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'I Don't Feel Trapped On Earth': Ketamine Lifts Many From Depths Of Major Depression

Sarah Kramer, 37, has been profoundly depressed most of her life. But "right now, thanks to ketamine," she says, “I don’t feel despair. I don’t feel hopeless. I don’t feel trapped on earth.” (Jesse Costa/WBUR)

Sarah Kramer, 37, has been profoundly depressed most of her life. But “right now, thanks to ketamine,” she says, “I don’t feel despair. I don’t feel hopeless. I don’t feel trapped on earth.” (Jesse Costa/WBUR)

Thirty-seven-year-old Sarah Kramer has been profoundly depressed most of her life. She remembers feeling different from the time she was 4.

“I never wanted to be anything when I grew up, because I didn’t want to grow up, because I didn’t want to keep living,” Kramer, of Medford, recalls.

Kramer grew up a diplomat’s daughter. The family moved around Africa, the United States and Canada. She started out a straight-A student, then her grades slipped and she gained weight. She never attempted suicide, but it was always in her thoughts. She had a breakdown in high school and over time ended up on a slew of psychiatric medications.

But she remained depressed and suicidal. In more recent years, she barely left the house.

Now for the first time since Kramer was a child, she has hope. The veil of depression is lifting.

“I feel very much like a stranger in a strange land,” she says.

Within A Few Minutes, The Ketamine Kicks In

Kramer is taking a medicine doctors call the biggest discovery in the treatment of mood disorders in decades. It’s a drug that was never intended to treat depression. It’s used as anesthesia — and used illegally as a club drug called “Special K.”

The drug is ketamine. Kramer takes it as a nasal spray.

We meet Kramer at a Massachusetts General Hospital outpatient clinic where doctors are prescribing ketamine to the most severely depressed patients. Psychiatrist and lead researcher Christina Cusin says many of the patients are on the verge of suicide. They’re people who get little or no relief from traditional antidepressants. But they do get relief from ketamine. Continue reading

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It’s Not Just Heroin: Drug Cocktails Are Fueling The Overdose Crisis

Anthony, seen here in Chelsea, says he has overdosed 12 times. His really intense highs were produced by heroin, sometimes with an alcohol chaser, and pills. (Martha Bebinger/WBUR)

Anthony, seen here in Chelsea, says he has overdosed 12 times. (Martha Bebinger/WBUR)

A bald man in gray sweats bounds into the brick plaza next to City Hall.

“Hey,” someone calls out, “where you been?”

“At the hospital,” the man named Anthony says. “I OD’d.”

A half dozen people watching shake their heads. It’s a bad week in Chelsea, they say, with three overdose deaths.

“They’re dropping like flies,” says Theresa, a woman who manages a rooming house and does not want to share her last name.

Anthony, whose last name we’ve also agreed not to use, says he overdosed the night before on a particularly strong bag of heroin, laced with fentanyl, the dealer said, or something like it.

“[The dealer] told me how strong it was,” Anthony says, “but everyone says that to sell their dope.”

Fentanyl, an opiate that is many times more powerful than heroin, was present in about 37 percent of overdose deaths from January through June of last year, based on 502 cases analyzed by the Office of the Chief Medical Examiner in Massachusetts. Continue reading

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Haunted House Science: You Don’t Need Gore To Terrify, If You Know The Brain

Shir Atzil, a former post-doc in the Interdisciplinary Affective Science Lab, uses her head to help scare haunted house visitors. (Courtesy of NewtonHauntedHouse.org)

Shir Atzil, a former post-doc in the Interdisciplinary Affective Science Lab, uses her head to help scare haunted house visitors. (Courtesy of NewtonHauntedHouse.org)

It’s a classic Halloween activity: the homemade haunted house, replete with cold spaghetti “worms” and bowls of peeled-grape “eyeballs.” Remember?

That old tradition gets a 21st-century scientific twist at an elaborate haunted house in Newton that opens for just one night a year — the night before Halloween — to raise money for charity. And it is elaborate not just in its multitudes of living ghouls, its gaggles of graves and squads of skeletons.

It is an exercise in scare tactics informed by brain science.

“You can be really artful about how you scare people without a lot of gore,” says Northeastern University professor Lisa Feldman Barrett. “And I thought, well, who better to do that than a lab that studies the science of emotion? We can use research to predict what the effects will be, to make it super-scary without a lot of blood and guts.”

Barrett leads the Interdisciplinary Affective Science Lab at Northeastern and Massachusetts General Hospital. For the last 10 Halloweens, she and her family have created a haunted basement in their Victorian home, helped by her lab colleagues — grad students, post-docs and other researchers who play monsters for the night.

Some of their scare techniques may not seem to differ much from those of amusement park haunted houses, but they’re devised by neuroscientists who live and breathe the brain.

“What your brain is doing is making predictions based on past experience,” Barrett says as she leads the way into the labyrinth in her basement. “So if we set up things to look really kitschy at the beginning, with a lot of props, your expectation is, ‘This is going to be pretty lame, this is not going to be very scary.’ And when you walk in, we will violate that expectation.”

Indeed they do. You walk into a dimly lit room and notice some skulls, some bats and what seems to be a statue of a human-sized monster sitting on a table. You’re not sure, though, if it’s a statue or a live person, until it — or rather, he — opens his eyes very wide and stares into yours. Yikes.

Barrett says the effect carries a wallop in part because the brain is wired to pay huge attention to whether an object is alive or inanimate. (You can imagine why that would be important for survival.)

When visitors are unsure whether a figure is alive or a statue, they often “freeze in uncertainty,” she says, just like a rat in an experiment when it’s not sure whether it’s about to receive a small electric shock.

Also, certain special effects fire up specific parts of the brain, Barrett says, including the amygdala, an area important for detecting uncertainty or novelty. The neurons in the amygdala are very tuned to eyes, “to whether the eyes are open or shut or moving, and how much white. The more white there is, especially in a still face, the scarier people find it.”

Here’s another brain-science trick: It’s scarier when you first see something out of the corner of your eye, because your peripheral vision involves more uncertainty.

Many of the the haunted house effects are aimed at increasing uncertainty, Barrett says, “because uncertainty enhances arousal — I don’t mean sexual arousal, I mean feeling activated and worked up and jittery.” Continue reading

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‘Everything Is Grace’: Looking To Faith For Answers To Suicide

In 34 years as pastor of Morning Star Baptist Church in Mattapan, Bishop John Borders has seen it all in terms of life struggles: church members or their loved ones lost to murder; people suffering from addiction, poverty and cancer; grief and trauma from suicide.

“We need one another to survive in these challenging days. You cannot handle all the pressures of life alone,” Borders preached in a sermon earlier this year. “Any man or woman that’s suffering or going through hardship, you are not alone! Christ is suffering with you as you suffer with him!”

Bishop John Borders of Morning Star Baptist Church in Mattapan feels the faith movement has glossed over the pain of those with depression and suicidal feelings. (Robin Lubbock/WBUR)

Bishop John Borders of Morning Star Baptist Church in Mattapan feels the faith movement has glossed over the pain of those with depression and suicidal feelings. (Robin Lubbock/WBUR)

Borders views suicide in a way that would put him at odds with some other clergy.

“I do not see suicide as a sin. I do not think the Scriptures teach that,” Borders says. “Who can really understand what’s going on in the mind and heart spiritually, emotionally, biochemically? None of us really knows.” Continue reading

After 7 Overdoses, Joey Searches For A Reason Why He’s Still Here

Joey feeding the birds in the morning in Bellingham Square. (Jesse Costa/WBUR)

Joey, who recently started using methadone to try and kick his heroin addiction, feeds the birds in Bellingham Square in Chelsea. “People say that you OD two or three times, the third time you usually die. I OD’d seven times and I’m still here, so someone up there is watching me,” he says. “Someone has a purpose for me or a plan, but I keep waiting for that purpose of plan or purpose and I can’t find it.” (Jesse Costa/WBUR)

It’s the first few minutes of the early morning that are really hard for Joey. For about nine years, until just a few months ago, he’d wake up — in a bed or on a park bench or under the Tobin Bridge — and immediately put a needle in his arm.

“I would always save a shot of heroin for myself for the morning to get myself going,” Joey, 47 says — just enough to keep the vomiting and tremors of withdrawal at bay. (He asked that we only use his first name because he’s still using the drug, and dealing a little, and we agreed.)

Joey says he misses the whole morning routine in a small way — like how some people crave the smell, look and taste of coffee in the morning. His face softens as he describes “opening the bag, pouring [heroin] in the cooker, pouring the water in it, drawing it up, seeing the blood in the needle, that’s all a part of the high,” he said — all part of the anticipated euphoria, all part of the power of heroin. Continue reading

No Blame, No Shame: Treating Heroin Addiction As A Chronic Condition

Ever heard of a diabetic patient who ate a large muffin before having a blood glucose test, was scolded for giving in to temptation, and then told to just say no to carbs?

How about a cardiac patient who has a worrisome stress test and is shown the door when she admits to eating a few Big Macs?

That kind of response is all too familiar for patients whose brains have been altered by heroin or other opiates.

“We blame patients for their disease,” says Dr. Sarah Wakeman. “We also kick people out of treatment for having symptoms of their disease with addiction, which would honestly be malpractice if we did that with other conditions.”

Wakeman runs the Substance Use Disorders Initiative at Massachusetts General Hospital, where treating addiction as a chronic condition, like diabetes or asthma or high blood pressure, is the norm.

Patients are screened using questions that determine if they are at risk for addiction. There’s an assessment. Then Wakeman and her patients work on lifestyle changes, decide what medication will help break the addiction, and meet frequently to monitor progress. Continue reading

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Self-Diagnosing Online? Study Finds Sites Are Only Accurate About Half Of The Time

“Looking at whether these tools are good enough to replace the doctor is the wrong debate,” said Jason Maude, co-founder of Isabel. (Robin Lubbock/WBUR)

“Looking at whether these tools are good enough to replace the doctor is the wrong debate,” said Jason Maude, co-founder of Isabel. (Robin Lubbock/WBUR)

There’s a new warning for those of us who go online to figure out why we have a stomach ache or a nagging cough or occasional chest pain.

Symptom checkers — those tools that let you enter information and then produce a diagnosis — are accurate about half of the time, according to a study out of Harvard Medical School.

How Symptom Checkers Rate

Rate at which each tool got a diagnosis correct in the first three suggestions:

Best Performing:
Symcat – 75 percent
Isabel – 69 percent
AskMD – 68 percent

Worst Performing:
BetterMedicine – 29 percent
Earlydoc – 33 percent
Symptomate and Esagil – 34 percent

Source: Harvard Medical School study (full table page 11)

Looking at 23 websites, the Harvard study found that a third listed the correct diagnosis as the first option for patients. Half the sites had the right diagnosis among their top three results, and 58 percent listed it in their top 20 suggestions.

“Users of these tools should be aware that their performance is not perfect by any means, there’s often inaccuracies or errors,” said Dr. Ateev Mehrotra, the study’s lead author.

At the Mayo Clinic, Dr. John Wilkinson said, “We’re always trying to improve, but if most of the time the diagnosis is included in the list of possibilities, that’s all we’re attempting to do.”

Wilkinson, an editor of Mayo’s symptom checker, said patients should not expect it to deliver the correct diagnosis.

“It’s designed to be a starting point,” Wilkinson said, one that will direct patients to the best articles and help them “be better equipped to have a conversation with their doctor or a nurse triage line or whatever the next step might be.” Continue reading

Medical Marijuana Is Now For Sale In Mass.

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

Marijuana plants at In Good Health Inc., in Brockton (Jesse Costa/WBUR)

There’s another milestone in the storied history of Salem. On Wednesday, the state’s first dispensary for medical marijuana opened on the ground floor of a former factory here, a few blocks off a busy thoroughfare. Continue reading

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Your Doctor, Always Available, For A Monthly Fee

For 10 years, Jeff Gold showed up to a job he wanted to love: being a family doctor.

“I was busy as a bee,” says Gold, 39, with up to 2,500 patients, seeing 20 or so a day.

Dr. Jeff Gold runs a direct primary care office in Marblehead. (Martha Bebinger/WBUR)

Dr. Jeff Gold runs a direct primary care office in Marblehead. (Martha Bebinger/WBUR)

Rushing from one patient to the next, calling insurers who wouldn’t approve prescriptions, filling out paperwork that didn’t seem relevant to his patients, Gold kept asking himself, is this what I signed up for?

“I thought I was gonna help everybody and spend time with everybody and it’s impossible to do,” Gold says.

So Gold quit, wrote a business plan to be a doctor who does not take insurance, hired one staff member (a nurse), and borrowed almost $400,000 to outfit a two-exam-room office next to a candy shop and café in Marblehead.

Gold may be the first physician in Massachusetts practicing under a model called direct primary care. For a flat monthly fee, Gold offers patients one-hour same-day appointments, no wait. The doctor is available 24/7 in person, at the office, at the patient’s home, via text, email or Skype. Continue reading

Time The Healer Moves Slowly For 2 Boston Marathon Survivors

Marathon bombing survivor Martha Galvis is learning to use a hand doctors are still reconstructing. Here Galvis attempts to pick up a pen off a table after a physical therapy session at Faulkner Hospital. (Jesse Costa/WBUR)

Marathon bombing survivor Martha Galvis is learning to use a hand doctors are still reconstructing. Here Galvis attempts to pick up a pen off a table after a physical therapy session at Faulkner Hospital. (Jesse Costa/WBUR)

It’s just the crumb of a muffin, but Martha Galvis must pick it up. Lips clenched, eyes narrowed, she goes after the morsel, pushing it back and forth, then in circles, across a slick tabletop.

“I struggle and struggle until,” Galvis pauses, concentrating all her attention on the thumb and middle finger of her left hand. She can’t get them to close. Oh well.

“I try as much as I can. And if I do it I’m so happy, so happy,” she says, giggling.

Galvis, 62, has just finished a session of physical therapy at Boston’s Brigham and Women’s Faulkner Hospital, where she goes twice a week. She’s learning to use a hand doctors are still reconstructing. It’s been two years to the day since she almost lost it.

On April 15, 2013, Martha and her husband Alvaro Galvis headed for Cleveland Circle — mile 22 on the Boston Marathon route. This would be the first of three spots from which they’d enjoy the race and the boisterous crowd. Their last stop would be at or near the finish line in Boston. Continue reading