The Washington Post
Tom Graham
06-06-2000

The extensive memory loss described by Ann Lewis in the accompanying article reinforces some of the widespread negative impressions about electroconvulsive therapy. Even supporters of ECT acknowledge that memory loss is a common side effect, though they say it is typically far less severe than that reported by Lewis.

Juan Saavedra, the Bethesda psychiatrist who treated Lewis before she underwent ECT, says he generally considers this therapy only for a very old person who would have trouble tolerating medication or for a person who is "in danger of suicide [where] you really cannot wait for the antidepressants to be effective." In discussing this as an option, he says, "my approach will be to say that the most important thing is preservation of life."

"There is always a lot of fears, and it's understandable" in light of publicized cases of "people who have been mistreated," says Saavedra, who adds that in his experience the majority of patients who are urged to receive ECT agree to do so.

"There is no way to predict" the degree of memory loss from ECT, Saavedra says. "Every treatment has its possibilities of something going wrong," but ECT is "a very safe procedure these days." Not nearly safe enough, in the view of those who believe ECT remains more dangerous than it's worth.

"The shock induces an electrical storm that obliterates the normal electrical patterns in the brain, driving the recording needle on the EEG up and down in violent, jagged swings. This period of extreme bursts of electrical energy often is followed by a briefer period of absolutely no electrical activity. . . . The brain waves become temporarily flat, exactly as in brain death, and it may be that cell death takes place at this time."

That's the view of another Bethesda psychiatrist, Peter Breggin, in his book "Toxic Psychiatry." Breggin's Web site, breggin.com, is only one of many (ect.org, antipsychiatry.org, banshock.org, etc.) that warn about the nasty repercussions of ECT.

Last year's Surgeon General's Report on Mental Health gave ECT's opponents little solace, though it did acknowledge some of the scientific mysteries and past misuses of the therapy since it was developed in the 1930s:

"ECT consists of a series of brief generalized seizures induced by passing an electric current through the brain by means of two electrodes placed on the scalp. . . . The exact mechanisms by which ECT exerts its therapeutic effect are not yet known. . . . Accumulated clinical experience--later confirmed in controlled clinical trials . . .--determined ECT to be highly effective against severe depression, some acute psychotic states and mania. No controlled study has shown any other treatment to have superior efficacy to ECT in the treatment of depression."

On the issue of memory loss, the report suggests that most patients are far less affected than Lewis was: "The confusion and disorientation seen upon awakening after ECT typically clear within an hour. More persistent memory problems are variable. Most typical . . . has been a pattern of loss of memories for the time of the ECT series and extending back an average of six months, combined with impairment with learning new information, which continues for perhaps two months following ECT."

The report also reiterated the medical establishment's conclusion that ECT is a worthwhile tool for treating certain mental disorders:

"Although the average 60 to 70 percent response rate seen with ECT is comparable to that obtained with pharmacotherapy, there is evidence that the antidepressant effect of ECT occurs faster than that seen with medication, encouraging the use of ECT where depression is accompanied by potentially uncontrollable suicidal ideas and actions. However, ECT does not exert a long-term protection against suicide. Indeed, it is now recognized that a single course of ECT should be regarded as a short-term treatment for an acute episode of illness."

Or as Saavedra said last week, "ECT doesn't cure anything."

next: Shock Treatment!
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

Electroconvulsive therapy helped to treat her intractable, dangerous depression. But the author was surprised to find out how much of her memory was wiped out.

The Washington Post
Ann Lewis
06-06-2000

I've been asked over and over again whether undergoing electroconvulsive therapy -- also known as ECT or shock therapy -- was a good decision. And whether I would have ECT again under the same circumstances.

The only honest answer I can give is that I have no idea. To say whether ECT was the right treatment for me, I would have to compare my life before ECT to my life now. And I simply cannot remember life before ECT. In particular, I cannot remember much about the two years leading up to my ECT treatments. That period, along with much of the preceding years, is memory that I lost in exchange for the hoped-for benefits of ECT.

That loss was huge and painful and potentially crippling. And yet, when my therapist describes how I was just before ECT, I believe that ECT was probably the best option at the time. He says that I was spiraling down into a depression that wouldn't lift. He says that I was contemplating suicide. And I believe him. While I don't remember that particular depression, I remember others -- many paralyzing episodes of depression in my 37 years of living with mental illness.

My therapist also says that I was failing to respond to medications. And that I also believe. While I cannot remember specific experiences with the plethora of drugs I've tried over the years, I do know that I tried so many because I was constantly searching for one that would finally work.

I had 18 ECT treatments over a six-week period beginning in May 1999. Based on some vague recollections and on what I've been told, here's what happened: Three times a week I rose at dawn to be at the hospital first thing; I sat in a crowded waiting room until my name was called. Then I put on a hospital gown, lay down on a gurney and was wheeled into an operating room designated for ECT patients. Full anesthesia was administered intravenously, and the next thing I knew I'd be waking up in the recovery room, ready to be taken home, where I'd sleep for the rest of the day.

My boyfriend and my mother shared the burden of caring for me. On the days between treatments, she says, we sometimes went to museums, malls and restaurants. She says that I was a zombie, unable to make even the smallest decisions. My boyfriend says I asked the same questions over and over again, unaware that I was repeating myself.

Right after my last treatment--my mother made a note of this in her diary for July 8--I woke up. I can liken this only to what I expect a person coming out of a coma experiences. I felt like a newborn, seeing the world for the first time. But unlike the common notion of first sight as a thing of splendor and awe, for me it was complete frustration.

While I couldn't recall how I had felt before ECT, I couldn't imagine it was any worse than what I was experiencing now.

Every little thing told me that I had no memory. I couldn't remember who had given me the beautiful picture frames or the unique knickknacks that decorated my home. My clothes were unfamiliar, as were the jewelry and trinkets I had owned for years. I didn't know how long I had had my cat or who my neighbors were. I couldn't remember which foods I liked or what movies I had seen. I didn't remember people who greeted me on the street or others who called me on the telephone.

A former news junkie, I was especially frustrated to realize that I didn't even know who the president was or why someone named Monica Lewinsky was famous. I was floored when I found out about the impeachment hearings.

And I couldn't remember my boyfriend, although he practically lived with me. There was evidence all over the apartment that we loved each other, but I didn't know how or when we had met, what we liked to do together or even where we liked to sit while watching television. I didn't even remember how he liked to be hugged. Starting from scratch, I had to get to know him again while he had to accept the frustrating loss of what we once had together.

While continuing to battle my mental illness--ECT is no instant cure--I had to relearn how to live my life.

I didn't know my parents had moved. I had to be "reminded" about that great sub shop in Bethesda and about my favorite restaurant, the Lebanese Taverna. I spent 15 minutes in the cracker aisle in Safeway until I recognized the box of my favorite crackers, Stone Wheat Thins. I retrieved some clothes only by going to seven different cleaners to ask if they had an overdue order belonging to Lewis. Just yesterday I lost a contact lens: I've been wearing contacts for at least 10 years, but I have no idea who my eye doctor is, so replacing the lost one will be another tedious challenge.

Socializing was the hardest part of my recovery, since I had nothing to contribute to a conversation. While I had always been sharp-tongued, quick-witted and sarcastic, I now had no opinions: Opinions are based on experience and I couldn't recall my experiences. I relied on my friends to tell me what I liked, what I didn't like and what I'd done. Listening to them trying to reconnect me to my past was almost like hearing about someone who had passed away.

Before ECT I had been working for a legal concern in the District where the environment was exciting and the people were fun. That's what I've been told, anyway. Just before undergoing my treatment I informed my employer of my disability and requested time off. I estimated that I would need two weeks, unaware that the ECT would eventually stretch on for six weeks and that I would need months to recover.

As the weeks passed, I missed going to work, though I realized I had forgotten the names of major clients I had dealt with daily and even the names of the computer programs I had used routinely. And I couldn't recall the names--or the faces--of the people I had worked beside--people who had been to my house and with whom I had traveled frequently.

I didn't even know where my office building was located. But I was determined to get my life back on track, so I dug up all my work materials and began studying to catch up with my old life.

Too late: My therapist's request that the firm accommodate my extended absence failed. The company claimed that for business reasons it had been obliged to put someone else into my position and asked where my personal belongings should be sent.

I was devastated. I had no job, no income, no memory and, it seemed, no options. The thought of looking for a job scared me to death. I couldn't remember where I had saved my resume on my computer, much less what it actually said. Worst of all--and this is probably the most familiar feeling among those who suffer from depression--my self-esteem was at an all-time low. I felt completely incompetent and unable to handle the most minor of tasks. My resume--when I finally found it--described a person with enviable experiences and impressive accomplishments. But in my mind I was a nobody with nothing to hold onto and nothing to look forward to.

Perhaps due to these circumstances, perhaps due to my natural biological cycles, I fell back into depression.

Those first months after ECT were horrible. Having lost so much, I was facing another bout of depression--just what the treatments had been intended to correct. It wasn't fair and I didn't know what to do. Restoring my memory--or trying to accept its permanent loss--became the focus of my therapy sessions. I couldn't recall how badly I had felt before the treatment, but I knew now that I was desperate and completely demoralized.

At the edge of hopelessness, I somehow committed myself to hanging in there--not for me, but for the family members and friends who were working hard to make my life better. Daily thoughts of suicide were something I learned to ignore. Instead, I focused on making it through each day. I managed to get out of bed each morning and drive to the coffee shop, where I forced myself to read the entire newspaper, even if I couldn't remember much of what I had read. It was exhausting, but after a few weeks I was reading books and running errands. Soon I re-entered the world of computers and e-mail and the Web. Little by little, I was reconnecting to the world.

I also attended therapy religiously. The therapist's office was a safe place where I could admit just how bad I was feeling. Thoughts of suicide were a normal part of my life, but I felt it would be unfair to share those dark feelings with family and friends.

Through the Depression and Related Affective Disorders Association, I joined a support group, which became central to my recovery. There I realized that I was not alone in my plight and for once I had friends to whom I could talk honestly. Nobody was shocked to hear what the voice in my head was telling me.

And I began to run and exercise again. Before ECT I had been training for my first marathon. After, I couldn't run even a mile. But within a few months I was covering long distances, proud of my accomplishment and grateful for an outlet to deal with my stress.

In October I tried a new medication for depression, Celexa. Maybe it was this drug, maybe it was my natural cycle, but I began to feel better. I experienced days where death wasn't on my mind, and then I experienced days where I actually felt good. There was even a turning point when I began to feel hopeful, like something good could actually happen in my life.

The most poignant moment occurred a month after I changed medications. My therapist asked, "If you always felt the way you do today, would you want to live?" And I honestly felt that the answer was yes. It had been a long time since I had felt like living instead of dying.

It's close to a year now since I finished my ECT treatments. I am working full-time. I see my therapist only once every two to three weeks. I still attend DRADA meetings regularly. My memory is still poor. I cannot recall most of the two years before ECT, and memories prior to that time must be triggered and dug out of my mental archives. Remembering requires a great deal of effort, but my mind is sharp once again.

Friends and family say that I am less gloomy than I was, cheerful and less brash. They say I've softened a bit, though my basic personality has indeed returned. In part I attribute my gentler attitude to the truly humbling experience of having my self disappear. In part I attribute it to the loss of my well-honed vocabulary: I was reluctant to speak up when I couldn't find the right words. But in greatest part I attribute my change to a renewed desire for peace in my life. I am now dedicated to managing my depression and living a satisfying life day by day. I feel that if I can make the best of the moment, then the future will take care of itself.

As for my boyfriend, we're getting to know each other again. I'll be forever grateful for how he cared for the sudden stranger he met after my treatments.

Would I undergo ECT again? I have no idea. Where medication does not work, I believe the doctors' judgment that ECT is still the most effective treatment. For people who are sick enough to be considered for ECT--as I was--I believe the benefits justify the potential loss of memory. Losing my memory, my career, my connections to people and places may seem too much to bear, but I see all that as not a huge price to pay for getting better. What I lost was enormous, but if it is health I have gained, that is obviously far more valuable than what I lost.

While this year has been the hardest of my life, it has also provided me with a foundation for the next phase of my life. And I truly believe that this next phase will be better. Perhaps it will even be great. With a medication that seems to be working, a strong network of support and the ability to move forward, my life looks promising. I've learned to hang in there when it seemed impossible and to rebuild from a significant loss. Both are difficult. Both are painful. But both are possible. I am living proof.

next: Shocking Treatment
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

Can a preschooler be diagnosed with ADHD? And a 20-year old sadly looks back at opportunities passed by because of ADHD and learning disabilities. What can a parent do to help? ADHD expert, Dr. David Rabiner has some answers.

1. How old does a child need to be for ADHD to be diagnosed?

2. How can I help my grown child not to be discouraged by ADHD?

I've several parents ask about their child being diagnosed with ADHD at three—or even two—and started on medication. I suggest that parents be very cautious about this. Although many children with ADHD will begin to display symptoms at such a young age, it is difficult to diagnose ADHD with any certainty in a child so young. This is because many extremely active toddlers will calm down as they develop and mature. In addition, excessive activity and impulsivity is characteristic of many toddlers, which makes it hard to determine when it is unusual enough to possibly reflect a disorder.

Here is a quote from DSM-IV—the publication that specifies the diagnostic criteria for all psychiatric disorders, including ADHD: "Most parents first observe excessive motor activity when the children are toddlers, frequently coinciding with the development of independent locomotion. However, because many overactive toddlers will NOT (emphasis mine) go on to develop ADHD, caution should be exercised in making this diagnosis in early childhood."

Now, if parents are having difficulty with a young toddler because of excessive activity and/or other symptoms that may possibly reflect ADHD, it certainly is important for these problems to be addressed. This is true regardless of whether or not that child turns out to have ADHD. In a child so young, however, many mental health providers believe it is more appropriate to begin with non-medical interventions. In fact, the treatment guidelines recently published by the American Academy of Child and Adolescent Psychiatry state the following:

"In this age group (i.e. preschoolers), stimulants have more side effects and lower efficacy and should therefore only be used in more severe cases or when parent training and placement in a highly structured, well-staffed treatment program has been unsuccessful or is not possible."

I would urge parents to be cautious about starting their preschooler on stimulant medication and to consult with their child's doctor about non-medical interventions that can be tried. If your child was diagnosed with ADHD at such a young age, and you are uncertain about the accuracy of the diagnosis, you might also want to consider having your child reevaluated.

" 20 year old daughter is feeling really frustrated because she is seeing what she might have become if not for her ADHD and learning disabilities. How can she learn to cope with this?"

This is an excellent and important question and one for which a definitive answer is not possible. I have worked with several adolescents and young adults who struggled with similar frustrations and disappointments. Because of the many difficulties that ADHD can cause, some look back and see years of squandered opportunity. Some individuals in this situation feel confused and uncertain about their ability to successfully handle the demands of higher education, developing a fulfilling career path, and handling the responsibilities of adulthood. This can be especially difficult when peers seem to be moving forward.

I'm afraid that anything I suggest here may sound somewhat trite, but here are some ideas to consider. First and foremost, talking about these feelings can help. Most of us have at least some regrets about the choices we've made or failed to make in our lives, and being able to discuss these openly with a supportive and empathetic listener - whether that be a family member, friend, or professional therapist - can be enormously helpful.

For someone with ADHD, it can be especially important to develop a realistic understanding of how this condition influenced the course of their development and may have contributed to some of their struggles. Although this can not change one's history, this understanding can help protect against unreasonably overemphasizing (e.g. blaming all one's difficulties on the condition) or under emphasizing (e.g. refusing to acknowledge that the disability played any role).

Through these discussions, a young adult can also gain a better understanding of their strengths and weaknesses. Ideally, this self understanding can help guide their future plans in a way that realistically incorporates the role that any ongoing ADHD symptoms could or should play in these plans. When this occurs, shying away from areas where one can succeed should be less likely, as should pursuing paths that may not be ideally suited for one's personality and temperament. This process would not be expected to be something that happens suddenly or even quickly; rather it would be expected to occur over a period of time, and at different rates for different individuals. Ideally, it will help someone develop a perspective on their past that enables them to look towards the future with a greater sense of confidence and purpose.

A very important issue raised by this question concerns a child's understanding of ADHD during their development. In my experience, children are often not told that they have ADHD, or may have heard that they have "it" but have no real idea what "it" is. Some children take medication for an extended period without every really understanding why. In these circumstances, it is not uncommon for a child to have a vague sense that something is wrong with him or her, and the teasing that some children experience when peers find out they take "hyper pills" certainly doesn't help.

My own feeling is that it is quite important for a child with ADHD to have a realistic understanding of what ADHD is and what it means to have it. Parents I have spoken with are often concerned about saying anything to their child because they don't want their child to think there is something wrong with them. When a child is provided with an age appropriate explanation about what it means to have ADHD, however, I believe that this is actually less likely to occur.

This knowledge can also help protect children against teasing they may receive from some insensitive classmates. It may also help them during adolescence and young adulthood when most individuals deal with the important developmental task of deciding about the type of future they hope to build for themselves. Because they have realistically incorporated the awareness of having ADHD into their overall self-understanding, they may be better equipped to deal with this task than if they first begin coming to terms with what it means to have ADHD at this at this time.

Deciding how, or even if, to discuss these issues with your child is an important decision for parents. Several very good books are available to help parents with this task. Among those that I would recommend are Shelley, The Hyperactive Turtle by Deborah Moss (written for children 3-7); Putting on the Brakes by Patricia O. Quinn and Judith Stern (for children 5-10); and Distant Drums, Different Drummers: A Guide for Young People with ADHD by Barbara Ingersoll.

About the author: Dr. Rabiner is Senior Research Scientist at Duke University and Director of Undergraduate Studies Dept. of Psychology and Neuroscience. Dr. Rabiner has extensive experience evaluating and treating children for ADHD and has written numerous published papers on the impact of attention difficulties on academic achievement. He is editor of the Attention Research Update newsletter.

next: Diagnosis, Treatment of ADHD in Very Young Children May Be Inappropriate
~ adhd library articles
~ all add/adhd articles

Study shows Adderall more effective than Ritalin in treating ADHD symptoms.

A new study published in this month's Journal of the American Academy of Child and Adolescent Psychiatry found that Adderall (R) (mixed salts of a single-entity amphetamine product) is significantly more effective at reducing inattention, oppositional behavior, and other symptoms of attention deficit/hyperactivity disorder (ADHD) than methylphenidate (Ritalin), an older ADHD treatment.

The study of 58 children with ADHD also found that the benefits of Adderall last longer than those of methylphenidate (which is sold under the brand name Ritalin(R)). In fact, 70 percent of patients taking a single morning dose of Adderall found significant improvement in ADHD symptoms, while just 15 percent of patients taking methylphenidate improved significantly with only one dose.

"In our study, children with ADHD showed more improvement after Adderall treatment compared with methylphenidate," said Steven Pliszka, M.D., lead investigator of the study and chief of child and adolescent psychiatry at The University of Texas Health Science Center at San Antonio. "It is important for children with ADHD to have effective treatment, because left untreated, ADHD can increase the risk of low self-esteem and social and academic failure."

In Dr. Pliszka's clinical study, 58 children diagnosed with ADHD were given Adderall, methylphenidate, or placebo for three weeks in a double-blind parallel-group design. All groups started week one on a once-daily dosing regimen. If the children's afternoon or evening behavior did not improve after week one, a mid-day or 4 p.m. dose was added for week two.

Teachers rated morning and afternoon behaviors, while parents rated evening behaviors. According to teacher ratings, Adderall produced more improvements in inattentive and oppositional behaviors than methylphenidate (p less than 0.05).

In addition, the psychiatrist-administered Clinical Global Impression Improvement scale, which is used to assess response to treatment, showed that more children found greater ADHD symptom relief with Adderall than with methylphenidate. In fact, 90 percent of children taking Adderall were found to be "very much improved" or "much improved" in behavior, when statistically compared with 65 percent of the methylphenidate group and 27 percent of the placebo group (p less than 0.01).

The study also showed that 70 percent of patients taking Adderall and only 15 percent of patients taking methylphenidate were still on once-daily dosing at the end of the study, based on a pre-defined dose titration scheme. "The higher response rate for Adderall is very encouraging," Dr. Pliszka said. "Our study suggests that Adderall can be the first option for the treatment of ADHD."

In the study, both medications were well tolerated, and side effects were similar to placebo. The most common side effects associated with stimulant use are insomnia, loss of appetite, stomach pain, headache, irritability, and weight loss.

The University of Texas study was funded with a grant from Shire Richwood Inc., which manufactures Adderall.

About ADHD

ADHD affects 3 percent to 5 percent of all school-age children, and is considered the most frequently diagnosed psychiatric disorder in children and adolescents. The most common behaviors exhibited by those who have ADHD are inattention, hyperactivity, and impulsivity.

Stimulant medications -- which stimulate areas of the brain that control attention, impulses, and self-regulation of behavior -- are among the most successful treatments for people with ADHD. In fact, at least 70 percent of children with ADHD respond positively to treatment with stimulant medication.

About Adderall

Adderall is a stimulant medication for the treatment of ADHD. It has been shown to improve attention span, decrease distractibility, improve the ability to follow directions and complete tasks, and decrease impulsivity and hyperactivity.

Adderall is generally well tolerated. While adverse reactions are rare, the most frequently reported adverse reactions include anorexia, insomnia, stomach pain, headache, irritability, and weight loss. These side effects are similar to those seen with other stimulant medications used to treat ADHD. As with most stimulant medications indicated for ADHD, the possibility of growth suppression and the potential for precipitating motor tics and Tourette's syndrome exists with Adderall treatment, and, in rare cases, exacerbations of psychosis have been reported. Since all amphetamines have a high potential for abuse, Adderall should be used only as part of a comprehensive treatment program under close physician supervision.

Rainy River Record
March 21, 2000

By Ken Johnston
Editor

Could you imagine drinking all night and then getting in your car and driving somewhere impaired?

While it does happen, most people are sensible and use a designated driver or get a ride some other way. However, for Kenora's Wayne Lax, driving impaired was something he said he did for 25 years.

Lax who suffered from deep depression and extreme alcoholism after the death of his brother was treated by doctors with two types of medical practises. One involved pharmaceuticals arid the other was electro-shock therapy. At one point he was on 17 different drugs per day and all the while was shock treated 80 times in that period of time. With that in mind one would think that he was incapable of driving and that medical professionals would have notified the Ministry of Transportation of his constant impairment.

Well until 1992, when Lax had a severe motor accident and he was charged with impaired driving he was never told he could not drive, at least as not as far as he can remember and the MTO was not notified of his condition.

Lax says that he knows now that he should never have been operating a motor vehicle, much less have been a taxi driver, while on all those medications, but he swears that he can not recollect much of those years due to the electro-shock treatments: treatments he calls barbaric.

He is now actively leading a two-pronged crusade to have electro-shock treatments banned and to raise awareness about medicated impaired driving. Lax has joined a MoT group called the CAR Committee that has members from Mothers Against Drunk Driving, police, pharmacists and the MoT on it. Through their and his efforts Lax has received the attention of former Minister of Transportation Tony Clement and current MoT David Turnball. They have taken his material into consideration and Lax says they plan to use it when they review MoT policies and laws. According to Lax that takes place every two years and he is optimistic that they will be reviewed this year.

Lax is pushing for the government to take a tougher stance on the mandatory reporting by doctors patients who should not be driving while on medication. While it is the law, he said be was never once reported to MoT.

He plans to continue his efforts to raise awareness about these two important issues by working with self-help groups, visiting schools to talk to students and continue writing letters to officials until things change in a way that lives are saved.

next: Minnesota Forced Shock
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

SURGEON GENERAL DAVID Satcher's recently released position paper, "Mental Health: A Report of the Surgeon General," is inaccurate and misleading, because its conclusions are not the result of valid, scientific research. Satcher's report maintains that about one in five Americans - or 53 million people - are mentally ill during any given year, and that about 50 percent of Americans suffer from mental illness during their lifetimes. These assertions are neither new nor scientific.

In the early 1990s, the National Institute of Mental Health (NIMH) made precisely the same claims. The statistics came from surveys by "lay interviewers."

Along with the American Psychiatric Association, the NIMH recommended in the ill-fated 1993 Clinton health care plan that Americans should be insured for 30 outpatient psychiatric visits a year with unlimited psychotherapy sessions.

Let's do some math. If 53 million Americans had 30 outpatient visits, the insurance companies would have to pay for 1.6 billion psychiatric sessions a year. This would lead to the birth of what has been described by critics as "the Therapeutic Society."

If the recommendations and claims of the surgeon general's report were taken seriously, it also would mean that mental illness would rank as the most common chronic disease in America.

According to the latest "Statistical Abstract of the United States," it would surpass arthritis, which afflicts about 32.7 million, and hypertension, from which about 30 million suffer.

Psychiatrist Kay Redfield Jamison claimed in a Dec. 17 letter to the New York Times, "The science underlying the numbers and treatments in the surgeon's report ... is reliable and replicable." What she doesn't claim - what she cannot claim - is that the numbers are valid.

Psychiatry uses reliability of psychiatric disorders (testing to see if diagnosticians agree on which psychiatric disease patients suffer from) in the place of a search for validity (ascertaining whether psychiatric diagnosis measures what it claims to measure). This has been pointed out most recently by Dr. Paul McHugh of Johns Hopkins University in an article in last month's Commentary magazine.

The surgeon general's report maintains that mental health should not be viewed as "separate and unequal" to general health, and that there should be public support for the long-standing goal of "parity" for mental illness, which means insurers would have to treat mental illness on an equal basis with physical illness.

The costs of parity are widely disputed, but they are likely to be exorbitant.

In an article in The Washington Post, Carmella Bocchino, vice president for medical affairs of the American Association of Health Plans, said, "We've seen estimates that mental health parity would cost increases of 1 to 5 percent. ... Do we give up other parts of the benefits package, or are we looking to rising health care costs?" The Employee Benefit Research Institute, a nonprofit think tank, has determined that, at a minimum, parity will lead to increases in employer costs and possible elimination of other benefits in some cases, including health insurance coverage altogether.

The report also promotes the mental health system's second major goal in addition to the addressing of parity: the elimination of stigma, which produces public reluctance to pay for care and adds to the indignities of mental illnesses. In the words of the report, stigma "must be overcome."

There are three "severe mental illnesses" - schizophrenia, bipolar disorder and major depression - and they are arguably caused by brain disease. The stigma should be removed from them.

But stigma serves a useful purpose with the hundreds of other so-called mental disorders: It deters many who would frivolously claim to suffer from those "diseases."

One would think that the report's conclusions would be more tentative given its caveats, such as, "It is sometimes difficult to determine when a set of symptoms rises to a level of a mental disorder" and "No single gene has been found to be responsible for any specific mental disorder." Then there is this unqualified non sequitur: "For about one in five Americans, adulthood is interrupted by mental illness."

There is a reasonable alternative to the seemingly endless calls to expand the categories of mental illness and to exaggerate the incidence and prevalence of mental illness.

Instead of allowing a large number of Americans to get coverage for nebulous maladies such as "adjustment disorder" or "social anxiety disorder," the insurance companies should provide full coverage for everyone suffering from schizophrenia, bipolar disorder or major depression, all of which may result from authentic brain disease.

The American Psychiatric Association estimates that only about 3 percent to 4.5 percent of the public suffers from "severe mental illness." Focusing on the true brain disorders would save the nation millions of dollars and allow the money to be spent where it is really needed.

(Mr. Vatz is a professor of communications at Towson University and has written extensively on mental health issues.)

next: More Children Undergo Shock Therapy
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

Local shock treatment victim Wayne Lax is giving his support to a woman in Montreal who is suing the federal government for $4.6 million after most of her life was blanked out by shock therapy, induced comas and a mixture of drugs.

"I back this woman 100 per cent because I know what she went through," said Lax. "Shock therapy treatment was abused. It blanks the mind out and damages you permanently."

Gail Kastner, now 56, was admitted by her father to the Allan Memorial Institute when she was 19 for depression. She was given electroconvulsive therapy (ECT treatments) otherwise known as electroshock treatments in 1953 by a doctor notorious for his brainwashing experiments.

She is blaming the federal government for supporting Dr.Ewen Cameron's research, which left her with bizarre behaviour including screaming nightmares, persistent seizures and a complete blank about her past. Kastner was ostracized by her family and left nearly homeless after she reverted to childlike behaviour such as wetting the living room carpet, sucking her thumb, babytalk and wanting to be bottle fed. Her trial is presently underway in Montreal.

Lax, who currently lives in Kenora, is presently involved in his own series of lawsuits which he says are not out of revenge, but out of concern for others.

Lax said he spent 25 years in a state of confusion and despair, undergoing 108 admissions to mental institutions, 80 ECT treatments and taking up to 17 different pills per day.

"I am missing large portions of my memory and suffer from chronic, severe back pain when I broke a bone in my back because I didn't have enough muscle relaxant during ECT treatments," said Lax.

"People need to be aware of what shock does to human beings. And we are human beings, not just patients."

Lax is presently drug free and is a member of numerous psychiatric survivors groups.

next: Sister Fights Brother's Involuntary Electroshock By State Hospital
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It is possible to get Social Security benefits for your ADHD child. Read my experience plus helpful tips about applying and links.

My Two Cents on Social Security

Several years ago, I applied for Social Security benefits for my son James who has ADHD. I did this for several reasons. The first was because of his medical condition and the second was for the medical benefits. Being disabled myself left me with no other medical coverage for my son other than the states med-i-cal program which was hit very hard in the mental health services for children shortly after James was diagnosed.

On top of already scarce mental health clinics with large and long waiting lists, children's mental health services took huge budget cuts. This left help for children such as James at a minimum and only children who were in danger of being removed from their homes and placed into foster care or children who had crossed the boundaries into the Judicial system were given access to mental health services. Having social security benefits did several things for my son.

1). It opened the doors to doctors that before would not see him because he was on the state med-i-cal program, and two. Secondly, it allowed a cash benefit to obtain services that were not covered by giving us the extra cash we needed to pay for those services. It also allowed me to put James into programs that helped him tremendously with self esteem and social issues that we could not otherwise afford.

Social Security Benefits for Children with ADHD

I had a reader write to me and ask me for my best advice on applying for social security benefits for children with disabilities, so I thought that I would share what I learned with all my readers. At the time I applied for SSI for my son, I felt, as did his doctors, that James had a severe case of ADHD. It was explained to me that I should apply for social security in order to get the medical benefits that would allow me to obtain treatment for James and that due to the severity of the James' condition at the time, his doctors felt that there would be no problem getting him approved. Needless to say, I was surprised when James was denied SSI and also a bit angry when I had knowledge of other children, not nearly as affected by ADHD, as James that had been approved. This didn't make sense to me and hinted that there must be other factors involved when approving someone for social security other than medical fact. So I appealed the decision and started making phone calls and you'd be surprised what I learned.

One roadblock I ran into was the school district. Not only did they provide only minimal information during the first SSI inquiry, but they refused to even fill out the information for the appeal. The school psychologist and the teacher decided not to comply with the new request for information citing that paperwork had been done once before and that they were busy and couldn't stop what they were doing to fill out more paperwork. I felt this attitude was not only typical of the school district, but I was outraged at their audacity! How dare they take it upon themselves to assume that my son didn't need the benefits which SSI could provide for him which is how I interpreted their actions and attitude.

I started making phone calls after my son was denied and I learned that each worker is assigned X number of cases and they have X number of days once that case hits their desk to process it and move it off of their desk by either denying the case or approving it. Part of their evaluation for job performance is based on how effectively and timely cases pass through their hands. I found out that the worker who initially had my case denied it the day before he went on vacation. I concluded that the decision on my son's case was influenced by a worker, who in an attempt to clear their calendar before leaving on vacation, hurriedly and careless passed judgments on my son's disability in order to maintain their performance record.

The individuals and agencies that they contact in order to gain information on your child are not bound by any laws or regulations to comply with Social Security. If they send the information in by the time the file has to be processed or moved on that's fine. If not, the decision is made without the information. The next thing I learned was that the worker who was in charge of my son's appeal, had some education in psychology and felt that ADD/ADHD was not a disorder but basically a parental problem and issue of environment. These children don't have a disorder, they suffer from bad parenting and parents who have no desire to parent their children in a fashion that commands discipline or forces them to function. She went on to tell me that if these parents would simply spank these children and enforce penalties for bad behavior, these children would straighten up!

In retrospect, if I had to do it all over again, my best advice is this:

• Be very complete and thorough when answering the questionnaires you will be sent. Take time to explain every item in detail and don't be bashful about using additional paper. In fact, I used a separate piece of paper for each question and numbered them to correspond with the questionnaire and used my word processor to compile a neat and legible report and....it leaves you with a file you can return to if needed.

• When you initially apply, do not leave it in the hands of others to insure that Social Security gets all the information they need to make an accurate and fair decision in your case. Gather as much information from every source that has documentation on how ADD/ADHD and any related disorders or issues affects your child's ability to function, day to day activities, and his/her ability to operate as other children. If you can do this before hand and send it in with your application, all the better.

• Keep tight tabs on the progress of your application. I was able to call the Main Social Security Office to find out if my son's case had been assigned, and to whom it was assigned and also left a message for that worker to contact me.

• I kept in close contact with my doctors, asking them if they had been contacted by social security and followed up to make sure they sent the records being requested.

• Without harassing the worker about approving the case, I simply kept in contact to ensure that those contacted were complying with social security's requests. The worker was more than happy to tell me who had complied and who had not and I was able to contact the individuals and agencies involved and be sure they send the information requested out in a timely fashion. I did this because I learned during the appeal that those contacted for information on your child are in no way obligated by any laws or rules that they comply with any request for records. If any agency should fail to send in requested info, Social Security will make it's decision based on what they have which may not be enough.

• Last but not least. DO NOT be afraid to stand up for your child's rights! YOU are his/her only advocate. In the end, I went to my Congressman to be sure that my child was getting an impartial, unbiased and fair judgment in his case.

One more note before I get off my soapbox :) Another valuable lesson I learned was that when you initially apply for Social Security benefits for your child, they have a certain time frame in which to open/close the case. When you appeal a decision, your case comes under a whole new set of guidelines and rules and and can sit on someone's desk for months before it becomes active again.

I was told off the record, by a social security worker, that I would have been better off had I chose NOT to appeal the decision, waited the allotted time limit, and then just re-applied. This would have placed the case back at the beginning, with the original time table and minus, any bias or judgmental input from previous workers. The down side to this is that if you choose to do this, you lose your original filing date and you start over which will affect what Social Security will owe you once you are approved.

For the latest information on Social Security benefits for children with disabilities.

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When it comes to your ADHD child and school, you need to know your rights and the school's responsibility concerning Special Education. Trust me, most schools offer little help in this regard.

Warrior Beginnings

Kindergarten wasn't much better than preschool. In fact, it was worse.

My son James, who has severe ADHD, was unable to concentrate or focus, was all over his classroom, laying under the tables, wandering around the room, playing in the bathroom and rarely able to focus or stay on task. His teacher, burdened with too many students and no aids, allowed him to wander aimlessly as long as he didn't bother the other children. She did not have the time, the energy, or the help to redirect James.

I was told that I needed to sit in class with him or remove him from school. I wasn't aware of my rights or my child's education rights when it comes to how a school needs to accommodate a child with disabilities. I didn't realize I had choices. The school didn't tell me I had choices. So, I quit my job and went to school with my son.

I'm not sure which was more heartbreaking, seeing James' inability to function in class or watching the way the teacher and other students treated him. On top of all of James' other problems, now I was afraid that his self-esteem was suffering as well. I also added a new emotion to my list: shame.

The Importance of Knowing Special Education Laws and Your Child's Rights

As an ignorant parent, putting my trust and faith in the "trained professionals" that were teaching my son, one day while in class, I participated in their efforts to "teach him a lesson". To this day, the shame remains with me and tears come to my eyes when I think back to that day.... but it was a beginning. It's what it took to get the teacher to agree that my child needed help.

Asking for help and actually getting help was a different story. In addition, I must use a different dictionary than the school does because their idea of "help" and MY idea of "help" were two different things.

This is where knowledge of my rights, and my child's rights, would have empowered me and given me the tools I needed to ensure that the state and federal laws that grant my child's right to a free and appropriate education would have been honored. Had I simply known my rights, I could have prevented a lot of the horrific things that happened to my child.

This is why you need to know your rights and the school's responsibility concerning Special Education. Due to my ignorance at the time, and the belief that the "trained professionals" knew best, I settled for the school's promises of help.

Knowing what I do now, and having been there, here are some tips and ideas that could work for your child.

next: Being a Mother of an ADHD Child
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Several well conducted studies have shown that children with ADHD are more likely than others to become depressed at some time during their development. In fact, the risk for developing depression is as much as 3 times greater than for other children.

A study published in the Journal of Affective Disorders (January 1998, 113-122) examined the course of depression in 76 children with ADHD in order to learn more about the relationship between ADHD and depression. The authors were especially interested in whether depression in children with ADHD represents an actual clinical depression, or whether it may be better understood as a kind of "demoralization" that can result from the day-to-day struggles that children with ADHD often have.

Depression Defined

Lets begin by reviewing what mental health professionals mean when they talk about depression. The important point to emphasize is that the clinical diagnosis of depression requires the presence of a collection of different symptoms - just because one is feeling down or depressed does not necessarily mean that the diagnosis of major depression would be appropriate.

According to DSM-IV, the publication of the American Psychiatric Association that lists the official diagnostic criteria for all psychiatric disorders, the symptoms of major depression are as follows:

• depressed mood most of the day nearly every day (in children and teens this can be irritable mood rather than depressed);
• loss of interest or pleasure in all, or almost all, activities;
• significant weight loss when not dieting or weight gain, or a decrease or increase in appetite
• insomnia or hypersomnia (i.e., sleeping too much) nearly every day;
• extreme restlessness or lethargy (e.g., very slow moving;
• fatigue or loss of energy nearly every day;
• feelings of worthlessness or inappropriate guilt;
• diminished ability to think or concentrate nearly every day;
• recurrent thoughts of death and/or suicidal thoughts;

For the diagnosis of depression to apply, 5 or more of the symptoms listed above need to be present during the same 2 week period (i.e. the symptoms must have persisted for at least 2 weeks), and at least one of the symptoms must be either 1) depressed mood (irritable mood in children can qualify) or 2) loss of interest or pleasure.

In addition, it must be determined that the symptoms cause clinically significant distress or impairment, are not due to the direct physiological effects of a medication or general medical condition, and are not better accounted for by bereavement (i.e., loss of a loved one).

As you can see, the important point is that true clinical depression is indicated by a collection of symptoms that persist for a sustained time period, and is clearly more involved that feeling "sad" or "blue" by itself.

Is Depression in Children the Same as in Adults?

Let me also say a few words about depression in children. Research has shown that the core symptoms for depression in children and adolescents are the same as for adults. Certain symptoms appear to be more prominent at different ages, however. As already noted above, in children and teens the predominant mood may be extreme irritability rather than "depressed". In addition, somatic complaints and social withdrawal are especially common in children, and hypersomina (i.e., sleeping too much) and psychomotor retardation (i.e., being extremely slow moving are less common).

What, then, would a "typical" depressed child look like? Although there, of course, would be wide variations from child to child, such a child might seem to be extremely irritable, and this would represent a distinct change from their typical state. They might stop participating or getting excited about things they used to enjoy and display a distinct change in eating patterns. You would notice them as being less energetic, they might complain about being unable to sleep well, and they might start referring to themselves in critical and disparaging ways. It is also quite common for school grades to suffer as their concentration is impaired, as does their energy to devoted to any task. As noted above, this pattern of behavior would persist for at least several weeks, and would appear as a real change in how the child typically is.

Many Depressed ADHD Children Have Relationship Problems

With this brief overview of depression behind us, lets get back to the study. The authors of this study started with 76 boys who had been diagnosed with both major depression and ADHD and followed them over a 4 year period. Because depression can be such a debilitating condition they were interested in learning what factors predicted persistent major depression, and how the course of depression and ADHD were intertwined.

The results of the study indicated that the strongest predictor of persistent major depression was interpersonal difficulties (i.e., being unable to get along well with peers). In contrast, school difficulty and severity of ADHD symptoms were not associated with persistent major depression. In addition, the marked diminishment of ADHD symptoms did not necessarily predict a corresponding remission of depressive symptoms. In other words, the course of ADHD symptoms and the course of depressive symptoms in this sample of children appeared to be relatively distinct.

The results of this study suggest that in children with ADHD who are depressed, the depression is not simply the result of demoralization that can result from the day to day struggles that having ADHD can cause. Instead, although such struggles may be an important risk factor that makes the development of depression in children with ADHD more likely, depression in children with ADHD is a distinct disorder and not merely "demoralization."

Depression in children can be effectively treated with psychological intervention. In fact, the evidence to support the efficacy of psychological interventions for depression in children and adolescents is more compelling than the evidence supporting the use of medication.

The Importance of Recognizing the Symptoms of Depression in Children

The important point that can be taken from this study, I think, is that parents need to be sensitive to recognizing the symptoms of depression in their child, and not to simply assume that it is just another facet of their child's ADHD. In addition, if a child with ADHD does develop depression as well, treatments that target the depressive symptoms specifically need to be implemented. As this study shows, one should not assume that just addressing the difficulties caused by the ADHD symptoms will also alleviate a child's depression.

If you have concerns about depression in your child, a thorough evaluation by an experienced child mental health professional is strongly recommended. This can be a difficult diagnosis to correctly make in children, and you really want to be dealing with someone who has extensive experience in this area.

About the author: David Rabiner, Ph.D. is a Senior Research Scientist, Duke University, an expert in ADHD and author of the Attention Research Update newsletter.

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