Which of these treatments is most effective?  This is a question that doesn’t always have a clear answer.  Antidepressants have become the most frequently prescribed drug in doctor’s offices and outpatient clinics today.  In fact, between 1996 and 2005 the number of people in the United States taking antidepressants has doubled in size.

In a recent study, “Psychotherapy Versus Second-Generation Antidepressants in the Treatment of Depression”, researchers attempted to find a more clear answer to this frequently asked question.  This study when compared to past research focused more on comparing the “newest” drugs (i.e. Paxil, Zoloft, and Prozac) to psychotherapy administered by a “qualified” provider.  A majority of previous studies were comparing older drugs to psychotherapy which left an incomplete picture of the comparative effectiveness.

This study was a meta-analysis, meaning they looked at data from 15 studies of similar topics.  In the process of choosing these 15 they had to eliminate studies that were using inadequate treatment methods. This would include studies that included untrained psychotherapists or variables that affected treatment quality such as:  switching of treatments, changing of dosages of medication and/or changing frequency of psychotherapy.  Another factor taken into consideration was the level of depression of the participants.  Depending on severity of depression (mild, moderate, or severe) outcomes and effectiveness of medication and psychotherapy may vary and treatment recommendations may differ.  To improve accuracy this study focused only on participants that were diagnosed with major depressive disorder.

The result of this study found that psychotherapy can be just as effective in the treatment of depression when compared to the newest of antidepressant medications. It was also noted that in the long run psychotherapy showed slightly better results.

So the question is; did they come up with a clear answer?  When comparing risks, benefits, and cost the course of treatment is ultimately up to the individual and their providers.  Some questions to discuss with your doctor might include:

• How severe are my symptoms? How long have I experienced these symptoms?  In what ways do they impair my goals for my health?  Other research has indicated that anti-depressants are most effective for depression that is severe and/or chronic.
• Are their side effects that are more concerning to me?
• What are barriers to me following a treatment?  Can I remember to take medications as directed?  How will I get to appointments for therapy?  Do I have a plan for what to do if I relapse?

We still need more research to be completed that focuses on the effectiveness of these treatments.  Depression today is the fourth leading cause of disability in the United States and it is predicted to be the second by 2020.  It is essential for people with mental illnesses to understand the facts so they can make educated decisions with their doctors about which treatments are most suitable to their specific needs.

This post was written by MHAM Intern Jahna Sandkamp.

In more ways that one, the recent budget settlement is about going back to work.  The state government ordered employees to report as normal this morning, and will be bringing back functions and services as able.  For the politicians, they now go to the task of explaining, spinning, selling their actions to their constituents.  For us?  It means trying to fully understand where the impacts of this budget will be felt, and setting the stage for next year.

Because Minnesota borrowed money to patch the budget, it is very unlikely that we have hit bottom in terms of service cuts and reductions.  State grants to counties have been cut, something that we tried very hard to avert.  Much like in the years leading up to the successful reforms of 2007, we find ourselves with a mental health system with less and less capacity to foster recovery and support people in the community.  What will it take to get another victory, and start investing in mental health again?

But there are bright spots, as well as concerns.  Counties will still have spending requirements for mental health services (known as maintenance of effort).  This has been a major point of contention, and we are very relieved to see this.  The efforts to repeal the expansion of Medical Assistance were turned back.  And some of the crisis grants that help get people to treatment instead of taxing the 911 system were preserved.

This is a very mixed verdict, and one that will be difficult for many of us.  MHAM is more determined than ever to make the case at the capitol for community mental health.  We are so grateful for everyone who called, wrote, and pushed their legislators to consider the impacts.  We hope you will stick with us over the break (we will update as needed, but less often than in session) as we get ready for another chance to make things better.

For more details, please read our update on the website.

More heat is on the way for Minnesota.  Please take care of yourself, and check in with folks who may be sensitive to heat.  For more information, please check out our entry from earlier this summer.  Keep drinking water, maybe check out a library or other public build that has AC, and stay safe.

In other news, we may have a budget and an end to the shutdown in sight.  You can find our more on our legislative update page.

Are you feeling the impact of the state government shutdown yet?  If you care about accessible mental health service, the chances are you have.  Not not everyone is equally affected.

As the shutdown drags on, however, the number of people impacted is going to expand greatly. Construction projects are stalled, some restaurants can’t restock because their liquor license has expired.  Racetracks and state parks are closed.  Resorts are losing business, because fishing permits are on hold.  Lottery tickets can’t be purchased in MN.

While the ability to enjoy many of these recreational opportunities will not be “critical” as defined by Judge Gearin’s rulings, they are the kinds of things lots of folks notice.  We hope that people will take their frustration about these things and join the chorus: find a budget compromise, as free as possible from divisive policy issues, and get the state back to work.

We all play a role in creating the voice of the people.  Not everyone uses every service the state provides.  You might notice a different impact of the shutdown than what others do.  So speak out, and make sure your priorities are heard.  We need to make sure that we are reminding our elected officials that we expect the state to continue to fund programs and services that help make recovery a possibility for all Minnesotans with mental illnesses.

For more detail, please see our weekly update.

It strongly appears that we are no closer to an approved budget, despite getting one week closer to the final deadline before a government shutdown. This week’s update has more details on what some of the court filings have been and the issues that remain.

We are encouraging anyone who can to join us on Tuesday evening for a candlelit vigil on the steps of the State Capitol Building.  We’ll be there with other groups in the Mental Health Legislative Network, reminding policymakers of the impact of both the cuts that are proposed as well as the interruption of a shutdown.  For more information, you can check out the event here.

This morning, Judge Kathleen Gearin made initial rulings on some of the petitions before the courts.  She dismissed arguments from both sides, refusing to appoint a mediator as Dayton had asked, but also declining to order a special session of the legislature.  She pointedly reminded both sides of their ability to solve these issues and spoke of her concern of the potential impact of a shutdown.

Although the health care bill has recently passed, many of the new provisions will not take effect for some time.  For recent college graduates, staying on their parents’ coverage may be a good option since many insurance companies have already expanded their coverage to the children of dependents until they are 26.  As of last fall, health plans must offer this.  However, this might not be an option for everyone.

One important thing during this time of transition is to be consistent with a medication plan. In order to do so, it is a good idea to talk to your doctors before your coverage changes in order to develop strategies so that you guarantee continued coverage of your medication.  This will insure that you stay healthy both physically and mentally.  Getting a prescription for a 90 day supply is one potential option.

If you plan to buy your own health insurance, learning about the different options and plans is crucial.  First, it is a good idea to figure out how long you may be under or uninsured.  This would help you to decide if you should look at short-term health insurance plans or more long term plans.  Healthcare.gov has information on eligibility for public and private health insurance plans.  EHealthInsurance.com is a for-profit website, but can offer a useful comparison of different private plans.

Many insurance companies that provide short term insurance, offer plans where you can buy insurance a month at a time, usually for up to 6-12 months.  However, it is important to understand that short-term plans only provide coverage in the event of an emergency or a catastrophic event.  Many short-term plans don’t cover regular check-ups, pre-existing conditions, prescription medications, or other preventative care needs.

When considering a health insurance plan, learning about the limits and constraints of high deductibles vs. low deductibles, as well as the premiums is vital.  When considering an insurance plan, the annual deductible is the amount of money you have to pay out of pocket before your health insurance kicks in.  Normally, the higher the deductive, the lower the premium, or monthly payment.

Along with the security of health insurance, there are also several clinics that offer sliding fees. Depending on your income and other expenses, certain clinics can adjust the price of their services and other health care needs.  You can find more resources on our website or by calling one of our individual advocates.

Though graduation is accompanied by celebration and excitement, there are also lots of things to start thinking about.  It is especially important for people with mental illnesses to plan ahead when thinking about health insurance.  This summer in particular may leave many people not only jobless but also without the medical coverage they need.

Speaking with health care professionals and advocates can help.  They possess the tools and resources that can help in alleviating possible long-term stress or more serious illnesses.  Taking the time to learn about your options and coming up with a strategy now will certainly help you avoid the pain and anxiety of being in need of medical care later, and not having the coverage to afford it.

This post comes from volunteer blogger Margo Tell.

The Food and Drug Administration (FDA) notified health care professionals and the public of medication error reports in which patients were given risperidone (Risperdal) instead of ropinirole (Requip) and vice versa. In some cases, individuals who took the wrong medication needed to be hospitalized. The FDA determined that the factors contributing to the confusion between the two products include: 1) similarities of both the brand (proprietary) and generic (established) names; 2) similarities of the container labels and carton packaging; 3) illegible handwriting on prescriptions; and 4) overlapping product characteristics, such as the drug strengths, dosage forms, and dosing intervals.

Individuals who take Requip, Risperdal, or their generic equivalents are reminded to take note of the name and appearance of their medication, know why they are taking it, and to ask questions when the medication appears different than what they expect. Healthcare professionals are reminded to clearly print or spell out the medication name on prescriptions and make certain their patients know the name of their prescribed medication and their reason for taking it.

For additional information on this FDA drug safety alert, please link to: http://www.fda.gov/Drugs/DrugSafety/ucm258805.htm

Right now, we do not know if there will be a shutdown.  We don’t know how long it would last if it happens.  We don’t know for sure what services will be “essential” and what will stop.

We do know that it will be a bad outcome for so many.   Interruption of services, financial strain on  community health providers, loss of health insurance…

Please check out our update this week on what we’re seeing, and how you can help get a budget that is fair to Minnesotans with mental illnesses.

We’ve had a few hot days in Minnesota, and hope you all are beating the heat.

Individuals on certain medications may be more vulnerable to heat stress. Persons taking regular medication should consult with their physician.  Some medications cause an adverse reaction in hot weather, such as reducing a person’s ability to sweat. If you are on such a medication, or if you know someone who is, please take a look at these strategies for managing heat stress.

To avoid heat-related illness:

• Avoid, as much as possible, working or playing in the hot sun or other hot areas.  If you must be out in the sun, wear a head covering and sunscreen.  A wide brimmed hat or visor will not only protect your head from intense rays of the sun; it will also provide a shield for your eyes.
• Shut blinds and open windows slightly during the day to release trapped hot air.  Use air conditioners if you have them.
• Wear lightweight clothing.
• Drink plenty of water and fruit juices; avoid alcohol, carbonated or caffeinated drinks.  Because the body loses fluids in the heat, drinking lots of liquids helps to avoid dehydration.
• Eat frequent, small meals; avoid high-protein foods
• Take cool baths or showers—cold water can lower body temperatures 25 times faster than sitting in an air-conditioned room
• Spend time (even 2 hours will reduce the risk of heat-related illness) in an air-conditioned environment or basement; cover windows to block direct sunlight; turn lights on low or off; use fans to blow hot air outside.  Public libraries, community centers or other similar locations may be a good option for spending some time away from the heat.
• Do NOT direct fans to blow in at you.  Fans can actually increase heat stress.
• Do not leave older people, children, or pets, alone in cars.

Non-emergency questions about how to stay cool—call 2-1-1 or for emergency heat-related health problems—call 9-1-1

This week’s update really puts a focus on how cuts in the last few years have effectively rolled back the bipartisan 2007 reforms.  $34 million of new grant money was going to really change the way that mental health services are delivered in the state, by putting more focus on the community providers and what we can do to keep people from needing in-patient care.

The good news is that it worked.  Hospital bed days were down, crisis services were started, and people got the help they needed, where they were. (Link goes to PDF)

The bad news is that last year’s cuts totaled 15 million.  The proposed HHS budget that Gov. Dayton vetoed for being too drastic would have cut even more than that.  In 2007, members from both parties and Governor Pawlenty proudly said that $34 million would change the system.

So what would these cuts do?