The Depression Thread

[Hoggy]

Okay, download was awesome and all, but I have two gripes.

1) scrubbed

2) Smoked and drinked far far too much. Getting to Machine Head on saturday was so very strenuous. Anyways, seems like slowly giving up on drink and drugs has gone straight out of door and has already ducked into some shady alleyway before I could give chase.

Bugrit.

[zeratul]

I hath returned for yet more advi e. The resident "girl of questionable honor in relationships" made up a story about having sex with a guy who hung out with a bunch of us and is twenty 1. She ended up getting him arrested, though he is now out on parole. He is not alowed ANY contact with minors. The "girl of questionable honor in relationships " apparently trusts me for some reason and told me she is planning on having someone give an apology note to the guy and asks for my opinon. Any clue on what i should tell her?

No one else gonna say this? Screw loyalty, tell the cops, and have the 21 year old get her charged with Pergery. God this pisses me off. A fine, or some jail time is what she should get.

[The Great Skenardo]

Okay, download was awesome and all, but I have two gripes.

1) scrubbed

2) Smoked and drinked far far too much. Getting to Machine Head on saturday was so very strenuous. Anyways, seems like slowly giving up on drink and drugs has gone straight out of door and has already ducked into some shady alleyway before I could give chase.

Bugrit.

Sounds like you're fighting against the force of habit, here. Active habits are stengthened by repetition, as the saying goes, and it sounds as if you've made some initial efforts towards giving up (or at least cutting back) on the drugs and alcohol.
I cannot emphasize enough how much I encourage you to work towards eliminating the drugs and moderating the alcohol. It seems as if the problem you described in the scrubbed message was a direct result of the thing you've complained about in the #2.
If you really don't want that kind of thing to happen again (where there could be serious legal consequences), then I'd suggest you redouble your efforts to control yourself.

As for how to do that...it's a bit trickier. From what you say, it sounds as if you recognize that you need to change, but lack the staying power to do it. I suggest that you work on improving your habits; try avoiding the friends or venues or parties that lead inevitably to getting drunk or doing drugs. A social drink is fine, I think, but what you want to avoid is the situation where it becomes the focus of whatever you're doing. Catch a movie, play some football, go golfing, to the arcade, for some pizza, whatever! But I think you definitely ought to avoid places and people around whom drugs and too much alcohol happen.

Good luck with that.

[zeratul]

Time for me to unload again!

Theres a girl i've liked (possibly loved) for two years now, who is very kind about it, but tends to like other, ass-wholeish guys. She thinks of me more as a brother. The girl I'm starting to like, is one, and a half yaears older than me, and is loved by everyone, we're freinds, but I doubt she likes me.

I know this is a bad reson to be depressed, but it is yet another reason for me none the less.

[Hoggy]

Perhaps I ought to have clarified: when I said "got with", I do not mean "slept with". Probably lost in communication or something. Anyways, that was more a peeve than something to get angry about; I'd always professed to stick to the +/- 2 years rule before.

If that still needs scrubbage, so be, so be.

As for how to do that...it's a bit trickier. From what you say, it sounds as if you recognize that you need to change, but lack the staying power to do it. I suggest that you work on improving your habits; try avoiding the friends or venues or parties that lead inevitably to getting drunk or doing drugs. A social drink is fine, I think, but what you want to avoid is the situation where it becomes the focus of whatever you're doing. Catch a movie, play some football, go golfing, to the arcade, for some pizza, whatever! But I think you definitely ought to avoid places and people around whom drugs and too much alcohol happen.

Avoiding just about all my friends is something I cannot do. We've stuck together far too long that I can't just leave them like that, I owe them way too much.

And avoiding the venues and parties would mean leaving town, more or less. Sucks, but that's the way it is at my age 'round here.

Perhaps finding some (other) hobbies is a good idea, yeah. But I was never that good at football, and I don't have the money for a sea kayak. And if I did, I'd have spent it on a car anyways, or rent a flat so I can move out.

No arcades.

Anyways, thanks.

[The Great Skenardo]

@hoggy

To clarify, you feel that just about all of your friends are those that drink excessively and do drugs? Well, so long as you have other things in common besides those two interests, you don't have to shun them completely; I suppose what I'm trying to say is that if you're serious about changing your habits and you don't think you have the willpower to resist the temptation, then you need to adjust things so that you don't get tempted. Sooner or later, of course, you're going to have to face up to the problem directly.

As to parties, I find it hard to believe that there's nothing for someone to do for fun on the town that doesn't involve rampant alcohol and drugs. There may not be an arcade, but since you apparently have friends that you're very close to, it shouldn't take too much of a stretch of the imagination to work out something you can do. Going to the beach, for example, or playing video games until your eyes bleed, or going down to the hardware store and making up some foam and PVC weapons to battle each other with, or even taking up some kind of sport. Doesn't matter if you're any good at it or not if it's just you and your friends.

I think you'll find that there are alternatives, but I strongly believe that if you truly want to moderate your intake and cut out the drugs, it's going to take commitment on your part, and maybe even some sacrifice.

[Bor the Barbarian Monk]

@ TGS and, vicariously, Hoggy: I'm afraid I have to disagree to a certain extent. One's friends can be a terrible influence on one's behavior. I can even muster a Bor story to cite this example.

A hundred thousand years ago, when I was but a youth... ...I had a group of friends who would engage in substances that were far from legal. There was no pressure from them to try said substances, but I was always around them. Curiosity got the better of me, and I finally did. The narcotic adventures that followed produced some of the fonder memories of my youth.

Ah, but I was going to be a "smart" user. Believe it or not, I set up rules for myself. 1. I would never buy them. 2. I would never do them alone. Ah, but that euphoric state while under the influence seemed to be the perfect escape from the home life that was plaguing me, and I found myself breaking my self-set rules after only a couple of years.

Several incidents gave me a harsh awakening.

The first was after a night of partying with my friends. We'd taken a drive to a place called "Mount Misery." It was called this because it was a paved, narrow, winding, hilly road with no streetlights, and many a foolish teen would drive along it at night without headlights, just for the thrill. I remember being there and driving with a carload of friends (headlights on, thank goodness), but I don't remember driving there. Nor do I remember driving home. That I could have been responsible for half a dozen deaths haunts me to this day.

Next was an incident with a friend who fell victim to an "adrenaline loop." In his altered state, he became fascinated with the beating of his heart, which he thought was beating faster than normal. This scared him, producing adrenaline, which made his heart beat faster, which made him panic, which introduced more adrenaline, which made his heart beat even faster, which...Well, you can see how he ended up hospitalized for almost having a heart attack before the age of 20.

The final wake up call for me was my waking up and feeling sick as a dog after every night of partying. Diabetes and drugs do NOT mix. You see, I would eat while under the influence. I would joke that I would eat the entire kitchen, including appliances, eating utensils, etc. Alas, I never had the presence of mind to take more insulin to compensate for such caloric intake. Thus, I would wake the next day with a bloodsugar that was sky-high. The time had come to stop my foolish behavior.

Time passed, and such people exited my life. I miss my friends, but I don't miss the partying. Part of the reason why my diabetes has handicapped me is because of those foolish years when I sought to self-medicate. Those people, without any effort on their part, influenced me into a lifestyle that was truly detrimental to my health.

This is why I make the recommendations that I do. There has to be a better way to handle one's problems. Proper, legal medications. Therapy. Hobbies that engage and distract the mind. If it requires a change in one's social circles, so be it. Since I never did anything truly addicting, I suppose I was lucky. But sometimes the addiction is psychological, influenced by circumstance. These substances may SEEM like a good way to temporarily escape the problems, but are nightmarishly detrimental in the long run.

Find the alternatives. Make the sacrifices. And be well.

[Dallas-Dakota]

I´m sleepy but I´m not sleepy, I´m active yet inactive.
I must go to bed, But I dont want to.
dungeon siege II is so cool! that´s an awesome character!

Hmmm I think i´m going to bed after playing a ´few´ hours....which I more then happy already did.........

[LurkerinthePlaygnd]

These substances may SEEM like a good way to temporarily escape the problems, but are nightmarishly detrimental in the long run.

I can attest to that.

But sometimes the addiction is psychological, influenced by circumstance.

Addiction is mainly a chemical thing. Drugs cause excessive release of chemicals such as dopamine into the brain's neuroreceptors. Dopamine is a "reward" chemical (survival mechanism), produced by many things, including sex and eating. This overstimulation leads the brain to crave more and more. Eventually, a tolerance is built up, requiring more and more of the drug to produce the same amount of dopamine. It's a vicious cycle. This is a very brief description of how addiction works.

There may be underlying psychological problems that lead to taking drugs, but once addiction takes hold, it's a fairly simple chemical equation.

@Hoggy: If you feel as if your losing control to drugs and alcohol, I suggest seeking professional help coupled with a self-help program.

As to the friend thing: if you are seriously trying to quit, you have to remove yourself from the influence. True friends will understand. I had to ditch most of my old friends when I quit. I still talk to a couple on the phone every now and then, but so long as they're still drinking and drugging, I won't, for my own well-being survival, hang out with them anymore.

There's a saying: If you hang around in a barber shop long enough, you're gonna get a haircut sooner or later.

[ArlEammon]

I'm depressed because I was forced to have sex.

[Dallas-Dakota]

wat...um thats NOT good........
It´l clear up somethings if you said who it was...

[ArlEammon]

Five, teenagers broke into "Dad's" house while he was outside and then did the deed. It was 17 years ago. I'm twenty three now. All I can remember thinking is that it had to be a silent break in, unless he was drunk or something.

[Bor the Barbarian Monk]

Ummm...Wow...That's quite the bomb to drop on the thread without some kind of preamble.

Armin, that kind of trauma is difficult to address on a forum. It takes an intense amount of bravery to say something about it, and I must commend you for doing as much.

That said, I don't think every day methods of dealing with stress are going to do the trick. This calls for a professional and, quite possibly, medication. My completely unprofessional guess is that you have post traumatic stress disorder (PTSD).

For those who haven't guessed, it's time for a Bor story.

Prior to receiving disability money from the government, I lived in a boarding house. This is not to be confused with the 1950's version of a boarding house, where everyone had a private room and was served three meals a day. No, this was a house that was falling apart, absolutely filthy, and one meal served a day. And my roommate was my first real encounter with an alcoholic.

I didn't fully grasp the concept of alcoholism until I'd met my roommate. His money would come at the beginning of the month, he would pay his rent, and then he would start to drink...and wouldn't stop until the money had run out about two weeks later. He was fall-down, blind-as-a-bat, dumb-as-a-stick drunk 24 hours a day, seven days a week.

Because of my helpful nature, the landlord made me his babysitter. It became my job to search for his booze while he was passed out and give it to her. She would then pour it out and verbally give him hell.

July 2, 2002, I was drifting off to sleep after a late night of reading. I was almost completely asleep when the world seemed to explode around me. For the briefest of moments, I thought I was experiencing a violent dream. Then I was awake and screaming in terror, fending off my drunken roommate as he continued to try and hit me in the head with a makeshift wooden club. I earned six or seven staples in my head for his efforts, and was lucky that he was drunk, or I might have ended up with a concussion.

This experience added PTSD to my list of illnesses. Sudden loud noises don't do well with me, especially when I'm asleep. I don't sleep well at all, and require prescription meds to calm myself to sleep. I have an irrational fear of rather rough looking strangers, even though they might be the kindest of souls. Memories of past traumas that seemed to have dismissed have surfaced with frightening clarity. I could use some therapy, but such a thing remains inconsistent for those whole rely on government aid to pay the medical bills. Meanwhile, at least I have psychiatrists to help deal with the trauma.

Please, Armin...Seek appropriate medical aid.

[Hoggy]

Bor hath compelled me. Allow me first to stock up on some hot ribena for my poor throat, and, er, to get dressed, and postage shall be.

Rightyho then, let's go.

To clarify, you feel that just about all of your friends are those that drink excessively and do drugs? Well, so long as you have other things in common besides those two interests, you don't have to shun them completely; I suppose what I'm trying to say is that if you're serious about changing your habits and you don't think you have the willpower to resist the temptation, then you need to adjust things so that you don't get tempted. Sooner or later, of course, you're going to have to face up to the problem directly.

Well, yes, most of them are. I did have some more 'geeky' friends from when I used to play DnD and stuff, but I fell out with them a bit. And as for temptation, about every second person round here drinks excessivly or does drugs excessivly, so that's kind of difficult.

Okay, I might be exxagerating slightly, but there's still a helluva lot of it around.

As to parties, I find it hard to believe that there's nothing for someone to do for fun on the town that doesn't involve rampant alcohol and drugs. There may not be an arcade, but since you apparently have friends that you're very close to, it shouldn't take too much of a stretch of the imagination to work out something you can do. Going to the beach, for example, or playing video games until your eyes bleed, or going down to the hardware store and making up some foam and PVC weapons to battle each other with, or even taking up some kind of sport. Doesn't matter if you're any good at it or not if it's just you and your friends.

We go to the beach sometimes and surf, then smoke and drink the night away.
We smoke and drink whislt playing video games.
For sport, see beach.
That's the problem. It's become a way of life for us.

I think you'll find that there are alternatives, but I strongly believe that if you truly want to moderate your intake and cut out the drugs, it's going to take commitment on your part, and maybe even some sacrifice.

I suck at sacrifice and commitment. Example of sucking at commitment: New Year's resolution was to give up smoking. I was proud it lasted 13 and a half hours.

Next!

@ TGS and, vicariously, Hoggy: I'm afraid I have to disagree to a certain extent. One's friends can be a terrible influence on one's behavior. I can even muster a Bor story to cite this example.

Please allow me to look up vicariously one second.

Ah. I see.

Ah, but I was going to be a "smart" user. Believe it or not, I set up rules for myself. 1. I would never buy them. 2. I would never do them alone. Ah, but that euphoric state while under the influence seemed to be the perfect escape from the home life that was plaguing me, and I found myself breaking my self-set rules after only a couple of years.

I had rules too!
1) Never do drugs alone
2) Never bring drugs home
I broke both of them too.

Several incidents gave me a harsh awakening.

Likewise. One was waking up in a pool of vomit after a christmas party. It was one of the more unpleasant things I've done.

These substances may SEEM like a good way to temporarily escape the problems, but are nightmarishly detrimental in the long run.

I had noticed.

Moving on oncemore...

If you feel as if your losing control to drugs and alcohol, I suggest seeking professional help coupled with a self-help program.

I tried, it didn't really work out. I now suffer from a lack of trust in these so-called 'professionals'.

As to the friend thing: if you are seriously trying to quit, you have to remove yourself from the influence. True friends will understand. I had to ditch most of my old friends when I quit. I still talk to a couple on the phone every now and then, but so long as they're still drinking and drugging, I won't, for my own well-being survival, hang out with them anymore.

Hmmm... let me list those I class as true friends.
1) Got me into drugs in the first place, now lives about 2 hours away.
2) Lives in Croatia.
3) Lives the other side of the country.
Slight predicament there. I mean, there are many I class as friends, and many I class as close friends, but I don't trust people quite enough to calss them as true friends. How jolly of me.

Anyways, I do beleive that is all, so toodlepip for now, and thank each and every one of you.

[The Great Skenardo]

We go to the beach sometimes and surf, then smoke and drink the night away.
We smoke and drink whislt playing video games.
For sport, see beach.
That's the problem. It's become a way of life for us.

That is a problem. A BIG problem, in my opinion. It also worries me, because it's ingraining the habit even further by association; the more often you do these things while having fun, the harder it will be to have fun without doing them. Even worse, it looks like drinks and drugs have become the focal point of how you associate with your friends. I wouldn't be so worried about this if you gave some indication that you have other social activities that don't rely on these two things.

I suck at sacrifice and commitment.

That's a problem too, but I'll let you in on a secret; sacrifice and commitment isn't easy for anyone. If it were, it wouldn't be sacrifice. At bottom, if you're serious about changing your habits, you're going to have to force yourself to do it. It won't be fun, and it'll be hard, and you may have to give up on some of your buddies, but unless you change...
Vomit will be your pillow and hangovers will greet you each morning, and liver trouble will be your companion in old age. If you reach it.

I don't think I can give you any better advice than that. Good luck.

[Narmoth]

Five, teenagers broke into "Dad's" house while he was outside and then did the deed. It was 17 years ago. I'm twenty three now. All I can remember thinking is that it had to be a silent break in, unless he was drunk or something.

Ehm. Don't really know what to say. I'm sorry. I wish I could help. I hope you at least alow me to complement you on your bravery to come forth with this. Hopefully, someone, like Bor allready has, will be able to give you good advice on your situation.

[smellie_hippie]

Armin: Bor hit the nail on the head. (sorry if that's a bad pun or too cliche) You could be suffering from some serious psychological trauma. We're here to help you through some of your ordeal... but we have limits. Your needs are fairly well beyond ours. I hop you can find a therapist or at leats someone you can trust to talk about these feelings you are having as a result of what happened.

Hoggy: There's a critical key to overcoming addiction. You need to replace it with something else. We could talk about the negative effects it's having on your health, your lifestyle... potentially your freedom. But we would never be addressing the enjoyable feeling of "the high". I mean... that's the whole point of doing drugs in the first place. Yes some people use them as coping tools, others succomb to peer pressure, still others try to overcome shortcomings with drugs. Bottom line is... if you don't enjoy the high, you wouldn't be doing them in the first place.

Ok. So start slow, and make some more obtainable goals. You already broke your first two rules, so make some smaller ones.
"I'll use less this week."
"I'll stay clean for one whole day."
"I'll drop using alcohol for a week, but will still smoke pot."

If you can accomplish one of these lesser goals, you will start building the confidence to make another one. Keep in the back of your mind the following thought... You wouldn't be here asking for help if you weren't thinking of quitting.

[blackfox]

Is it possible to get seasonal depression in the summer?

[Bor the Barbarian Monk]

Is it possible to get seasonal depression in the summer?

My answer: of course!

Different events during a certain time of year can trigger emotional reactions. For many, the holiday season of Christmas, etc, represents togetherness and good will. Despite never being alone, people can still feel lonely.

One of my mottos is: Never alone, always lonely. It probably points toward a symptom of my depression. Even when among friends and family, and even when I've had a romantic life, some part of me never quite felt like it fit in. For me, it was the holiday season, and still is.

Back to your question, Blackfox...I imagine you've asked because you, or someone elese you know, is feeling this way. I don't have an answer for the immediate issue. That is, I don't know what to tell you to get through the depression which relies heavily on the season. I'm depressed all the time. It's hard to see from my posts, as they come through with clarity and even some humor from time to time. I guard against it, and have luckily avoided hospitalization, thanks to...a cat.

Yes, a cat. My little Nike keeps me from going to the hospital out of a fear that no one will be around to take care of her. It seems silly, but my caring for this loving little beast has been infinitely helpful in anchoring me outside various institutions.

My advice is to do your best to guard against the severity of the depression. You need not watch it like a hawk seeking prey, but keep an eye on it. If destructive thoughts start to invade the mind, GET HELP! Don't wait for the thoughts to settle and grow. Get help when they start to arrive.

@ Hippie: (Nail on the head...I'll get you, Hippie! And your little dog, too!) It's somewhat comforting to see the professional agree. It reaffirms that I'm on the right track...somewhere.

@ Everyone: Through experience, personal and as a witness, mental illness can have horrific effects when they take root and remain unattended. They are much like weeds. Their roots go deep, and they can affact every aspect of your life. There are some things that flow over you like water in a stream; they wash over you and move on. Breaking up with a romantic interest, losing a job, failing a course in school, an argument with a friend. These events can result in what I call "a case of the blues." In time, the feeling will go away.

Other events - traumatic events - can have a very different reaction. The mind is a wondrous organ, and remains a mystery to some degree, even to those engaged in its study. Depression, OCD, ADD, schizophrenia, paranoia...It seems like we know how to treat these things, but we have little understanding of WHY they happen. Oh, we can point to various reasons and theorize, quite logically, as to why something is happening in the brain. But there are few, if any, solidified answers.

So we watch. We feel a symptom and we watch. It's all we can do. When these symptoms become invasive into one's life - the moment it's noticed...that's when we need to get help. If you're young, tell an adult whom you trust. If you're an adult, tell a trusted friend and then get help. Do your best to find some support in your quest, but GET HELP!

I have Bor stories about such things, but I believe this post is long enough.

[blackfox]

Back to your question, Blackfox...I imagine you've asked because you, or someone else you know, is feeling this way.

You guessed right.

Yes, a cat. My little Nike keeps me from going to the hospital out of a fear that no one will be around to take care of her. It seems silly, but my caring for this loving little beast has been infinitely helpful in anchoring me outside various institutions.

I wish I could have a cat... my dad's allergic.

My advice is to do your best to guard against the severity of the depression. You need not watch it like a hawk seeking prey, but keep an eye on it. If destructive thoughts start to invade the mind, GET HELP! Don't wait for the thoughts to settle and grow. Get help when they start to arrive.

My friends would probably be the best help with this... at least they were before, when they threw a surprise birthday party for me, it made me happy, appreciative, etc. (Which was a week or so after school ended, and maybe two or three weeks after the teachers stopped assigning homework. And it wasn't even my birthday.) Now that it's summer I don't see them on a daily basis because I'm not at school... I've been trying to do something with friends at least once a week or so... maybe seeing them more often would help. I'm going on a family vacation for a week starting Saturday though... don't know what to do about that. At least it's to the beach where the ocean will cool it down. Heat is evil.

...I hate Virginia.

[Dallas-Dakota]

I'm very sad, becouse I wont pass.............
yesterday my parents told me they discussed it with my school,that the chance was 0.0001 that I am going to pass........

and I am/was in such a great class...........

[Yiel]

I need to ask some advice from the wise on this forum thread.

As a young teenager I was prescribed a type of Methylphenidate (a commonly known one is Ritalin). As a young adult I decided that I did not want to be medicated and with the help of my local doctor, stopped taking them after 7 years.

Now, with three years off this medication, my doctor has recommended I go back on it for something entirely different to my original prescription. (I have my attention problems controlled through other non-medication methods now.)

The question: Should I find other ways of managing my mental & physical health? Or should I let them put me under the influence of this stimulant again?

[Rex Idiotarum]

Do whatever feels right. I've been on pills for the last few years, and I think I may have become a little addicted. If you truly feel worse when you are off them, like I do, then I suggest you consider the pills, If you don't like it don't do it. What pills does he want to put you on?

Meditation is probably one of the worst ideas of curing ADD. How is a person with no attention span suppose to be able to clear their mind?

[thehothead]

I guess I'm not so much depressed as apathitic, but I'm getting the feeling that apathy is worse. At least depression would be motivating me to do something Even if something bad. seriously, we had to write a poem in class, and the ONLY subject I could think about was apathy. So I wrote a large poem about apathy.

The cause of my apathy is my feeling of purposelessness. I have no idea where, when, or how this started, but it did. I'm not entirely upset that it happened, sinse it motivated me to make one of the most relieving decisions of my life but it's causing my apathy.

Cut to now. I don't care about ANYTHING long term. I have about 8 days to turn in enough late work to get my grade from a D to a B, and I'm posting a forum. Seriously, this had me considering suicide at one point (No real chance of that, but I considered none-the-less)

[SweetLikeLemons]

Do whatever feels right. I've been on pills for the last few years, and I think I may have become a little addicted. If you truly feel worse when you are off them, like I do, then I suggest you consider the pills, If you don't like it don't do it. What pills does he want to put you on?

Meditation is probably one of the worst ideas of curing ADD. How is a person with no attention span suppose to be able to clear their mind?

I personally have found meditation to be a pretty useful exercise for dealing with ADD. Clearing one's mind may be very difficult for someone with no attention span, just as physical exercise may be very difficult for someone who is obese. That doesn't mean that an overweight person shouldn't exercise, in fact, it is probably a very good idea for them do so.

I dunno. I find it helpful, but everyone is different. I would say it's worth looking into, though.

[Narmoth]

I need to ask some advice from the wise on this forum thread.

As a young teenager I was prescribed a type of Methylphenidate (a commonly known one is Ritalin). As a young adult I decided that I did not want to be medicated and with the help of my local doctor, stopped taking them after 7 years.

Now, with three years off this medication, my doctor has recommended I go back on it for something entirely different to my original prescription. (I have my attention problems controlled through other non-medication methods now.)

The question: Should I find other ways of managing my mental & physical health? Or should I let them put me under the influence of this stimulant again?

The question really depends on what the new condition is. At present, methylphenidate is investigated for causing heart problems. In a study we did at the local hospital (in Tromsø, Norway that is) we could not find a connection, but I would still be carefull with it if you have heart problems or blood pressure problems. I suggest you read about the drug yourself so you know what to ask you doctor about.

Spoiler

Show

ADHD Drugs and Cardiovascular Risk
Steven E. Nissen, M.D.
On February 9, 2006, the Drug Safety and Risk Management Advisory Committee of the Food and Drug Administration (FDA) voted by a narrow margin — eight to seven — to recommend a "black-box" warning describing the cardiovascular risks of stimulant drugs used to treat attention deficit–hyperactivity disorder (ADHD). This action was unexpected, largely because the FDA had not requested a review of current labeling for this class of drugs; it had merely asked for recommendations of approaches to studying the cardiovascular risks associated with these drugs. The committee, however, decided to take an independent course. As a consultant to this committee, I introduced two motions, one recommending the black-box warning and the other proposing the development of a guide for patients, which was approved by a vote of 15 to 0. The guides are handouts that are required to be provided at the time prescriptions are dispensed; they contain information, written in nontechnical language, about the potential hazards of the medication.
The drugs under review were primarily amphetamines (Adderall and other brands) and methylphenidate (Ritalin, Concerta, and other brands). These agents are closely related members of the class of sympathomimetic amines, the structures of several of which are shown in the diagram. These compounds exert potent stimulant effects on the cardiovascular and central nervous systems. One of the oldest such agents, methamphetamine, was originally synthesized in 1891 and first widely used during World War II in Nazi Germany to enhance the ability of Luftwaffe pilots to stay alert during extended hours of combat. Medical use of this agent is now limited, but illicit use has grown rapidly and now represents an increasing public health problem. When smoked or injected intravenously, methamphetamine ("speed") is associated with hyperthermia, rhabdomyolysis, myocardial infarction, stroke, and sudden death — effects well known to coroners in regions of the United States where abuse is common. Beginning in the 1950s, the stereoisomer dextroamphetamine and related agents were introduced as appetite suppressants.
ADHD is a disorder commonly diagnosed in school-age boys (less commonly in girls) and is characterized by increased activity, an inability to concentrate, and poor school performance. The effectiveness of stimulants in treating ADHD has been well documented in randomized clinical trials. Amphetamines and amphetamine-like stimulants were introduced to treat ADHD in the 1950s, but the frequency of this diagnosis and the use of stimulants to treat it have accelerated enormously in recent years. The FDA advisory committee heard testimony indicating that 2.5 million children now take stimulants for ADHD, including nearly 10 percent of all 10-year-old boys in the United States.1 The committee also learned that the use of these agents is much less prevalent in European countries, where the diagnosis of ADHD is relatively uncommon. Even more strikingly, 1.5 million adults now take such stimulants on a daily basis, with 10 percent of users older than 50 years of age. The diagnosis of "adult" ADHD is a relatively recent phenomenon and has resulted in the most rapid growth in the use of such agents.1
The concern of the advisory committee reflected several considerations. The cardiovascular effects of the sympathomimetic amines have been thoroughly described in the medical literature. These agents substantially increase the heart rate and blood pressure. In a placebo-controlled trial, mixed amphetamine salts (Adderall) administered to adults increased systolic blood pressure by about 5 mm Hg; similar effects were found with methylphenidate formulations.2 Blood-pressure changes of this magnitude, particularly during long-term therapy, are known to increase morbidity and mortality. In 2005, a separate FDA advisory committee that I chaired concluded that blood-pressure changes represented such a reliable predictor of cardiovascular outcomes that class labeling would be appropriate in most cases.3 The increases in heart rate induced by sympathomimetic agents also have well-described adverse cardiovascular effects. The administration of these drugs produces persistent increases in heart rate, inducing chronic heart failure in animal models of dilated cardiomyopathy.
A review of the regulatory history of this class of drugs also helps to explain why the advisory committee took decisive action. The dietary supplement ephedra, sometimes called ma huang, contains two alkaloids, ephedrine (see diagram) and its enantiomer, pseudoephedrine. These supplements have been used by millions of Americans to assist in weight loss or to increase energy. Some athletes have advocated the use of ephedra-containing dietary supplements as performance-enhancing agents. On December 31, 2003, federal officials announced plans to ban ephedra immediately. Health and Human Services Secretary Tommy Thompson told reporters, "The time to stop using these products is now." This action followed several high-profile catastrophic outcomes linked to ephedra products, including the death of 23-year-old Baltimore Orioles pitcher Steve Bechler. Published studies reported that sales of ephedra-containing supplements represented less than 1 percent of all dietary-supplement sales but that these products accounted for 64 percent of the serious adverse reactions to supplements reported to the Centers for Disease Control and Prevention.4 Unfortunately, in April 2005, a federal court in Utah struck down the federal ban on ephedra. Many companies that make these products are located in Utah.
Similar regulatory actions have been proposed for phenylpropanolamine (PPA), another closely related sympathomimetic amine (see diagram). On December 22, 2005, the FDA issued a notice of "proposed rulemaking for over-the-counter nasal decongestant and weight control products" containing PPA. The notice called for a public comment period until March 22, 2006, after which the FDA would undertake regulatory action that would probably include banning the use of the agent in over-the-counter preparations. The FDA's action followed many years of concern about the potential of PPA products to cause hemorrhagic stroke. Six years ago, a case–control study published in the Journal reported a 16-fold increase in the risk of stroke among women taking PPA for appetite suppression.5
Briefing documents prepared for the February 9 advisory-committee meeting described cases of myocardial infarction, stroke, and sudden death in children and adults taking ADHD stimulants.1 These narratives were derived from the FDA's Adverse Event Reporting System (AERS), a database containing reports of adverse events submitted by health care providers. The AERS is a voluntary reporting system that has been criticized because only 1 to 10 percent of serious adverse events are actually reported, limiting the database's usefulness for identifying emerging drug hazards. The drug-related events reviewed by the committee included 25 cases of sudden death in children or adults (see table), some with evidence on autopsy of undiagnosed congenital heart disease, such as hypertrophic obstructive cardiomyopathy. The physiology of this condition renders patients particularly vulnerable to the adverse effects of sympathomimetic drugs, because such agents increase contractility, thereby increasing the pressure gradient in the left ventricular outflow tract. Many additional cases of major adverse cardiovascular events, including myocardial infarction, stroke, and serious arrhythmias, were reviewed by the committee. However, the documentation of cases was frequently incomplete, and neither the FDA reviewers nor the committee considered the AERS data to be definitive.
Despite the difficulty of interpreting these data, the advisory committee acted preemptively to recommend strong regulatory action. The majority of the group accepted my argument that the propensity of sympathomimetic agents to raise blood pressure and heart rate, the history of serious adverse effects associated with two members of the class (ephedra and PPA), and the rapid increase in exposure, particularly among adults, warranted strong and immediate action. Although the committee recognized that there are important potential benefits of these drugs for certain highly dysfunctional children, we rejected the notion that the administration of potent sympathomimetic agents to millions of Americans is appropriate. We sought to emphasize more selective and restricted use, while increasing awareness of potential hazards. We argued that the FDA should act soon, and decisively.

Source Information
Dr. Nissen is the interim chairman of the Department of Cardiovascular Medicine at the Cleveland Clinic, Cleveland, and was a consultant to the FDA's Drug Safety and Risk Management Advisory Committee for the hearings on ADHD drugs.

This article was published at www.nejm.org on March 20, 2006.

An interview with Dr. Nissen can be heard at www.nejm.org.
References
1. Food and Drug Administration. Drug Safety and Risk Management Advisory Committee Meeting, February 9 and 10, 2006: table of contents. (Accessed March 16, 2006, at http://www.fda.gov/ohrms/dockets/ac/...202_00_TOC.htm.)
2. Wilens TE, Hammerness PG, Biederman J, et al. Blood pressure changes associated with medication treatment of adults with attention-deficit/hyperactivity disorder. J Clin Psychiatry 2005;66:253-259. [ISI][Medline]
3. Nissen SE, Cardiovascular and Renal Drugs Advisory Committee. Report from the Cardiovascular and Renal Drugs Advisory Committee: US Food and Drug Administration: June 15-16, 2005: Gaithersburg, Md. Circulation 2005;112:2043-2046. [Medline]
4. Kingston RL, Borron SW. The relative safety of ephedra compared with other herbal products. Ann Intern Med 2003;139:385-385. [Medline]
5. Kernan WN, Viscoli CM, Brass LM, et al. Phenylpropanolamine and the risk of hemorrhagic stroke. N Engl J Med 2000;343:1826-1832. [Free Full Text]

[The Great Skenardo]

I guess I'm not so much depressed as apathitic, but I'm getting the feeling that apathy is worse. At least depression would be motivating me to do something Even if something bad. seriously, we had to write a poem in class, and the ONLY subject I could think about was apathy. So I wrote a large poem about apathy.

The cause of my apathy is my feeling of purposelessness. I have no idea where, when, or how this started, but it did. I'm not entirely upset that it happened, sinse it motivated me to make one of the most relieving decisions of my life but it's causing my apathy.

Cut to now. I don't care about ANYTHING long term. I have about 8 days to turn in enough late work to get my grade from a D to a B, and I'm posting a forum. Seriously, this had me considering suicide at one point (No real chance of that, but I considered none-the-less)

Believe it or not, I know someone else in a very similar situation in RL, which led me to coin the phrase;
"Apathy is the most Dangerous of Anodynes. It's addicting, but it gives you no joy. It's better to live and love and hurt than to live your life in a gray shell of apathy, feeling nothing for fear of feeling pain."

I hesitate to jump and label the two cases as identical, however; I'm still really trying to understand precisely what's motivating the apathy.

So I'll pepper you with some questions;
You say that you have no long-term ambitions...suppose someone said that having a good education is the key to getting the job you want. What's your reaction?

Is it that you feel that any endeavor is ultimately pointless, and therefore not worth doing, or that it would be waste of effort?

Also, can you expand a little on the "relieving decision" that the sense of purposelessness empowered you to make?

[smellie_hippie]

Yiel: Some doctors prescribe medications in an effort to tap into some of their side effects. Discuss with your doctor his/her rational for starting you back on any kind of medication, and if there are any other alternative if you are concerned about starting them again.

thehothead: Finding yourself apathetic is a struggle that few people will be able to help pull you out of. If I had the "miracle cure" to making you feel motivated and you turned everything around, you wouldn't know how to get out if you started feeling that way again... except to ask me for help. Sorry for the tough love, but you should use this time for self-reflection in finding your own key to motivation.

dallasdakota: I'm sorry for your academic situation. Is there any chance that those classes you did poorly in could be caught up during the summer? That would give you the opportunity to stay with the class you enjoy and graduate with them? If that's not an option, then I can offer nothing but sympathy, and hope you do well next school year.

[ocato]

I'm going to preface this by saying that I try very hard to never, ever complain about my life because compared to starving babies and african refugees, I live like a king. However, I've been doing fairly poorly lately and perhaps a little venting will help me feel better. Prepare for a lot of text. I kind of wish there was a way to post this anonymously. I apologize if it is frantic and disjointed.

Right after I graduated High school, my parents opted to move our family from Virginia to Indiana. All of my friends, everything I knew, it all just flushed away because my dad retired and wanted to live near his extended family. I don't know exactly why he thought this was a good idea, because frankly we rarely if ever talk to them. After that, I spent about a year working and sitting around playing world of warcraft, because heck, I had nothing else to do. I wasn't able to start college for another year because of the move, so I just wasted my life. I worked one part time job, then later I got a full time job to go with it. I was working 60 hour weeks busting my hump. My mother and sister weren't working at all and my dad had gotten a security job in a nearby bigger town (we live in a little burg with a C-rate amusement park attached to it). He works pretty hard even though he is retired, and I worked pretty hard too. I lost all touch with all of my virginia friends, and also two internet friends from Texas who were both very important to me. This move also cost me my first big relationship, even though she lived in Maryland. Pretty much I lack the social graces to meet people in real life and all of my relationships are initiated through the internet. Because I am a giant creep.

So, I sorta snap out of my little haze of work and World of Warcraft (which I used as a big time escape mechanism. I mean, I stopped talking to people I lived with, I would go from the front door to my bedroom, from my room to the fridge/bathroom and so on, I had no interest in anyone) and started talking to 'my girls' again. We'll call them C and T. C was still a good friend but we just didn't click too well. T was pretty much my absolute best friend. I mean, in everything. She had found some guy to be her boyfriend, and I did and still do despise him on a fundamental level. But she and I were pretty much madly in love with one another, at least that's how I see it in hindsight. She was torn between the two of us and he won. However, the fact of the matter is that she and I continued to be absolutely within each other's minds at all times. I mean, we thought the same, we talked about the same stuff, we liked the same stuff. We were understood each other on a level that no one had ever understood me before. Time went on and I started college, which was about 50mi away, as the bird flies. Roads? Less straight. So, 4 days a week I had to drive ~90 minutes to and from college. I kept to myself as I often do, reading my books by myself and getting straight As. I'm a smart kid and there was nothing else to focus on but school. and T. However, T was pretty much solid in her decision to stick with the new boyfriend. She also knew that C had a big crush on me, and sort of orchestrated things to the point where C and I developed a relationship. This sounds like it's somehow illegit, but honestly, I loved C and she loved me. I made arrangements and visited them both over my spring break. Unfortunately, some jealousy in T rose up when she realized that shifting my affections onto C meant shifting my attention as well, and T and I ended up having an affair while I was visiting. After that was admitted to, C was very upset but stuck by me (she's an angel) and T was forbidden by her boyfriend to speak to me ever again. C and I eventually split later for other reasons (mostly because it was a distance relationship and that doesn't always work out very well). I spun into a pretty bad way after that. I mean, I'd lost the only two people I had left in the world. Worse yet, C went off to college and I started hearing through the grapevine about her alcohol, sex, and crazy related antics that many young freshmen in college partake in. Each word was like being stabbed.

This was about a year ago. I briefly reconnected with my Virginia friends but it all fell through and I never talk to them anymore. College has really spiraled out of control. I stopped going to classes. I mean, 15% of my final grade was carved off my History grade (and I was qualified to teach that class, by the way) for lack of attendance. I just lost the will to be there. SInce then I've applied to transfer from my community college which is affiliated with IU to IU proper. When I went to IU proper to fill out some paperwork and visit the campus, I stayed with my sister who has been going there for a year, for the day. I hung out with her and her boyfriend and it became painfully aware that they are the sophisticated Bloomington collegiates and I am the yokel from upstate. This isn't the beginning of this, my entire life I have been terribly enraged by the prospect of being set aside because I wasn't good enough. Pretty much they acted like they were better than me the whole time. Worse yet, I haven't heard back from IU, which means that I might not get to go. If I don't get into IU, I really feel my life is pretty much done. I'm studying History Education but only because it's so easy, I could probably do it. I bet my C in US history 1875-1975 probably will keep me out of school. I just don't know what happens then, but it probably involves forgetting about everything that holds me back and just... I dunno.

My job is terrible. They treat me like a putz even though I work pretty hard for them. There are too many people there. They get too close to me, and I begin to feel very trapped. I keep getting interrupted by customers with really, incredibly stupid questions that are based on their lack of willingness to look around them. I just feel very anxious around people I don't know, and around large groups of strangers. I get trapped out on the floor trying to stock shelves, and I get very upset. I've always had a mean streak, and I pretty much have to go into the back and break something, punch the walls, rip stuff off the walls and go berzerk. Today I turned and a woman was literally 5 inches from my face, and I quelled the urge to scream so hard that I felt my entire sinus cavaty quiver. The sound inside my skull was nearly deafening. It takes all of my self control not to go and start fighting people. I'm getting very violent. I told my sister's boyfriend if I heard any hanky panky in her room while he was vsiting, I would come into their room in the night and cut his throat. I threaten and seriously restrain myself from serious violence on a regular basis.

Since college started back in 04 I had a stretch where I wanted to kill myself. Really, for serious kill myself. I even planned it. Infact, I set a date and everything, but I couldn't find my razorblades. I think they were discovered and hidden from me, but I can't say for sure. On more than a few occasions, I've tried to pick the lock on the plastic fireproof case my dad keeps his pistol in.

I started talking to T again, and she thinks I need therapy. Pretty much, I am obsessed with a fear of what other people think of me. I think that everyone thinks they are better than me and/or hates me. I'm paranoid about it. I am also fundamentally ashamed of absolutely everything I like. Fantasy, Sci Fi stuff, etc etc. I mean, I change the channel if I'm watching something and someone comes in. People talk about stuff I like and I walk away instead of making friends. I'm afraid everyone will think I'm a nerd and make fun of me and beat me up like in Jr. High school.

I'm always thirsty, I drink pop way too much. I'm pretty sure I need to go to the doctor (I might have diabetes) but I refuse to trouble my dad with this crap. He cares if I am sick and my teeth hurt, but he works really hard (my mom decided they were going in the antique business, so he works his job AND moves furniture and runs an antique shop, pretty much 7 days a week) and I refuse to trouble him with stupid stuff like going to the Doctor, the Dentist, or seeking some sort of Mental Professional's aide. He has his own problems and to be honest, I don't want to talk about it. He asks me from time to time if I'm okay or need anything like that and I immediately and abrupty say no. I refuse to trouble him with my problems.

I honestly think that it is a matter of time before I hurt myself or someone else in a sudden fit of just... self-hatred. I mean, that's what it all boils down to. I hate myself so much, because I wish I was better than I am. I have no friends and literally spend all of my time at work, or waiting for work to start. IU won't be a big change because I know I won't let anyone into my life because I am afraid of what they'll think of me. I am just slowly losing my mind, I feel. And if I can't get into IU... I mean, I can't go back to 90 minute drives... and if I don't go to college I'll just hate my life forever (even more than I do now) so I just wonder... at what point do I say screw it and just... stop restraining myself?

[The Great Skenardo]

@Ocato.

Whew. That's certainly a rough ride you've laid out. I know you weren't explicitly asking for advice here, but I'd like to pick at a few things in what you've posted here.

First off, I'd like to compliment you on two things; Your courage in typing this up and posting it, and the readability of the rant. (We who read these greatly appreciate your efforts to make the text coherent and sensible. )

Secondly, I suggest that you seek professional help. If things have ever gotten to the point where you've tried to pick the lock to the guncase, or started casting about for your razor blades, then your thoughts of suicide have gone far beyond the normal insincere musings that are common to just about everyone. Furthermore, if you're having serious concerns about your anger management and paranoia (which it sounds like you are), then it seems as if you ought to try and get something done about that.

As for bringing it (or your physical worries) up because you don't want to burden your parents...I'd urge you to look at it another way. It's always best to try and catch any kind of developing problem in its early stage. Even if it's trouble now, it'll be far worse trouble later when it develops into a full-blown ailment or disease. Maybe it'll be your own problem then, but I don't think it's going to make them feel any better than if you'd brought it up now.

I think to some degree you're letting self-pity and self-loathing cloud your judgment in this aspect. You've made some mistakes in the past, and maybe things are looking bleak for the immediate future, but let me ask you this; How old are you, and how old is your father (rhetorical questions)? If you think about the fact that your father's only now reaching retirement and then think about the gap between your ages, I think you'll find that there's a very large gap between them.

My point? You have a lot of time. Making mistakes is par for the course, even if they retard your career by a year or two. Where's your rush, after all? If you don't have any close friends in school whom you need to keep up with, you can take your time in your education, especially since you don't seem adverse to working for it. If you're not going towards medical school, you'd be surprised how little impact a single C grade will have. So I think you shouldn't give up hope on that particular aspect just yet.

Work issues. Not being good with crowds is one thing; having to suppress violence (and only barely succeeding!) when people are close is a problem. I'm not a psychologist, but I think it needs addressing, if you're going towards that teaching idea; Teaching takes an extraordinary amount of patience and confidence.

As far as lady/friend troubles, I can only offer you my sympathy. I know very well the trials of a long-distance relationship.

...I refuse to trouble him with my problems.

I honestly think that it is a matter of time before I hurt myself or someone else in a sudden fit of just... self-hatred. I mean, that's what it all boils down to. I hate myself so much, because I wish I was better than I am. I have no friends and literally spend all of my time at work, or waiting for work to start. IU won't be a big change because I know I won't let anyone into my life because I am afraid of what they'll think of me. I am just slowly losing my mind, I feel. And if I can't get into IU... I mean, I can't go back to 90 minute drives... and if I don't go to college I'll just hate my life forever (even more than I do now) so I just wonder... at what point do I say screw it and just... stop restraining myself?

See, I think this characterizes very well what I'm talking about; I think you're being blinded by self-pity and self-hatred to the point that you don't recognize the gross disservice you're doing not only to yourself, but also those who care about you. Consider; if your father had the choice, would he want you alive or dead? Would he want you sick, or healthy? Would he want you happy or tortured? By keeping your problems from him, you're not sparing him from them; you're just delaying the point at which things come to a head.
It's a bit like hiding the leak in the faucet until the pipe explodes and floods the house.
But it may be that you're too proud to call a plumber, as it were, but haven't mustered the effort to try and fix it yourself. And maybe you can't fix it yourself. That's why I strongly recommend that you talk to someone about it.

However, if you're bent on making a start, here's my opinion; you say that you hate yourself because you want to be better. It seems obvious, but what you need to do is work at making yourself better. Give up WoW for a while and take up some kind of craft or active hobby. Read history books on your leisure time, start learning a language, join a Gym, anything. Just make sure that all you have to show for the time you've spent at the end of a day isn't just a level 70 character, and I think you'll find a great increase in your self-esteem.

Finally, let me emphasize this; Please, get help. You're not being unselfish by letting yourself deteriorate. If anything, it's the most self-centered kind of behavior there is because of the pain you cause those who love you because you won't accept nor ask for help.
Please, get help. We don't want to lose any more playgrounders.

-TGS