Merry Christmas everyone

We want to wish everyone a Merry Christmas and safe and happy holidays.

There will be no more posts for the remainder of 2007, but if you're looking for help with anything you can search our archive of articles, or visit the forum for a list of agencies that deal with emergencies, or can provide a friend on the telephone.

Meri Kirihimete (that's Maori for Merry Christmas)

Talia and Nancy

P.S. If you'd like some Christmas cheer check out Talia and her Elves wishing you a Merry Christmas

Overbooked Kids

My therapy practice includes quite a few adolescents, mainly high school students. Lately, I've been amazed at how packed their schedules are. They practically have to pull out a PDA to make an appointment! When I asked one yesterday if things were winding down before the holidayr break, she looked at me like I had two heads. Evidently, the teachers are piling it on.

Of course, I can't be entirely objective about this topic. I'm a mental health professional and the kids I see are usually being treated for anxiety, depression, substance abuse, etc. So I'm looking for any causes for the pathology I'm seeing.

In an article in Psychology Today, The Overbooked Child, psychologist David Elkins talks about the stress and depression he sees in his young patients. After interviewing his patient Kevin (not his real name) and his mother, the mother dismissed the idea that her son was stressed. She maintained that he enjoyed all the activities in which he was scheduled.

"But Kevin wasn't having a good childhood. He was overscheduled and on the brink of clinical depression. When I talked to him on his own, he confided that he missed playing with his friends in the neighborhood. They used to ride bikes, have water-balloon fights and build forts out of cardboard boxes. Now there wasn't time for those activities. 'I really like being in sports and everything,' he said. 'But not all that much.' "

In the book, The Over-Scheduled Child: Avoiding the Hyper-Parenting Trap, authors Alvin Rosenfield, M.D. and Nicole Wise discuss this issue. Rosenfield believes it's the parents who are driving this, "it's how we parent today."

"Parents feel remiss that they're not being good parents if their kids aren't in all kinds of activities. Children are under pressure to achieve, to be competitive. I know sixth-graders who are already working on their resumes so they'll have an edge when they apply for college."

But what continues to surprise me about this phenomenon is that the kids are doing much of this over-scheduling themselves. They are enrolled in AP (Advanced Placement) courses to get a leg up on college, they have a certain number of hours of community service to fulfill for National Honor Society and to look good on college applications. Then there are the extracurricular things like sports, drama, music-related activities, etc. This is all on top of regular school hours and homework. This schedule leaves very little free time or family and friend time.

When I've asked them about their schedules and whether their parents are pushing it, I often here that most of the activities, including enrolling in AP courses, are their choice.

On the Web site FamilyEducation.com, they suggest ways to help your kids work towards a balance in their activities:

Help Your Kids Strike a Balance

• Help your child set priorities.


• Help your child develop a realistic schedule to accommodate family, school, sports, and everything else.


• Find out at the beginning of the season what the coach's expectations are for the team.


• Let the coach know about your child's other commitments.


• Encourage your child to get homework done early in the day.


• Set aside a certain period every day for quiet study.


• Watch for signs of burnout, i.e., falling grades, diminished interest in other activities, and fatigue.


• Work with coaches and school officials to minimize sports interference with academics.


• Be a good role model: set priorities for yourself and stick to them. Point out athletes who maintain good grades.

This last point is critical. If you, as a parent, are so overscheduled yourself that you can't make time to discuss a healthy balance with your kid, that's an indicator of a problem. I'm amazed when I ask parents to schedule an appointment with me to discuss their child. I will often hear an incredulous, "Both of us?!" That always tells me very important information about the family's priorities. And yes, I insist that they both make time to come in.

Nancy L., LISW, LICDC

Recreational Drugs for Depression?

A horse tranquiliser could hold the key to treating depression.

Ketamine, which is used as an anaesthetic for humans and animals, and is also sold as a street drug to induce a "high", is being considered as a possible treatment for depression in those that have not responded to conventional treatments.

Researchers may be able to develop an antidepressant which takes effect almost immediately by directly targeting novel molecules in the brain instead of taking a less direct route, which can lead to longer times for medication to take effect, according to a study presented this week at the American College of Neuropsychopharmacology (ACNP) annual meeting.

The antidepressant is also thought to be effective in people for whom previous treatments have been ineffective. This human and rodent research is among the first to examine the effects of rapid antidepressant strategies.

Lead researcher and ACNP member Husseini Manji, M.D., director of the mood and anxiety disorders program at the National Institute of Mental Health (NIMH), says one of the major limitations in existing pharmacological treatments for major depression is the time between starting to take the medication, and when it starts to alleviate the depression, often a period of one month or longer. He adds that strategies that work at much faster rates would have a tremendous impact for Americans who suffer from depression – nearly 21 million annually, according to NIMH.

"Today's antidepressant medications eventually end up doing the same thing, but they go about it the long way around, with a lot of biochemical steps that take time. Now we've shown what the key targets are and that we can get at them rapidly," says Dr. Manji. “This research is leading to some very real possibilities for a whole new generation of antidepressant medications."

The study looked at patients in a “difficult to treat” group, meaning individuals who had not responded to other treatments including psychotherapy, traditional antidepressants or electroconvulsive therapy.

Researchers treated the depressed patients intravenously with ketamine, a general anesthetic usually used for minor surgical procedures in which muscle relaxation is not required. The doses of ketamine used in this study were considerably lower than when it is used as an anesthetic. These tests are part of an ongoing study

Ketamine produced results much more quickly than traditional antidepressants because it acted directly upon critical molecules in important neuronal circuits instead of having to bypass multiple locations en route to those circuits. Typically, currently available antidepressant medications work via serotonin or norepinephrine, neurotransmitters which act within the brain to help regulate emotion and cognition.

The results showed that patients responded after only two hours, and within 24 hours, 71% had responded. Patients were followed over time, and 35% maintained their response for up to one week. Traditional antidepressants usually take many weeks, or even months, to begin to work. “This is intriguing data which suggests that targeting these important molecules in critical circuits would be extremely helpful in treating depression more quickly, before it worsens and becomes more severe,” Dr. Manji said.

The researchers also studied rodents to determine whether they could get medication to highly responsive brain areas more quickly. By looking at different biomarkers – specific physical features used to measure the progress of a disease or condition – in mice and rats, researchers came closer to identifying at what point in the biochemical process medication might become effective, which would ultimately lead to faster treatment.

Treating patients with rapid strategies is essential since some patients who suffer from depression are tempted to stop their medication if it doesn’t work quickly enough.

Ongoing human studies using magnetoencephalography (MEG) are also helping to identify the specific brain circuits through which these rapid antidepressant effects occur. Identifying these precise circuits may lead to the development of molecules with even more precise effects, and therefore fewer side effects.

It's unclear whether Ketamine can be developed as a commercially viable antidepressant due to its side-effects. However, by identifying the underlying actions of the components of Ketamine and correlating these to biomarkers, scientists hope to develop fast-acting safe treatments for depression.

Sources:
American College of Neuropsychopharmacology (ACNP) press release
National Institute of Mental Health (NIMH)press release

Coming to the End of "Guest Hosting"

I wanted to mention that today's post is the last in my "guest hosting" stint. I have enjoyed filling in the past month for Talia while she tackles other projects.

Thanks to all of you who have read my posts and especially to those who have taken the time to comment.

I look forward to dropping in occasionally to post on topics of interest to me.

Have a safe, sane and enjoyable holiday season!

Nancy L., LISW, LICDC

Colleges to Notify Parents When Students Violate Alcohol/Drug Rules

Right to privacy vs. duty to inform is a sticky, complicated issue. By law, I must maintain my patients' confidentiality unless they sign a release form indicating I can share information. But what about underage drinking on college campuses? Does the college have a duty to inform parents when a student violates alcohol or drug use policies? Until recently, most universities cited privacy laws - they did not inform parents.

An article in the Wall Street Journal, Colleges Move Boldly on Student Drinking examines a "loop hole" in federal privacy law that is allowing colleges to inform parents when a student violates a campus drinking or drug use policy. The law, Family Educational Rights and Privacy Act (Ferpa), was enacted to protect the privacy of student education records. Under the law, students and/or parents must give written permission before their information can be released. The law was enacted in 1974, but according to the WSJ article,

"The college parental-notification policies for alcohol and drug violations utilize an exception added in 1998 to Ferpa that allows schools to call parents if a student gets an alcohol or drug violation and is under 21 years of age. After the law was changed, some colleges created parental-notification policies, while others insisted that contacting parents would go against their goal of nurturing independence in their students."

College drinking and drug-related incidents are staggering. According to the National Insitute on Alcohol Abuse and Alcoholism (NIAAA),

• 1700 college students between the ages of 18 and 24 die each year from alcohol-related unintentional injuries, including motor vehicle crashes.


• More than 696,000 students between 18 and 24 are assaulted by another student who has been drinking.


• More than 97,000 students between 18 and 24 are victims of alcohol-related sexual assaults or date rape.

The Virginia Tech shootings and other recent campus tragedies have made college administrators less sure of their historic stance of protecting students' privacy. But some parents argue that being notified of alcohol/drug violations inhibits their child from learning to make good choices.

As a substance abuse counselor and mental health therapist, I can certainly see both sides of this issue. But I do know that involving family when a student has an alcohol or drug problem can have a very positive effect.

What do you think? Violation of privacy or safety issue that overrides it?

10 Tips to Kick Holiday Stress-Management into High Gear

Yesterday, as I polished off the remaining 1/4 bag of Maui Onion Kettle Chips (yes, they are as good as they sound!) and became very cranky, I realized I haven't been following my own holiday stress-reduction tips.

Hanukkah began yesterday at sundown. Christmas, Kwanzaa and Boxing Day are three weeks away. The holiday crunch is on us: time for a refresher in slowing it down, regaining our focus and getting re-grounded.

1. Quit trying to find the "perfect" gift. The teenagers in my life are all getting gift cards from a retail store. Teens like those almost as much as money. Your picky mother-in-law won't appreciate the time you took to select her gift - and she still won't like it. So don't stress about it.


2. Avoid high-traffic times if possible. Drivers are terribly distracted this time of year. Add that to inclement weather and you have an accident waiting to happen. Stay out of stores at peak times. I call it "shopping psychosis," that look that comes over people as they block store-aisle traffic with their carts. Stay home and order holiday items and gifts online; you still have time.


3. You do not have to entertain this season. Give yourself permission to NOT have people over for parties, etc. Unless you can afford to cater the event, have a cleaning service and/or it's already in the works - just don't do it. And not worrying about the mess can be very healthy.


4. Watch your breathing. Most of us don't breathe enough normally; we take shallow breaths and deprive ourselves of oxygen. Add stress to that and we can even become light-headed. Sit in a quiet place, close your eyes and take 10 deep breaths. Inhale slowly and exhale more slowly. You'll be amazed at how relaxed you will feel!


5. Get enough rest. I have patients tell me that they only sleep 4-5 hours a night. Most research would say they are sleep-deprived. Cut out some TV or computer time at night and get some sleep. And naps are not just for cats. Try one or two...


6. Make sure you have some quiet, alone time scheduled. The social demands of holiday seasons are high. We are required to interact more with family, co-workers, etc. That can be very tiring, especially if socializing causes you anxiety. Factor in some down-time.


7. Watch alcohol and food intake. I am not setting a good example by sharing my potato-chip mini-binge above. Spiked eggnog, wine, drinks and high-fat, high-caloric food abound this time of year. Denying yourself any treats this season isn't necessary. But try to eat healthy foods, too.


8. Plan one fun event just for you. You probably spend much time and effort insuring others are taken care of and entertained this season. Remember to treat yourself - get a manicure, go to a heated driving range, babysit a friend's new puppy or read that new best-seller you've been hoarding.


9. Watch a favorite holiday movie or show. In an earlier post, I mentioned the film Home for the Holidays. It's great if you want to laugh at family dysfunction. But I'm talking about a sentimental favorite. It's corny and dated, but I love Holiday Inn. Bing Crosby singing "White Christmas" does it for me.


10. Get some exercise. Most usual exercise routines get abandoned this time of year. We are full of excuses. But exercise is a terrific stress-buster. Take a walk in the snow with your kids or dogs.

Nancy L., LISW, LICDC

Related posts:
Holiday Stress-Reduction Tips - Listen to the Real Experts
Set Realistic Expectations for the Holidays
Strategies for Surviving the Holidays - H.A.L.T.

New Study Shows Anorexics Have Different Brain Patterns

An article in U.S News & World Report, Brain Activity Points to Origins of Anorexia, cites a study about differences in brain activity between anorexic patients and those who do not have the eating disorder. The study at the University of Pittsburgh School of Medicine did MRI scans of the brains of 13 "normal" women and 13 recovered anorexic patients while they played a computer game.

The brains of the healthy women showed heightened responses to winning and
losing, while the women with a history of anorexia showed little difference
between winning or losing. Dr. Angela Wagner said of the results, "For
anorexics, then, perhaps it is difficult to appreciate immediate pleasure if it
does not feel much different from a negative experience."

The results of this study, published in the December issue of the American Journal of Psychiatry, suggest that the women with a history of anorexia were more focused on the consequences of their choices during the guessing game.

In another report about the study, the BBC News suggests that this may give us more insight in how anorexics are able to deny themselves the reward of food.

Anorexia has always been associated with a distorted body image - anorexics usually see themselves as fat, even when they are grossly underweight. Research such as this study could be very helpful in determining if there are specific causes and in finding successful treatment protocols.

Teens Open Up to Peer about Drinking

Awhile ago, I worked as the substance abuse counselor for a small school district. There were many challenging aspects to the job, but the biggest hurdle I encountered was the level of denial from parents, school personnel and the community. "It's not that bad," I would hear repeatedly. Surprisingly, the students were more open with me about the level of drinking and drug use. But as an adult in a position of authority, I could never get the honesty that peers share. So I was excited to learn that recently my 16 year old nephew, Evan Trout, wrote an article about teen drinking. Published in the high school's newspaper, The Lion's Roar, he spoke to his peers about their drinking.

Evan's school is in Gahanna, a predominantly middle-class town in central Ohio. His class is 530 students, which is about 2 1/2 times the size of the classes in the school where I worked. Although the settings are much different, Evan's article demonstrates that both communities have a serious problem with teen drinking. His article, which I've edited for length, is below:

A teenager goes to a party at friend’s house after a football game on a Friday. There’s alcohol at the party, and although he’s never gotten drunk before, he decides he’d rather be cool and just go with the flow.

This is a common occurrence among teens these days. Teen drinking these days is a serious problem and often goes to an extent of which most teachers and adults are unaware.

According to the Primary Prevention Awareness, Attitude and Use Survey (PPAUS), an anonymous questionnaire given to high school age students, approximately 33 percent of students between ninth and 12th grade in Gahanna Lincoln High School drink alcohol at least once a month. This is a problem that stretches much further than the big cities. It has become a serious problem in Gahanna, as some students at Lincoln consume alcohol.

Drinking can be evident in settings throughout Gahanna. According to rumors throughout Lincoln, prior to its football game against Upper Arlington, a number of students were found under the influence of alcohol and some were able to get into the game without the knowledge of security.

Sandy Pershing, an administrator at GLHS, said such actions could have serious consequences. Any student caught drinking at a football game, “would probably get suspended from school."

Mary Anne Albanese, the GLHS Safe and Drug-Free Schools Counselor, said alcohol is the most serious threat to high school students “because of the availability, and sometimes they just don’t take the risk seriously. Also, it is so accepted with friends and family. The top three causes of death among teens are alcohol related."

A major problem that leads to alcohol use is the availability. “I drank anything I could get my hands on: beer, tequila, vodka, 151; scotch was easy to get because my dad has some around a lot,” an unnamed male sophomore said. One drink he recalls was “tequila with Bacardi 151 and coke. It tasted like crap, but an hour later when I got home it hit me like ‘whoa’.” He is now, however, proud to say that he has been alcohol free since middle school and plans on staying sober.

"It made me feel worse the day after, not because of hangovers, but because I knew the next day the choices I was making were really bad and it was just taking a toll on me and my grades suffered. I had a realization,” he said.

Most students do not drink very frequently, but when they do drink, it can lead to problems. One female junior said she drinks “just like once every couple months.” She said she most often drinks vodka and mixed drinks, as well as tequila and Jack Daniels. She does not tell many of her friends about her alcohol use, though. “Probably about like ten people know, so it’s not a well-known thing."

Although she chooses not to share her drinking with others, she does not consider it much of a problem. “I think I’m okay with it, because it’s never really been a problem. It’s not like I have to drink to have fun, so no, it’s not to that point yet,” she said.

Another female junior, however, said she has had bad experiences with alcohol use. At times when she has chosen to drink, it has led to some serious consequences. “I was at a friend’s house and their parents were gone and we started playing pong with vodka and lemonade. I got real drunk and started flirting heavily with some guy, so then we went up to a room and all I remember is I woke up the next morning next to him. It was the first time it ever got out of control.” This was not the only time things have ever gotten out of control for her.

“I went to a party once and there was punch and there was a mix and I didn’t know what was in it. I knew I shouldn’t drink it but I did anyway and got real drunk.” When asked about her preferences, she said she normally would have vodka or tequila when she drank and that beer and wine coolers are “for losers.”

Like the other interviewed girl, not many of her friends were ever aware of what she did.“Not many [know] because I don’t tell my friends because they wouldn’t approve. Just my friends I go to parties with. They’re all older, because I need a ride and a way to get home.”

Besides keeping their habits from friends, these students all had other things in common. They all started drinking at an early age, for one. “I had my first sip at nine,” said the sophomore. The first junior girl also started in sixth grade. Another thing in common is the influence of older friends. Both girls started drinking because older friends encouraged it. All of the teen drinkers tended to avoid beer and use harder drinks, such as vodka and tequila, especially. Some adults have such drinks on occasion, but they may not be keeping them from their children well enough, as is evident in the case of the sophomore boy.

Also, most teen drinkers never saw drinking as much of a problem.

When asked about whether she thought her drinking was a problem, the second
junior girl replied, “No, because I can control myself. I only do because I
enjoy it every once in a while, it’s not like an everyday thing.”

With teen drinking as big of a problem as it is, Albanese said that teachers and parents need to intensify alcohol prevention measures. It needs to start at home. “Parents are very important; they impact teen drinking the most. We need to keep telling them, because they don’t realize it,” Albanese said. She then said that the majority of alcohol use among teens could be prevented by parents.There is room for optimism, Albanese said, as alcohol abuse is decreasing both locally and nationally.

Aside from being very proud of my nephew for having his first article published, I was impressed with his ability to get his peers to open up about their drinking. Several things in the article are particularly alarming to me as an addiction specialist; the age of first use, the easy availability of the alcohol and the parents' lack of awareness. The article underscores that parents, teachers, school administrators and other concerned adults need to be much more aware of the seriousness of this problem.

Nancy L., LISW, LICDC