Category Archives: Mental Health News

Complementary and Alternative Medicine: Be Informed!

According to findings from the 2007 National Health Interview Survey (NHIS), approximately 38% of American adults used some form of complementary or alternative medicine (CAM) and spent about $33.9 billion on CAM services and products. The increased use of CAM shows that individuals are seeking ways to enhance their health and wellness; however, the effectiveness and safety of many CAM therapies are relatively unknown.

To gain a better understanding of the effectiveness and safety of CAM, the National Center for Complementary and Alternative Medicine (NCCAM), part of the National Institutes of Health, sponsors and conducts research using scientific methods and advanced technologies to study CAM practices. On the NCCAM website, there are several health topics and studies that address CAM practices, including mental health. This information can help guide informed decision-making among individuals and healthcare professionals.

It’s important to talk to your doctor if you decide to use CAM practices, especially if you have existing health conditions, using prescription medications, or over-the-counter medications. The following tips, provided by NCCAM, can help you talk to your health care providers about CAM.

> When completing patient history forms, be sure to include all therapies and treatments you use. Make a list in advance.
> Tell your health care providers about all therapies or treatments—including over-the-counter and prescription medicines, as well as dietary and herbal supplements.
> Don’t wait for your providers to ask about your CAM use. Be proactive.
> If you are considering a new CAM therapy, ask your health care providers about its safety, effectiveness, and possible interactions with medications, both prescription and nonprescription. (Download the Steps to Wellness Medication Form to keep track of your medications, including dietary and herbal supplements)

For more information, please visit the NCCAM website at www.nccam.nih.gov

Medication vs. Therapy?

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.

Heat Alert! (And Budget Settlement?)

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.

FDA Safety Alert – Risperidone (Risperdal) and Ropinirole (Requip): Medication Errors – Name Confusion

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

Heat Alert

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

Anti-inflammatory drugs may decrease the effectiveness of SSRI antidepressants

A study published online in the Proceedings of the National Academy of Sciences, suggests that anti-inflammatory drugs may decrease the effectiveness of SSRI antidepressants. Researchers at the Fisher Center for Alzheimer’s Disease Research at The Rockefeller University found that mice that were treated concurrently with SSRI antidepressants and anti-inflammatory drugs had diminished behavioral responses compared to mice treated with SSRI antidepressants alone.  To see if this finding had the same effect on humans, the researchers examined data extracted from the completed National Institute of Mental Health funded STAR*D study. The findings from the STAR*D data showed that individuals that were depressed and taking an SSRI antidepressant and an anti-inflammatory drug were less likely to have their symptoms relieved (40%), compared with individuals that were depressed and taking an SSRI depressant, but not taking an anti-inflammatory (54%).

Experts caution that this is a preliminary study and further studies need to be done. Individuals should not change their medication regimen based upon these recent findings, but should follow the advice of their prescribing physician.

Is your medical care working for you?

Care Manager vs. Primary Care Provider…does it matter who you are seeing in regards to your health?  In some cases it may.  NIMH supported research has shown benefits for people with multiple medical conditions who use primary care plus case-managed care.

According to CMSA, the term “case management” is defined as “collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual’s health needs through communication and available resources to promote quality cost-effective outcomes.”

To evaluate the effectiveness of this combined approach, Wayne Katon, M.D., of the University of Washington, and other colleagues conducted a study that zeroed in on methods of care for patients with diabetes or heart disease and depression.  Patients such as these, on average, tend to practice poorer self-care methods and experience more complications due to treatment.

To aid in decreasing these detrimental issues researchers developed a model in which a nurse care manager and primary care provider coordinated care.  This approach was used to ease depression symptoms and improve medical conditions.  Of the 214 patients that participated in this study, half experienced a 12-month trial with the additional case management. In this trial the nurse care manager’s role was to act as an advocate for the patients by informing them about their medical condition and by motivating them to take a more proactive role in their treatment.  The remaining half of the patients were treated with usual care, solely by a primary care provider.

The two groups were compared and the result of this study showed that patients experiencing the case management found it to be a successful approach.  More  of these patients reported a decrease in depressive symptoms, improved blood glucose levels, and improved blood pressure when compared to patients that only received the primary care.   The recipients of the additional resources also reported better overall wellness and felt their care had improved.

Currently in action, The Diamond Program and MN 10 by 10 have been implemented in Minnesota to promote  holistic approaches to mental illness.  The Diamond program includes primary care physicians, consulting psychiatrists, care managers, and other mental health specialists working together to provide the best care for patients.  The care manager plays an important role in this process in that they manage the components of the program for the patient.  The patient is responsible for taking an active part in their own care. MN 10 by 10 aims to reduce early mortality of the persons with mental illnesses by 10 years in 10 years. Similarly, this program focuses on improving primary care by educating health care professionals (social workers , case managers, primary care physicians, counselors etc…).  They also provide information such as health check lists are available to patients so they can learn how to get the most for their doctor visits.

At the end of the day it is important for these programs to continue educating health care professionals on how to built the best possible care for individuals faced with multiple medical conditions.  This will hopefully generate more satisfied patients who then become motivated to take better care of themselves.

At MHAM we offer Steps to Wellness that can be use as a helpful guide in learning how to motivate yourself in terms of improving your own wellness. To order the Steps to Wellness kits, please call us at 651-493-6634 or kits can also be ordered online. Individual items from these kits can be downloaded from our website as well. Providers that need multiple copies, please contact Brett Dumke, Education Coordinator, at brettd@mentalhealthmn.org.

This post was written by Jahna Sandkamp, who is interning with MHAM this Spring.

It’s not that simple…

By Ben Ashley-Wurtmann, MHAM Policy and Outreach Associate

In the wake of the tragic shooting in Arizona, many people have been asking questions about the mental health system and how it responds to individuals who may be capable of violence.  We believe that a strong health system is better able to handle individuals in crisis when it focuses on providing a strong continuum of care.  When every case is an emergency, few people will get the kind of care they require.  However, some of the discussion around the nation has been focused on the perceived danger presented by “the mentally ill.”

The truth is that people with mental illnesses vary greatly in terms of the symptoms they experience, the personalities they have, the experiences they have lived through, and the extent to which their illnesses affect their daily life.  Simply put, there is no one experience of mental illness, or even a particular condition, such as schizophrenia.

An interesting article was posted by the Wall Street Journal, questioning the validity of link of violence and mental illness caught our attention.

But another, more recent study showed that people with schizophrenia are no more likely to commit violence than those without mental illness. That research did find an increased risk of violence among those with schizophrenia who are also using drugs or alcohol.

Complicating things is that even if someone with schizophrenia commits a violent act, the illness isn’t necessary[sic] the reason for the behavior, say experts. With regard to Loughner, “my concern is that people immediately leap to the explanation that [the mental illness is] the master answer to why he committed this crime,” says Swanson. “It’s much more complicated than that.”

These are both important points to keep in mind.  Mental illnesses do not automatically make people violent, nor do they explain everything there is to know about a person.  More than ever, the public understands that mental illnesses are biological and treatable.  Unfortunately, this has not led to a reduction in stigma. This is an ongoing conversation at MHAM as we pursue our vision of improved lives for people with mental illnesses.  You can find more about how stigma works and how we are changing our struggle against it in our recent newsletter (page 4), on our blog, in the news, or by contacting us at info@mentalhealthmn.org.

Expanded Medical Assistance

As promised and expected, Gov. Dayton signed an executive order to expand Medical Assistance (MA) eligibility for single adults under %75 of the poverty line.  Federal law will expand eligibility even more in the future, but these changes are not scheduled to take place until 2014.  In the mean time, states are being given options to begin the transition early.  Under Gov. Pawlenty, Minnesota had declined these funds, but signed a compromise that would let the next Governor to take action.

Dayton’s signature on this is a major step forward.  MA, unlike the weakened GAMC plan that emerged last session, is a comprehensive plan.  It allows eligible individuals to seek treatment at any number of hospitals and clinics, not just a handful of locations in the Twin Cities.  Unlike Minnesota Care, it offers real coverage for expensive inpatient hospitalization for those least able to afford it.  While we are still waiting on information about how long the transition will take place and individuals are enrolled, we are very heartened to have good news to share.  Particularly for individuals who have lost work or housing and are living with mental illnesses, Medical Assistance represents a better hope for good quality medical care.

This is going to be a difficult legislative session, as the Governor and Legislature wrestle with a 6.2 Billion deficit.  Further cuts are all but inevitable.  With expanded MA, more low income individuals will be able to access resources they need to keep themselves healthy and safe.  For Minnesotans with mental illnesses, this is a victory.

Please stay tuned for further updates and stay in contact with your state legislators.  You can find out who represents you here.  They need to hear from you early and often as they consider the steps necessary to balance the State’s budget.  Let them know why your services are important to you and your community.

Volunteers Sought for Hennepin County Citizen Advisory Boards

The Hennepin County Board of Commissioners is seeking applicants from the community to fill positions on seven citizen advisory boards, including the Adult Mental Health Advisory Council. This 32 member council advises the County Board on adult mental health issues within Hennepin County and monitors, studies, and comments on mental health issues at the federal, state, and local levels. Members serve three-year terms and meet monthly on the third Thursday from 2:00 until 4:30 p.m. The council meets at the Hennepin County Hosmer Library in Minneapolis. located at 347 East 36th Street. Volunteers must be a resident of Hennepin County to be eligible to serve on the council.

For more information or to apply for this volunteer position, please visit the Hennepin County website.

Applications will be taken through Friday, January 7, 2011.