of a campus community have been and will be deeply affected by fears of violence.  Alert systems, enhanced reporting and communication methods concerning potential threats, response teams and capable public safety operations are all now a part of daily campus life.  We have gotten better at identifying and providing initial responding to students in distress.  But what do we do after that?

The answer is a feeble one.  In many jurisdictions, there aren't enough psychiatric beds to hold all the individuals who may be of concern.  There aren't statutes which permit a mental health professional to issue an order to law enforcement to detain a threatening individual and hold him or her in a hospital   The process of petitioning for commitment in these same hospitals can take weeks, even longer.  The average stay in those hospitals may be two to five days.  For many, especially the un- and under-insured, there may be a long wait to follow up with a mental health professional after discharge.  Hospitals are closing, patients are being released into "community care", but there may be no such thing in reality.  In short, all the current incentives, intentional or not, are to block access to care.

As you see in the news, these issues occur at a time of threat and anxiety.  The families of the dead and maimed are looking for support and answers.  We are learning more about the factors behind and indicators of risk for potentially violent individuals.  But we can tell them more about that than we can about what to do with them.  This is a national travesty and it must be addressed.  Please press your legislators to take action.  Demand that they develop sound, sustainable funding models for state services.  Demand that they sponsor legislation that provides a rapid and seamless system of detainment and treatment for people who threaten our safety.  Tell them to support mental health insurance parity.  The folks in Newtown, Portland, Aurora, Oak Creek, Tucson, Blacksburg and many other past and future communities are waiting for our help. 

Diabetic Medication Helps Improve Memory

Researchers at the University of Texas Medical Branch at Galveston revealed that an FDA-approved medication called rosiglitazone that is used to treat insulin resistance in diabetics also enhances learning and memory. This discovery could improve cognitive performance for those with Alzheimer’s disease.

By studying genetically engineered mice designed to serve as models for Alzheimer's, “the scientists believe that the drug produced the response by reducing the negative influence of Alzheimer's on the behavior of a key brain-signaling molecule.”

The molecule in question is called extracellular signal-regulated kinase (ERK). In the brains of Alzheimer's patients as well as the mice in the study, this molecule becomes hyperactive, which leads to improper synaptic transmission between neurons thereby interfering with learning and memory.

“Rosiglitazone brings ERK back into line by activating what's known as the peroxisome proliferator-activated receptor gamma (PPARγ) pathway, which interacts with genes that respond to both PPARγ and ERK.”

Basically, the medication helps to restore signals between neurons so that cognitive functions become more normal. This research opens a gateway allowing researchers to test more FDA-approved drugs to try and normalize insulin resistance in Alzheimer's patients while potentially improving their memory at the same time. It could also lead to a greater understanding of the biology behind the cognitive issues in Alzheimer's disease.

Alzheimer's disease (AD) is the most common form of dementia. There is no cure for the disease, which worsens as it progresses, and eventually leads to death.

Symptoms:

• Memory loss that disrupts daily life.
• Challenges in planning or solving problems.
• Difficulty completing familiar tasks at home, at work or at leisure.
• Confusion with time or place.
• Trouble understanding visual images and spatial relationships.
• New problems with words in speaking or writing.
• Misplacing things and losing the ability to retrace steps.
• Decreased or poor judgment.
• Withdrawal from work or social activities.
• Changes in mood and personality.

Prevalence:

• An estimated 5.4 million Americans of all ages have Alzheimer’s disease in 2012. This figure includes 5.2 million people age 65 and older and 200,000 individuals under age 65 who have younger-onset Alzheimer’s.
• One in eight people age 65 and older (13 percent) has Alzheimer’s disease.
• Nearly half of people age 85 and older (45 percent) have Alzheimer’s disease.
• Of those with Alzheimer’s disease…
• an estimated 4 percent are under age 65
• 6 percent are 65 to 74
• 44 percent are 75 to 84
• 46 percent are 85 or older
• Every 68 seconds, someone in America develops Alzheimer’s.
• By mid-century, someone in America will develop the disease every 33 seconds.

Diabetes Drug Improves Memory, Study Suggests
Alzheimer's disease
Facts and Figures facts and figures

© www.mentalhealthblog.com

Down in a Hole

Depression.  Churchill aptly called it "The Black Dog", though the alcohol and tobacco he reportedly consumed may have made it blacker.  Depression is so prevalent that it has often been called the common cold of mental health problems.  As an example, in its most recent annual report, the Center for Collegiate Mental Health noted that 31.6% of some 74,000 students seeking counseling endorsed just a single symptom consistent with depression (thoughts of suicide) at any level.  Endorsement rates for other depressive symptoms are in similar ranges.  SAMHSA reports that 8.4% of college students have experienced a major depressive episode in the past year, but also notes that this rate is not statistically different from that for non-college peers.  Some claim that rates of mental illness among American college students have increased, and reports of increased severity and emotional states which are incompatible with college life abound.  These observations are not without dispute in the college mental health community itself, in large part because other data don't square with the hypothesis.  For example, in the Center where I work, adjustment issues, a category one can think of as reflecting normal stresses and strains of living, still are the most common presenting problem and diagnosis, as they have been for the more than 20 years I have worked there.  By the way, depression was formerly number two in this ranking.  It has recently been overtaken by anxiety, which as you will see below supports other possible theories of dynamics in student functioning.

That is not to say there are no recent dramatic changes in college student behavior.  There is no question that the number, frequency and intensity of crises, for example, have increased during my career.  This has also been a steadfast observation among my counterparts for many years now.  Some, myself included, suspect that the phenomena we are seeing may not be due to diseases as defined in the medical model but rather to impairment in coping skills, which is somehow being transmitted across society and culture.  What could possibly account for the apparent rise in severity of what looks like more serious mental health problems?


All things being equal, the student with impaired coping ability will look "sicker" than the student with better skills.  I recall a student who struggled when she realized she did not know anything about how to look for a job, including understanding the classified ads.  In her next breath she also told me she did not know the location of the book store.  My friends, these statements were made in late October.  I assure you, she "looked" depressed, and if I only used a checklist I could say she had "depressive symptoms".  But depression in the medical sense was not her problem, per se.  She had somehow missed out on some very basic life skills which created the breeding ground for her symptoms.  This is but one example of a great many crisis situations in which I have been involved.  The facts change, but the essential pattern remains the same: the stresses of an environment or situation, most often involving relationships, exceeds the ability to cope.  Symptoms of depression and anxiety are the result.  Taking this a step further, this is the way it is supposed to be.  It is a clarion call for change.

Therapists of the analytic or psychodynamic ilk understand that the number and quality of our defenses against life's slings and arrows are what protect us from negative mental health.  When these defenses are too few or of poor quality, depression and anxiety are the expected outcome.  College life is interesting partly because it represents a distinct moment in time in which a late adolescent or young adult leaves familiarity, to which they have adjusted most, and joins novelty, to which they often have adjusted the least.  Any lack of preparation is likely to be revealed in short order.  This is because the defenses on which they have relied will fail.  (What former college student can look back on that time and not see that some of their behavior was "disordered"?)  "Symptoms" are often the result of reliance on defenses which are no longer working well.  Faced with this scenario humans tend to keep doing what they have always done, thereby digging down into the hole even further.  Yes, one could call that depression and throw medicine at it.  And it may even help in the short term.  But only lasting change in defenses will get students out of that hole.

Seeing a problem in living as an external entity which inhabits us, and which requires an external intervention, is a facile act.  It relieves us, students and parents alike, of a more complex responsibility to self and others: changing our behavior.  It also happens to be supported by enormous economic forces in healthcare industries which can, intentionally or not, keep us in a hole.  Any person well into recovery from a wide range of mental health states will tell you that assuming responsibility and agency was the essential ingredient to success, even when external interventions are taken into account.  That is one sound way out of the hole.

Heroic Students

Few things in my professional life have been more rewarding than to witness college students overcoming tremendous obstacles to their success and happiness.  For most of those around them, professors and administrators, friends and sometimes even family, their struggles were invisible and silent.  Working with them in the privacy and safety of therapy, college mental health professionals are privileged to nurture their strength, shore up battered psyches, and nudge them in the directions they need to travel.

I wish I had the memory banks to tell each of their stories.  Everyone can benefit from seeing how a young adult bravely confronts horrendous conditions and accomplish things that many of us never have or will.  Here are some examples, disguised and condensed for the sake of confidentiality.

• Tyrell, 21, came from extreme poverty and at one point lived in his car on the edge of campus.  He was the first in his family to attend college, and he was determined to graduate and make something of himself.  It took unrelenting energy and conviction to rise each morning, stay awake in class, and disregard the doubts from within and without, but he got his diploma.
• Janie, 19, saddled with a history of physical, sexual and emotional trauma at the hands of adults who were supposed to be her caretakers.  Her days were filled with intense fear and phobic anxiety; just sitting in class around other students, thinking they were judging her, took gargantuan effort.  She battled impulses to harm herself and exit her life altogether, but deep inside there was a constant, though sometimes faint, voice which told her there were other possibilities in her life.  Class attendance and grades were far from perfect, but she did not give up or quit.  She registered each semester, and worked on her goals persistently, not with great force, but like ocean waves on the shore.
• Will, 23, lost and roaming in the grip of various addictions he brought to college with him.  He encountered many entanglements with friends, family, the legal system.  He had to face academic probation more than once.  Will sought treatment several times, each with the same outcome: relapse.  With enough support and encouragement he entered treatment one more time, and began a 12-step program.  There were ups and downs even then, but he did better in school and eventually graduated.
• Beatrice, 18, in great distress over her gender and sexual identity.  She encountered frequent harassment and bullying from middle school forward.  Those who professed love for her rejected her emotionally, and also communicated not-so-vague threats of disowning her altogether.  The simple act of walking across campus took immense fortitude and exhausted her at times.  Through therapy, she found supportive others and got engaged in activism and justice for all students.  This empowered her and gave her confidence to be herself and interact with others respectfully and assertively.

There are so many more stories to tell.  In each case, the student clung tightly to something dim but abiding in their core: a genuine, healthier self which sought expression and release.  So many have lost this fight.  We have all known them in our lives, and we would all do well to use our powers to "see" the whole person in front of us, imagining a great struggle in which they are engaged, and facilitating their journey into being who they really are, which is always the path to emotional health.

Experiences Shape the Brain

Much has been said and written on the subject of medication and its role in mental health care.  Perhaps too much.  Though it is growing, comparatively little has been said or noticed about other ways the brain is and can be shaped in order to improve emotional well being.  Let's take a brief look at how experiences, both positive and negative, influence brain development and functioning.

A recent study, for example, examined the transmission of anxiety from parents to children.  This research found that socially anxious parents imparted anxiety through specific parenting behaviors involving lack of warmth and affection, and criticism and doubt directed toward the child.  The role of these experiences is thought to contribute to the development of anxiety apart from genetic contributions, because the latter alone are not thought to be sufficient in the etiology of an anxiety disorder.  It does not require a tremendous leap to imagine that parental warmth and confidence provided to children reduces the likelihood of a future anxiety disorder.  The experience of warmth and confidence is more powerful, in my opinion, than any medication we would later give to the adult child to address their anxieties.  And more lasting too.

In another arena, a play-based method of teaching social interaction, called ESDM, to autistic children was shown to result in positive brain changes.  Researchers studied brain activity in both autistic and non-autistic children, after the former received the therapy for two years, and could not identity differences which are apparent otherwise.  Clearly, this behavioral intervention altered brain activity in a very desirable manner.  I'll wager that there are not many parents of children with autism who would not jump at the chance of this non-medical or intrusive intervention.  If only they were given the chance, or that such behavioral interventions were as aggressively marketed as medications are.

Currently, one has to dig deeply into the literature or perhaps be lucky enough to have an insightful and gifted care provider to access information about evidence-based psychological interventions.  The American Psychological Association does maintain resources on these interventions on their very good web site and Help Center (www.apa.org).  I encourage consumers to be educated concerning these alternatives to physiological interventions, which, in my experience are helpful at times and with some individuals, though the benefits come with cost and ultimately fade with time.

Experiences shape the brain.  Those who have experienced stress, trauma and deprivations have brains, and even appearances, which show this.  Those who have experienced positive relationships and satisfaction of needs also have brains which show that.  It would seem, given that we know this, that individuals, groups, communities and even countries would develop systems which promote the application of sound psychological principles to the advancement of human welfare.