Elderly And Drugged: Far More Psych Meds Prescribed To Old Than Young

Evidence suggests that anti-anxiety medications like Xanax increase the risk of falls in older adults, which can cause a cascade of problems. (johnofhammond/Flickr, with edits by WBUR)

Evidence suggests that anti-anxiety medications like Xanax increase the risk of falls in older adults, which can cause a cascade of problems. (johnofhammond/Flickr, with edits by WBUR)

By Nell Lake
Guest Contributor

Are we over-treating the elderly with psychiatric drugs?

That’s the natural question arising from a recent report that found adults over 65 are receiving psychotropic medications at twice the rate of younger adults. The study, published in this month’s Journal of the American Geriatrics Society, also found that elders are much less likely to get their mental health care from psychiatrists or to receive psychotherapy.

What’s the problem? First, psychotropic drugs generally pose greater risks to the elderly than they do to younger patients, and non-drug approaches, from therapy to meditation, may be as effective as psychotropic medications for some seniors’ mental disorders, without the risks.

The findings suggest that physicians and insurers should reassess psychotropic drug use among the elderly, says lead author Donovan Maust, a geriatric psychiatrist and assistant professor of psychiatry at the University of Michigan.

Maust’s team used 2007-2010 data from the CDC’s National Ambulatory Medical Care Survey and from the U.S. Census to compare the rates at which older and younger adults — those 65 and older, and those 18-64 — get prescribed psychotropic medications during outpatient doctors’ visits. After analyzing more than 100,000 of these doctor visits, and taking into account the fact that the younger population is much larger than the older one, the researchers found that older adults were much more likely to be prescribed psychiatric drugs for anxiety, depression and other mental health conditions. Researchers also found that these seniors were less likely to receive other types of non-drug treatment for their mental distress.

The importance of all this is fairly clear: The elderly population is booming, and seniors use the health care system more than any other demographic. So, finding safe, effective and appropriate treatments for their mental health problems is critical — for the well-being of a large swath of people, and as a policy matter.

Too Many Meds, And The Wrong Kind?

Psychotropic drugs pose both direct and indirect risks to the elderly: First, the drugs themselves can be dangerous. The American Geriatrics Society lists many psychotropic medications as potentially inappropriate for elderly patients. Continue reading

Study: Sexual Minority Kids More Likely To Be Bullied — As Early As 5th Grade

A new study out of Boston Children’s Hospital paints a bleak picture of the social lives of many kids who identify as lesbian, gay or bisexual: As early as fifth grade, researchers report, these sexual minority youth are far more likely than their peers to be bullied.

This ongoing victimization (defined in the study as at least once a week over the course of a year) can have short-term consequences, of course, but can also lead to problems down the road. Those long-term troubles include, for instance, “anxiety, low self-esteem, depression, suicidal ideation, post-traumatic stress and negative school performance,” according to the study’s lead author, Mark Schuster, MD, PhD, chief of general pediatrics at the children’s hospital and professor of pediatrics at Harvard Medical School.

For the study, published in the New England Journal of Medicine, researchers interviewed over 4,000 fifth graders and followed up with the kids again in seventh and 10th grade. In an accompanying video Schuster offers this takeaway:

What we found is that the kids who were sexual minorities were more likely to report bullying in all three grades, in 5th grade, 7th grade and 10th grade, and this was true for the boys and the girls. What was particularly striking, in 5th grade, before most of these kids would even be aware of their own sexual orientation, their own identity, or the orientation of their peers, they’re already being bullied more…

That really stood out, and it suggests that these kids, by the time they’re in 10th grade they’ve been bullied and bullied and bullied over many years.

In this context, bullying is defined as “the intentional and repeated perpetration of aggression over time by a more powerful person against a less powerful person.” In the study, researchers suggest that screening for “bullying experiences” should become more commonplace:

“Our findings underscore the importance of clinicians routinely screening youth for bullying experiences, remaining vigilant about indicators of possible bullying (e.g., unexplained trauma and school avoidance), and creating a safe environment in which youth feel comfortable discussing their sexuality. Further research could determine the effectiveness of incorporating the experiences of sexual minorities into general school-based anti-bullying programs.”

So how can parents help? In an interview Schuster offers this:

There are several things parents should be doing: creating an environment in the household where their kids feel comfortable being open with them, and an environment where the kids feel unconditional love. One of the places kids learn to bully is from watching adults around them; kids learn from their parents. So if a neighbor’s name comes up and he’s known to be gay and dad does the limp wrist thing, or mocks the neighbor, and the kid observes that, the kid learns it’s OK to mock based on who they are. It also sends a message that if there’s a gay child in the house who is not out, the message is that the kind of person dad is scorning or mocking is not just the neighbor but also the child, and that’s a terrible experience for a child, to feel that their own parent would reject them. Continue reading

Can Mindfulness Help My Raging Anxiety When My Kid Gets Sick?

I was a cool hand, before I became a mother. Now, I’m a hopeless phobic. Whenever a child of mine gets sick, even with just a routine flu or stomach virus, every cough makes my heart race. I have to force myself to breathe slowly and deeply while I wait for the number to flash on the thermometer.

And I know I’m far from alone in this. One otherwise sane mother I know still sleeps on the floor by her teenaged son’s bed when he gets the flu, to be sure he’s breathing. A college professor i know says three different pediatricians have prescribed a stiff drink — for her — whenever her child gets sick.

“Can you help people like me?” I abjectly ask Prof. Sue Orsillo in the latest episode of The Checkup, our WBUR/Slate podcast.

(Mary MacTavish/Compfight)

(Mary MacTavish/Compfight)

“Absolutely,” replies Dr. Orsillo, a professor of psychology at Suffolk University and co-author with Lizabeth Roemer of “The Mindful Way Through Anxiety.”

And she does. She offers a framework to help me think and feel better about my own thoughts and feelings. You can listen to her from minute 17:00 on in the podcast above. Below, see an edited transcript and three additional key points.

How can you help?

SO: We all experience fear and anxiety. It’s very natural. If your child were out in the street and you saw a car veering around the corner, that fear would tell you that there’s a threat present, and it would get you ready to take action. So you have these clear emotions. Why people struggle with emotions is when those clear emotions become muddy.

What’s the difference between a clear emotion and a muddy emotion?

Muddy emotions are ones that aren’t giving us particularly useful information. They also tend to be pretty intense and distressing. There are lots of ways that clear emotions can become muddy, like if we’re feeling overtired or we judge ourselves for having certain feelings. But the one that comes up a lot when we are worrying has to do with this unique human ability we have to think about something that happened before to us or imagine something that could happen, like a terrible disease or something awful happening to our child. Your emotion is saying there’s a threat, but it’s a threat you’re imagining and there’s not a clear action.

So it’s like an emotion with nowhere to go.

Exactly. And we keep worrying, going through our mind to try to figure out where to go. And there really is nowhere to go.

Your book is about mindfulness. So first, what is mindfulness?

Most people define mindfulness as paying attention to the present moment with curiosity and compassion, just allowing the moment to be as it is.

So it’s being here and now, not getting lost in your thoughts and imaginings.

Or noticing when you’re doing that and bringing your attention back to the here and now. Even when the present moment is not a perfect, beautiful moment, if it’s a moment of pain — letting go of that struggle against what is happening right now. Just letting go of that can be calming.

How do we use mindfulness to cope with muddy emotions?

Normally, when we’re in that cycle of a muddy emotion, we’re not thinking about, ‘Oh, here’s a thought,’ or ‘There’s a feeling.’ We’re right there in it, we’re being pushed around by it, we’re defined by it in some ways. With mindfulness, we can sort of take a step back and notice, this is a thought, this is a feeling, and ask ourselves, ‘Is this a clear emotion? Is there an action to take?’ Or  are these painful thoughts and feelings that are coming up just a natural part of being human? Am I trying to control the uncontrollable, and if so can I gently acknowledge that and bring my attention back to the present moment and the things I can do, and the things that matter to me?

So let’s say that my child has a 103-degree fever. Continue reading

‘The Checkup’ Podcast On Aspects Of Anxiety: High, Parental And Hormonal

Screen shot 2013-08-01 at 9.39.48 AM

Extra, extra, get your hot-off-the-presses new episode of The Checkup, the health podcast that WBUR produces in partnership with Slate, here! It explores three different aspects of that incredibly common (especially among CommonHealth co-hosts) psychiatric disorder: anxiety.

First, we get into Rachel’s fear of flying and how she (sort of) overcame it. For a fuller story, she wrote about it here, but the saga continues.

Then, we speak with Harvard Medical School’s Mohammed Milad about his research on an intriguing hormone-based hypothesis that might help explain why so many more women suffer from fear and anxiety disorders than men. For more, see Rachel’s full interview with him: “Why Do So Many Women Have Anxiety Disorders? A Hormone Hypothesis“.

And finally, we talk about parental anxiety and how we can try to manage it better through mindfulness techniques, featuring a recent book on the topic — “The Mindful Way Through Anxiety” — by Suffolk University professor Sue Orsillo. For more, the book’s website is here, a sample chapter is here, and please stay tuned for a post with the full interview.

Each episode, The Checkup features a different topic — previous episodes focused on college mental health, sex problems, the Insanity workout and vaccine issues.

And in case you missed our most recent episodes: “Grossology” included a look at the first stool bank in the nation and research on the benefits of “bacterial schmears” from a mother’s birth canal — you can listen here. And “Sexual Reality Checks” busted myths about penis size, aging and female sexuality — it’s here.

If you listen and like it, won’t you please let our podcasting partner, Slate, know? You can email them at

Why Do So Many Women Have Anxiety Disorders? A Hormone Hypothesis

(Stuart Anthony/Flickr)

(Stuart Anthony/Flickr)

Why do so many women suffer from anxiety? Is it something inherent in being female, are we more attuned to our moods? Or is that breath-clenching feeling of impending doom hard-wired?

According to the National Institute of Mental Health, women are 60 percent more likely than men to experience an anxiety disorder over their lifetime. (Obviously, men are not immune: taken together, anxiety disorders are among the most common mental health conditions — they affect about 40 million men and women age 18 and older, or about 18 percent of the U.S. population.)

Mohammed Milad is an associate professor of psychiatry at Harvard Medical School and director of the Behavioral Neuroscience Program at Massachusetts General Hospital. He studies the complex interplay of gender, fear and anxiety. More specifically, he’s looking at how hormones, notably estrogen, might play a role in the fear response and our ability to extinguish fear and anxiety.

I spoke with him about his work. Here, edited, is some of our conversation:

RZ: OK, can you just clearly explain the difference between fear and anxiety? Sometimes it’s a fine line indeed.

MM: I was thinking about taking my kids camping over the summer, and I was reading about bears and potential bear encounters, and considerations for taking cover and putting your food this distance away from your camping site, etc. Anxiety is when you’re camping and you have that heightened awareness — hyper-vigilance  — that’s anxiety, it’s sustained, it’s continuous, but it’s not at the point where it makes you run or look for cover. Fear is when you see the bear; fear is intense, it’s immediate, it’s right there in front of you.

RZ: Thanks for that. But I’m curious, how did you start studying how men and women are different when it comes to fear and anxiety?

MM: When I was in grad school we used to host kids from middle and elementary school…showing our lab to them, showing them the rats, and one kid, maybe 10, 12 years old, asked, are they male or female rats and I said they’re all male rats, and he asked, why, what about the female rats? And I didn’t know the answer, so I went to my mentor and asked, why don’t we study the females? And the answer, simply put, was they’re complicated.

RZ: So the female rats were just too complicated. I get that. But considering far more women than men suffer from anxiety disorders, the fact that you were studying only male rats wasn’t such a great approach, was it?

MM: No, so I think that’s not an acceptable answer now.

RZ: In your experiments on rats and humans, you and your team use Pavlovian conditioning, as in Pavlov’s dogs, who were famously conditioned into drooling every time they heard a bell because they associated that sound with food. So, in these studies you repeatedly showed a blue light on a screen to men and women who would then receive a mild shock, until they came to expect — and fear — a shock every time they saw the blue light. Then, you stopped giving shocks when the blue light came on, to teach the subjects not to fear it. That’s “fear extinction.” And the next day, the men and women were tested to see if they still had a fear response to the blue light.

The results in these studies were all over the place, but most of the variance in fear response was among women in the experiment, right? The men were much more consistent. Why might that be?

MM: That’s what got me into beginning to think about hormones, because what could account for that other than maybe some women that we’re bringing in to the lab were at a particular phase of their menstrual cycle? And when we did that study we found that women who came in when their estrogen is elevated, they had their [fear] extinction capacity much better, in other words, they were able to control their fear, or express much less fear, compared to the women that came in in the early phase of their cycle… when they had low estrogen.

RZ: So just to be clear, high estrogen was linked to better control of fear, and low estrogen meant more potent and longer lasting fear?

MM: Right. Continue reading

Medicated (And Unmedicated) Women Are Talking

By Alicair Peltonen
Guest Contributor

I think a crucial step in decreasing the stigma surrounding mental illness is talking about it openly. And it seems readers want to talk.

My post, “The Medicated Woman: A Pill To Feel Better, Not Squelch Feelings,” on mental health and medication, was shared on Facebook more than 15,000 times and now has over 200 comments, so I thought it was worth a follow-up.

One thing readers wanted to discuss is the safety of antidepressants during pregnancy, a complicated topic which has been covered here and here on CommonHealth. Safety studies are mixed in many cases so women should consult their doctors. Here’s what it says on the Mayo Clinic website:

A decision to use antidepressants during pregnancy is based on the balance between risks and benefits. Overall, the risk of birth defects and other problems for babies of mothers who take antidepressants during pregnancy is very low. Still, few medications have been proved safe without question during pregnancy, and some types of antidepressants have been associated with health problems in babies.

Other comments underscored that stigma still exists but may be slowly diminishing.

(Flickr Creative Commons)

(Flickr Creative Commons)

Jackie wrote: “It took me until I was in my 50’s to accept that medication wasn’t the ‘weak”‘ way. I now see how much I lost and am living through a tremendously stressful life without those urges to accelerate into other cars or cement walls.”

“It’s in our family, but I was the first to seek help, and was probably the worst off. It was a secret that my grandfather had committed suicide,” wrote lilycarol.

And here’s a comment from helentroy4: “My mother was much like me. But to her dying day she never acknowledged that her behaviors were anything but ‘perfect mothering.’ I think had she been able to take advantage of this medication (or others of its kind), she would have been able to have the calming of her heart and soul that I have been blessed to have.”

There were many who suggested that lifestyle changes, including more exercise and sleep, meditation or yoga might be safer and more beneficial than medication. Continue reading

The Medicated Woman: A Pill To Feel Better, Not Squelch Emotions

By Alicair Peltonen
Guest Contributor

I am a medicated woman. I take 50mg of Sertraline (the generic form of Zoloft) a day. I don’t take it to be more tolerable to my husband. I don’t take it because I’m embarrassed by my emotions. And I definitely don’t take it to quietly fit into a polite societal mold. I take an anti-depressant every day to quell my anxiety simply because it feels better. I feel better.

I grew up in a talk therapy household. My father began group therapy for anger management issues in 1984, when I was 10, breaking a cycle of rage and avoidance that tends to swallow people whole, particularly men. He would come home feeling calmer and then he would implore my sister and me to explore our feelings and talk about our problems. Begrudgingly at times, I learned to think analytically. And thankfully, I learned that asking for help is not only acceptable, it’s downright healthy.

I started seeing therapists here and there in my 20s and then regularly several months after my first daughter was born. Medication had never been suggested by any of my previous therapists but this time was different. I couldn’t shake the feelings of inadequacy, the certainty that my daughter didn’t like me and I was just a glorified dairy cow. Post-partum depression is a hell of a thing.

(Rachel Zimmerman/WBUR)

(Rachel Zimmerman/WBUR)

When my therapist suggested I see a psychiatrist to discuss the possibility of medication, I went home and cried for an hour. I felt ashamed, defeated, embarrassed, weak. Even though I had seen medication transform my father from a man who growled and dragged to one who laughed and hugged, it still stung to feel like I couldn’t pull myself together.

But, remembering my father’s bravery, I thought I should at least give it a try. If I didn’t like it, I could always stop taking it. The first pill was swallowed through tears. And each successive pill went down easier. For a full year, I could go days without yelling or wanting to break things and entire weeks without crying. And I felt better.

After a year, I decided to go off the medication. Things had been much better and I wanted to see if I could “go back to normal.” And things did go back to normal. But it turns out my normal wasn’t very comfortable.

There have been many discussions and articles recently asking if modern psychiatry is over-medicating women. A recent op-ed in the New York Times by psychiatrist Julie Holland suggested that many of the symptoms for which women are treated with antidepressants are natural and healthy. “We have been taught to apologize for our tears,” she writes, “to suppress our anger and to fear being called hysterical.”

Here’s the thing, though. Breaking down into uncontrollable tears because you stubbed your toe and it’s the straw that broke the stress-camel’s back doesn’t feel good. Continue reading

Don’t Worry, Be Rational: Why Extreme Fear Of Ebola Is Bad For Your Health

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

A licensed clinician participates in a CDC training course in Alabama earlier this month for treating Ebola patients. (Brynn Anderson/AP)

Let’s face it, Ebola is scary. My kids are scared. The moms at school are talking about giving their children extra multi-vitamins to boost their immune systems in a desperate attempt to do something, anything, to protect their families. But we live in Boston and there are no cases here — yet. Still, that “yet” can make us crazy.

So, in a crisis, who do you call for comfort? The level-headed risk perception consultant: David Ropeik, who spoke with me briefly today about why such intense, prolonged worry and anxiety can backfire, make your body weaker and perhaps even damage your health:

Here, edited, is our short interview:

RZ: So, why is being scared of Ebola bad for your health?

DR: The health ramifications of this are profound. When we worry, that, biologically, is stress — that’s a mini fight-or-flight response going on in the body. When stress persists for more than several days (short-term stress is not the problems), it becomes damaging to our health. Chronic stress raises our blood pressure and increases the risk of cardiovascular problems; it suppresses our immune system and makes us more likely to catch infectious diseases or get sicker from them if we do. It interferes with neurotransmitters associated with mood, and it is strongly associated with clinical depression. Chronic stress interferes with digestion and memory and depresses fertility and bone growth (slows it down).

[The negative effects of chronic stress are widely reported, but Ropeik cites the book “Why Zebras Don’t Get Ulcers,” by the biologist Robert Sapolsky, as a key source here.]

So you think people are overreacting and we’re moving into some kind of widespread nation-wide chronic stress phenomenon here?

We’re on the cusp. It’s like what the fear of SARS did to people in Canada — it freaked [them] out for weeks: “Here it comes again,” is what they’re saying.

How do you see all this evolving?

In the last day and a half the criticism of how health officials have handled things and the mistakes they made in Dallas, real as those mistakes are, have become a focus, and it’s now starting to undermine trust in our health care system.

In a crisis, trust is the pivotal factor for how worried people are. Continue reading

Enterovirus D68: Good News, Bad News, What To Do



Pick your viral anxiety: Do you want to focus your media-fueled jitters on Ebola or on enterovirus D68?

Personally, even with today’s news of the first U.S. death from Ebola, I pick the enterovirus every time. For one thing, it’s actually around; it’s not a single case in Texas. But I’d prefer no anxiety at all, and the best antidote tends to be knowledge. So here are some data points:

The Massachusetts Department of Public Health fact sheet on enterovirus D68 is here and the CDC’s here. At a news conference last week, Dr. Alfred DeMaria, the department’s medical director for the Bureau of Infectious Disease, told reporters that enterovirus D68 had probably been “the predominant cause of respiratory illness over the last four weeks.”

Mostly, that meant colds, he said, and he thinks he even had the bug himself. But reports of lung ailments have “decreased significantly over the past couple of weeks,” he said, so “enterovirus 68 seems to be going away.”

Let’s hope. But what the heck? Here & Now reports that the enterovirus has been connected to five deaths nationwide, most recently of a 4-year-old in New Jersey. Of course, we know that viruses can sometimes lead to deaths by unleashing bacterial infections; flu has been known to kill dozens of American children in a bad year. But still, what to make of all the coverage of this unfamiliar virus?

I asked Dr. Ben Kruskal, chief of infectious diseases at Harvard Vanguard Medical Associates. My takeaway: Yes, this is quite a bit like flu, only it’s drawing attention because it’s a virus that’s acting atypically, surprisingly. Our conversation, edited:

There are so many viruses around; why are we even hearing about this one and what should we make of the coverage?

We’re hearing about it because it is not just a strain of a virus we don’t see very often but because it’s causing unusual manifestations, and manifestations that have enough impact for us to pay attention to. It’s actually in 30 or 40 states now, and we don’t really know how widespread it is because it’s clinically not terribly distinctive. It’s a respiratory virus that looks like a lot of other respiratory viruses, including the flu and the cold viruses and a whole bunch of others. And the reason we’re paying attention is not just the fact that it’s an unusual strain — then it would be a sort of laboratory curiosity — but because it’s actually on a more severe end of the spectrum for some people.

So it’s been confirmed that it’s here in Massachusetts, and it sounds like we have had more kids being hospitalized for respiratory trouble than usual in recent weeks, right? For example, Tufts Medical Center tells us that they’ve had 54 hospital admissions of kids with repiratory problems this year, compared to 27 admissions by this date last year, and they’re tending to stay in longer and need more treatment.

I understand from Dan Slater, who’s the director of pediatrics here at Harvard Vanguard, that we went months without having to admit any kids with asthma to the hospital, and in the last few weeks we’ve had quite a few admissions.

So what’s your public health message then at this point? What do you say to parents?

It’s reasonable to think of this outbreak in most respects as being like a sort of a nastier flu season. The timing is different from the flu season but in terms of how it manifests itself, it’s pretty similar to a severe flu. Remember that the flu and this virus — like any infectious agent — have a spectrum of severity. So even though this one is on average more severe, there are still lots of people who will get just a regular old cold. And there are some people who will get kind of a nasty cold. And there are some people who will get more severe things, including asthma-like illness in people who don’t have pre-existing asthma or an exacerbation of underlying asthma in people who do.

So are there telltale symptoms to watch for? Continue reading

School Lockdown Calculus: The Line Between Preparedness And Trauma

(Cory Doctorow/flickr)

(Cory Doctorow/flickr)

By Dr. Steven Schlozman
Guest Contributor

“If there’s a lockdown and they tell me to go under the table, and there’s a window open next to my desk, I’m going out that window. There’s no way I’m sticking around.”

That’s what a 14-year-old boy recently told me after he was reminded again that with the start of the school year comes as well the now increasingly familiar “lockdown” drill protocols.

Not very long ago, you’d probably have to ask kids what “lockdown drill” meant. Now, however, most kids recognize the term as routine. There’s recess, lunch-time, fire drills and lockdowns. Since the beginning of this school year alone, there have been more than 10 actual school lockdowns across our nation. One, as recently as this week, in New York. Importantly, none of these incidents featured the horrible images that come to mind when we picture nightmares like Sandy Hook or Columbine. A child might think she’s seen a gun in the school, or neighbors nearby might brandish shotguns in the midst of suburban altercations.

In all cases, schools aren’t taking any chances. The lockdown is quickly enacted and, school officials are quick to note, no one gets hurt.

But at what cost? Is there a psychological risk to what has now become routine practice? It’s time that we examine the lockdown and all its potential repercussions.

As a child psychiatrist, I worry a lot about these drills. Schools regularly ask for advice from mental health professionals on these matters, and parents often reach out and ask, understandably, what we ought to do in the setting of the still enormously rare and, at the same time, increasing and enormously traumatic spate of school shootings. The implementation of the mandatory lock down drill at our nation’s schools represents an awful lot of energy and resources and a potentially significant threat to the psychological well-being of our students in preparation for something that still thankfully hardly every happens.

Here are the facts:

•School shootings are horrific.

•School shootings are extremely rare.

•School shootings are increasing (at least according to this FBI analysis).

•Given how rare these events are, one can accurately say that school shootings are in fact increasing at a steady clip.

In other words, if we go hypothetically from one event to four events per year, that’s a fourfold increase even though the overall number of schools without incidents still massively dwarfs the schools that have had to endure a shooter.

•Every parent and every teacher worries about these events.

•Kids, it turns out, seems to worry less about these shootings than do adults.

•Some kids, however, are significantly frightened by these drills. Continue reading