Behavioral signs that indicate your child or teen may find a psychiatric evaluation beneficial.

Parents are usually the first to recognize that their child has a problem with emotions or behavior. Still, the decision to seek professional help can be difficult and painful for a parent. The first step is to gently try to talk to the child. An honest open talk about feelings can often help. Parents may choose to consult with the child's physicians, teachers, members of the clergy, or other adults who know the child well. These steps may resolve the problems for the child and family.

Following are a few signs which may indicate that a child and adolescent psychiatric evaluation will be useful.

Younger Children

• Marked fall in school performance.
• Poor grades in school despite trying very hard.
• A lot of worry or anxiety, as shown by regular refusal to go to school, go to sleep or take part in activities that are normal for the child's age.
• Hyperactivity; fidgeting; constant movement beyond regular playing.
• Persistent nightmares.
• Persistent disobedience or aggression (longer than 6 months) and provocative opposition to authority figures.
• Frequent, unexplainable temper tantrums.

Pre-Adolescents and Adolescents

• Marked change in school performance.
• Inability to cope with problems and daily activities.
• Marked changes in sleeping and/or eating habits.
• Many physical complaints.
• Sexual acting out.
• Depression shown by sustained, prolonged negative mood and attitude, often accompanied by poor appetite, difficulty sleeping or thoughts of death.
• Abuse of alcohol and/or drugs.
• Intense fear of becoming obese with no relationship to actual body weight, purging food or restricting eating.
• Persistent nightmares.
• Threats of self-harm or harm to others.
• Self-injury or self destructive behavior.
• Frequent outbursts of anger, aggression.
• Threats to run away.
• Aggressive or non-aggressive consistent violation of rights of others; opposition to authority, truancy, thefts, or vandalism.
• Strange thoughts and feelings; and unusual behaviors.

If problems persist over an extended period of time and especially if others involved in the child's life are concerned, consultation with a child and adolescent psychiatrist or other clinician specifically trained to work with children may be helpful.

Source: American Academy of Child and Adolescent Psychiatry, Sept. 1999

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Internet addiction expert, Dr. Kimberly Young delves into the psychology of Internet addiction.

KIMBERLY S. YOUNG
University of Pittsburgh at Bradford

A Case that Breaks the Stereotype

SUMMARY

This case involves a homemaker 43 years of age who is addicted to using the Internet. This case was selected as it demonstrates that a nontechnologically oriented woman with a reportedly content home life and no prior addiction or psychiatric history abused the Internet which resulted in significant impairment to her family life. This paper defines addictive use of the Internet, outlines the subject's progression of addictive on-line use, and discusses the implications of such addictive behavior on the new market of Internet consumers.

This research note concerns the case of a 43-yr.-old homemaker whom the author recently interviewed as part of a larger study designed to examine addictive use of the Internet (Young, 1996). Media attention on the subject of "Internet addiction" has stereotyped those who become addicted as predominantly young, introverted, computer-oriented males. Further, prior research has indicated that predominantly object-oriented introverted males become computer addicted (Shotton, 1989, 1991), and educational specialists have shown that women report lower self-efficacy than men when asked about their use of information technologies (Busch, 1995). In contrast to these observations, this case was selected from the author's original study, as it demonstrates that a nontechnologically oriented woman with a self-reported content home life and no prior addiction or psychiatric history, abused the Internet which resulted in significant impairment to her family life.

DEFINING ADDICTION

The original project was initiated based upon reports which indicated that some on-line users were becoming addicted to the Internet in much the same way that others became addicted to drugs, alcohol, or gambling. The way to clinically define addictive use of the Internet is to compare it against criteria for other established addictions. However, the term addiction does not appear in the most recent version of the DSM-IV (American Psychiatric Association, 1995). Of all the diagnoses referenced in the DSM-IV, substance dependence may come the closest to capturing the essence of what has traditionally been labeled addiction (Walters, 1996) and provides a workable definition of addiction. The seven criteria considered under this diagnosis are withdrawal, tolerance, preoccupation with the substance, heavier or more frequent use of the substance than intended, centralized activities to procure more of the substance, loss of interest in other social, occupational, and recreational activities, and disregard for the physical or psychological consequences caused by the use of the substance.

While many believe the term addiction should only be applied to cases involving chemical substances (e.g., Rachlin, 1990; Walker, 1989), similar diagnostic criteria have been applied to a number of problem behaviors such as pathological gambling (Griffiths, 1990; Mobilia, 1993; Walters, 1996), eating disorders (Lacey, 1993; Lesieur & Blume, 1993), sexual addictions (Goodman, 1993), generic technological addictions (Griffiths, 1995), and video game addiction (Griffiths, 1991,1992; Keepers, 1990; Soper, 1983). Therefore, in the original study was developed a brief seven-item questionnaire which adapted similar criteria for substance dependence in the DSM-IV to provide a screening measure of addictive use of the Internet (Young, 1996). If a person answered "yes" to three (or more) of the seven questions, the person was deemed to be an Internet "addict." It should be noted that the term Internet is used to denote both the actual Internet and on-line service providers (e.g., America Online and Compuserve) in this paper.

A CASE STUDY

This subject reported that despite being 'computer phobic and illiterate," she was able to navigate easily through the on-line system of her new home personal computer because of the menu-driven applications provided by her on-line service. Her on-line service was the only application for which she used her computer, and she initially spent a few hours per week scanning a variety of social chat rooms, i.e., these are virtual communities which allow multiple on-line users to converse or "chat" instantly with one another in real time. Within a 3-mo. period, the subject gradually needed to spend longer periods of time on-line, which she estimated to reach a peak of 50 to 60 hours per week. She explained that once she became established in a particular chat room where she felt a sense of community among other on-line participants, she frequently stayed on-line longer than she intended, e.g., two hours, reporting sessions lasting up to 14 hours. Typically, she logged on the first thing in the morning, she constantly checked her e-mail throughout the day, and she stayed up late using the Internet (sometimes till dawn).

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She eventually felt depressed, anxious, and irritable whenever she was not in front of her computer. In an effort to avoid what she referred to as "withdrawal from the Internet," she engaged in activities to stay on-line as long as she could. The subject canceled appointments, stopped calling real life friends, reduced her interpersonal involvement with her family, and quit social activities she once enjoyed, e.g., bridge club. Further, she stopped performing routine chores, such as the cooking, cleaning, and grocery shopping, that would take her away from being on-line.

The subject did not see her compulsive use of the Internet as a problem; however, significant family problems developed subsequent to her overuse of the Internet. Specifically, her two teenage daughters felt ignored by their mother, as she was always sitting in front of the computer. Her husband of 17 years complained about the financial cost of the on-line service fees which he paid (up to $400.00 per month), and about her loss of interest in their marriage. Despite these negative consequences, the subject denied that this behavior was abnormal, had no desire to reduce the amount of time she spent on-line, and refused to seek treatment despite repeated requests from her husband. She felt it was natural to use the Internet, denied anyone could be addicted to it, felt her family was being unreasonable, and found an unique sense of excitement through on-line stimulation that she would not give up. Her continual overuse of the Internet eventually resulted in becoming estranged from her two daughters and separated from her husband within one year of the purchase of her home computer.

The interview with this subject took place six months subsequent to these events. At that time, she admitted having an addiction to the Internet "like one would to alcohol." Through the loss of her family she was able to reduce her own use of the Internet with no therapeutic intervention. However, she stated that she was unable to eliminate on-hne use completely without external intervention nor was she able to reestablish an open relationship with her estranged family.

DISCUSSION

Given the recent surge in access to information technologies (Graphics, Visualization, and Usability Center, 1995), we have a new generation of diverse computer users. As this case suggests, contrary to the stereotype of a young, male, computer-savvy on-line user as the prototypic Internet "addict," new consumers of the Internet who do not match this general stereotype are just as susceptible. Given the severity of the family impairment in this case, future research should focus on the prevalence, characteristics, and consequences of this type of addictive behavior.

This case suggests that certain risk factors may be associated with the development of addictive use of the Internet. First, the type of application utilized by the on-line user may be associated with the development of Internet abuse. The subject in this case became addicted to chat rooms which is consistent with prior research that has found highly interactive applications available on the Internet (e.g., virtual social chat rooms, virtual games called Multi-user Dungeons played in real time simultaneously with multiple on-line users) to be most utilized by its consumers (Turkle, 1984, 1995). Research may document that, in general, the Internet itself is not addictive, but perhaps specific applications play a significant role in the development of Internet abuse. Secondly, this subject reported a sense of excitement when using the Internet which can be paralleled to the "high" experienced when people become addicted to video games (Keepers, 1990) or gambling (Griffiths, 1990). This implies that the level of excitement experienced by the on-line user while engaged in the Internet may be associated with addictive use of the Internet.

Based upon the issues raised here, it would be beneficial to adapt the brief questionnaire (Young, 1996) for use in classifying cases of such Internet abuse. By monitoring such cases, prevalence rates, further demographic information, and implications for treatment can be obtained. More significantly, one may show whether this type of behavior is implicated in or acts as a substitute for other established addictions, e.g., chemical dependencies, pathological gambling, sexual addictions, or if it is a co-morbid factor with other psychiatric disorders, e.g., depression, obsessive-compulsive disorders.

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REFERENCES

AMERICAN PSYCHIATRIC ASSOCIATION. (1995) Diagnostic and statistical manual of mental disorders. (4th ed.) Washington, DC: Author.

BUSCH, T. (1995) Gender differences in self-efficacy and attitudes toward computers. Journal of Educational Computing Research, 12,147-158.

GOODMAN, A. (1993) Diagnosis and treatment of sexual addiction. Journal of Sex and Marital Therapy, 19, 225-251.

GRAPHICS, VISUALIZATION, AND USABILITY CENTER.(1995) Online Access, March Issue, 51-52.

GRIFFITHS, M. (1990) The cognitive psychology of gambling. Journal of Gambling Studies, 6, 31-42.

GRIFFITHS, M. (1991) Amusement machine playing in childhood and adolescence: a comparative analysis of video game and fruit machines. Journal of Adolescence, 14, 53-73.

GRIFFITHS, M. (1992) Pinball wizard: the case of a pinball machine addict. Psychological Reports, 71, 161-162.

GRIFFITHS, M. (1995) Technological addictions. Clinical Psychology Forum, 71, 14-19.

KEEPERS, C. A. (1990) Pathological preoccupation with video games. Journal of the American Academy of Child and Adolescent Psychiatry, 29, 49-50.

LACEY, H. J. (1993) Self-damaging and addictive behaviour in bulimia nervosa: a catchment area study. British Journal of Psychiatry, 163, 190-194.

LESIEUR, H. R., & BLUME, S. B.(1993) Pathological gambling, eating disorders, and the psychoactive substance use disorders. Comorbidity of Addictive and Psychiatric Disorders, 89-102.

MOBILA,P (1993) Gambling as a rational addiction. Journal of Gambling Studies, 9,121-151.

RACHLIN, H.(1990) Why do people gamble and keep gambling despite heavy losses? Psychological Science, 1,294-297.

SHOTTON, M. (1989) Computer addiction? A study of computer dependency. Basingstoke, UK:

Taylor & Francis.

SHOTTON, M. (1991) The costs and benefits of "computer addiction." Behaviour and Information Technology, 10, 219-230.

SOPER, B. W (1983) Junk-time junkies: an emerging addiction among students. School Counselor, 31, 40-43.

TURKLE, S. (1984) The second self' computers and the human spirit. New York: Simon & Schuster.

TURKLE, S. (1995) Life behind the screen: identity in the age of the Internet. New York: Simon & Schuster.

WALKER, M. B. (1989) Some problems with the concept of "gambling addiction": should theories of addiction be generalized to include excessive gambling? Journal of Gambling Behavior, 5,179-200.

WALTERS, G. D. (1996) Addiction and identity: exploring the possibility of a relationship. Psychology of Addictive Behaviors, 10, 9-17.

YOUNG, K.S. (1996) Internet addiction: the emergence of a new clinical disorder. Paper presented at the 104th annual convention of the American Psychological Association, Toronto, Canada

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Referral sources for parents seeking psychiatric help for your child. Also definitions of various mental health professionals.

Parents are often concerned about their child's emotional health or behavior but they don't know where to start to get help. The mental health system can sometimes be complicated and difficult for parents to understand. A child's emotional distress often causes disruption to both the parent's and the child's world. Parents may have difficulty being objective. They may blame themselves or worry that others such as teachers or family members will blame them.

If you are worried about your child's emotions or behavior, you can start by talking to friends, family members, your spiritual counselor, your child's school counselor, or your child's pediatrician or family physician about your concerns. If you think your child needs help, you should get as much information as possible about where to find help for your child. Parents should be cautious about using Yellow Pages phone directories as their only source of information and referral. Other sources of information include:

• Employee Assistance Program through your employer
• Local medical society, local psychiatric society
• Local mental health association
• County mental health department
• Local hospitals or medical centers with psychiatric services
• Department of Psychiatry in nearby medical school
• National Advocacy Organizations (NAMI, Federation of Families for Children's Mental Health, NMHA)
• National professional organizations (American Academy of Child and Adolescent Psychiatry, American Psychiatric Association)

The variety of mental health practitioners can be confusing. There are psychiatrists, psychologists, psychiatric social workers, psychiatric nurses, counselors, pastoral counselors and people who call themselves therapists. Few states regulate the practice of psychotherapy, so almost anyone can call herself or himself a psychotherapist.

Child and Adolescent Psychiatrist — A child and adolescent psychiatrist is a licensed (M.D. or D.O.) physician who is a fully trained psychiatrist and who has two additional years of advanced training beyond general psychiatry with children, adolescents and families. Child and adolescent psychiatrists who pass the national examination administered by the American Board of Psychiatry and Neurology are board certified in child and adolescent psychiatry. Child and adolescent psychiatrists provide medical/psychiatric evaluation and a full range of treatment interventions for emotional and behavioral problems and psychiatric disorders. As physicians, child and adolescent psychiatrists can prescribe and monitor medications.

Psychiatrist — A psychiatrist is a physician, a medical doctor, whose education includes a medical degree (M.D. or D.O.) and at least four additional years of study and training. Psychiatrists are licensed by the states as physicians. Psychiatrists who pass the national examination administered by the American Board of Psychiatry and Neurology are board certified in psychiatry. Psychiatrists provide medical/psychiatric evaluation and treatment for emotional and behavioral problems and psychiatric disorders. As physicians, psychiatrists can prescribe and monitor medications.

Psychologist — Some psychologists possess a master's degree (M.S.) in psychology while others have a doctoral degree (Ph.D., Psy.D, or Ed.D) in clinical, educational, counseling or research psychology. Psychologists are licensed by most states. Psychologists can provide psychological evaluation and treatment for emotional and behavioral problems and disorders. Psychologists also provide psychological testing and assessments.

Social Worker — Some social workers have a bachelor's degree (B.A., B.S.W., or B.S.), however most social workers have earned a master's degree (M.S. or M..S.W.). In most states social workers can take an examination to be licensed as clinical social workers. Social workers provide most forms of psychotherapy.

Parents should try to find a mental health professional who has advanced training and experience with children, adolescents, and families. Parents should always ask about the professionals training and experience. However, it is also very important to find a comfortable match between your child, your family, and the mental health professional.

Source: American Academy of Child and Adolescent Psychiatry, Aug. 1999

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She was making lunch for herself and a friend one Saturday this spring when an unfamiliar feeling swept over her. The 50-year-old social worker had fallen deep into depression two years earlier, and had given up on prescription antidepressants when the first one she tried left her sluggish, sexually dormant and numb to her own emotions. Then, in mid-March, she heard about a naturally occurring substance called SAMe (pronounced "Sammy"). She had been taking it for just a few days when she began setting the table that Saturday morning. A ginger-miso sauce was chilling in the fridge, and she was garnishing her finest plates with fresh anemones. Suddenly, there it was: a sense of undiluted pleasure.

This woman (who asked not to be named) has taken SAMe ever since, and her mood isn't the only thing that has changed. Until this spring she took prescription-strength anti-inflammatories for her arthritis, and still had trouble bending her knees. She's now off those drugs and feeling more nimble than she has in 20 years.

Could an over-the-counter tonic really do all this? Pills purporting to cure everything from hemorrhoids to hangnails are usually worthless and sometimes dangerous. And because SAMe has not been studied extensively in the United States, many doctors are leery. Beware, says Dr. Gilbert Ross of the American Council on Science and Health, a conservative watchdog group. Supplement dealers are once again trying to "flimflam the public into using untested remedies instead of FDA-approved pharmaceuticals."

The Food and Drug Administration has not rigorously evaluated SAMe, let alone approved it. (Federal law permits the unregulated sale of naturally occurring substances as long as marketers avoid therapeutic claims.) And the studies that researchers have conducted are not of the magnitude the FDA would require for a drug approval. But that doesn't mean SAMe is "untested." In dozens of European trials involving thousands of patients, it has performed as well as traditional treatments for arthritis and major depression. Research suggests it can also ease normally intractable liver conditions. SAMe doesn't seem to cause adverse effects, even at high doses. And doctors have prescribed it successfully for two decades in the 14 countries where it has been approved as a drug.

Until recently, few Americans had heard of the stuff. An Italian firm developed it as a pharmaceutical in the early 1970s but lacked the will or the resources to make a run at a drug approval in the United States. Then, this spring, two U.S. vitamin companies, GNC and Pharmavite, started importing large quantities of SAMe to sell as a supplement. The product took off quickly-Pharmavite's Nature Made brand now ranks 25th among the 13,000 supplements sold in grocery and drugstores-and the impact is still growing. When you consider that some 50 million Americans suffer from arthritis or depression, the implications are staggering.

SAMe (known formally as S-adenosylmethionine) is not an herb or a hormone. It's a molecule that all living cells, including our own, produce constantly. To appreciate its importance, you need to understand a process called methylation (chart). It's a simple transaction in which one molecule donates a four-atom appendage-a so-called methyl group-to a neighboring molecule. Both the donor and the recipient change shape in the process, and the transformations can have far-reaching effects. Methylation occurs a billion times a second throughout the body, affecting everything from fetal development to brain function. It regulates the expression of genes. It preserves the fatty membranes that insulate our cells. And it helps regulate the action of various hormones and neurotransmitters, including serotonin, melatonin, dopamine and adrenaline. As biochemist Craig Cooney observes in his new book, "Methyl Magic," "Without methylation there could be no life as we know it."

And without SAMe, there could be no methylation as we know it. Though various molecules can pass methyl groups to their neighbors, SAMe is the most active of all methyl donors. Our bodies make SAMe from methionine, an amino acid found in protein-rich foods, then continually recycle it. Once a SAMe molecule loses its methyl group, it breaks down to form homocysteine. Homocysteine is extremely toxic if it builds up within cells. But with the help of several B vitamins (B6, B12 and folic acid), our bodies convert homocysteine into glutathione, a valuable antioxidant, or "remethylate" it back into methionine.

SAMe and homocysteine are essentially two versions of the same molecule-one benign and one dangerous. When our cells are well stocked with B vitamins, the brisk pace of methylation keeps homocysteine levels low. But when we're low on those vitamins, homocysteine can build up quickly, stalling the production of SAMe and causing countless health problems. High homocysteine is a major risk factor for heart attack and stroke. During pregnancy, it raises the risk of spina bifida and other birth defects. And many studies have implicated it in depression.

How, exactly, might taking extra SAMe improve a person's mood? Researchers have identified several possibilities. Normal brain function involves the passage of chemical messengers between cells. SAMe may enhance the impact of mood-boosting messengers such as serotonin and dopamine - either by regulating their breakdown or by speeding production of the receptor molecules they latch on to. SAMe may also make existing receptors more responsive. These molecules float in the outer membranes of brain cells like swimmers treading water in a pool. If the membranes get thick and glutinous, due to age or other assaults, the receptors lose their ability to move and change in response to chemical signals. By methylating fats called phospholipids, SAMe keeps the membranes fluid and the receptors mobile.

Whatever the mechanism, there is little question that SAMe can help fight depression. Since the 1970s, researchers have published 40 clinical studies involving roughly 1,400 patients. And though the studies are small by FDA standards, the findings are remarkably consistent. In 1994 Dr. Giorgio Bressa, a psychiatrist at the University Cattolica Sacro Cuore in Rome, pooled results from a dozen controlled trials and found that "the efficacy of SAMe in treating depressive syndromes... is superior [to] that of placebo and comparable to that of standard... antidepressants."

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This isn't the first natural substance to show promise as a mood booster. Small studies suggest that St. John's wort can ease low-grade melancholy, but SAMe has been tested against far more serious disorders. In one of several small U.S. studies, researchers at the University of California, Irvine, gave 17 severely depressed patients a four-week course of SAMe (1,600 mg daily) or desipramine, a well-established antidepressant. The SAMe recipients enjoyed a slightly higher response rate (62 percent) than the folks on desipramine (50 percent).

No one has found SAMe significantly more effective than a prescription antidepressant, but it's clearly less toxic. The drugs that predate Prozac (tricyclics and MAO inhibitors) can be deadly in overdose, or in combination with other medications. Newer antidepressants, such as Prozac, Zoloft and Paxil, are less dangerous, but their known side effects range from headaches and diarrhea to agitation, sleeplessness and sexual dysfunction. And SAMe? Studies suggest that like other antidepressants, it may trigger manic episodes in people with bipolar disorder. Aside from that, the most serious side effect is a mild stomach upset.

Until large U.S. studies confirm these findings, few American doctors will recommend SAMe to severely depressed people. "The evidence looks promising," says Harvard psychiatrist Maurizio Fava, "but it's not definitive. In some European countries they have different marketing standards than we do." UCLA biochemist Steven Clarke echoes that concern, saying the nation is embarking on a large, uncontrolled experiment in which consumers are the guinea pigs. A key concern is that depressed patients will drop other treatments to try SAMe, and end up suicidal. Columbia University psychiatrist Richard Brown warns of that hazard in "Stop Depression Now," a new book coauthored with Baylor University neuropharmacologist Teodoro Bottiglieri. Yet Brown himself has treated several hundred patients with SAMe in recent years, sometimes combining it with other drugs, and he has never had a bad experience. "It's the best antidepressant I've ever prescribed," he says flatly. "I've seen only benefits."

If the world needs a better antidepressant, it could also use a better arthritis remedy. Nearly a third of the 40 million Americans with chronic joint pain use drugs like aspirin and ibuprofen. In arthritis-strength doses, these so-called NSAIDs, or nonsteroidal anti-inflammatory drugs, can have devastating gastric side effects. Some 103,000 Americans are hospitalized annually for NSAID- induced ulcers, and 16,500 die. Even when NSAIDs don't destroy the digestive tract, they may ultimately worsen people's joint problems, for they slow the production of collagen and proteoglycans, the tissues that make cartilage an effective shock absorber.

Could SAMe provide an alternative? In a dozen clinical trials involving more than 22,000 patients, researchers have found SAMe as effective as pharmaceutical treatments for pain and inflammation. But unlike the NSAIDs, SAMe shows no sign of damaging the digestive tract. And instead of speeding the breakdown of cartilage, SAMe may help restore it. You'll recall that after giving up its methyl group, SAMe becomes homocysteine, which can be broken down to form glutathione (the antioxidant) or remethylated to form methionine (the precursor to SAMe). As luck would have it, the reactions that produce glutathione also yield molecules called sulfate groups, which help generate those joint-sparing proteoglycans.

What does this mean for patients? The Arthritis Foundation, a mainstream advocacy group, recently said its medical experts were satisfied that SAMe "provides pain relief" but not that it "contributes to joint health." The evidence that SAMe can repair cartilage is admittedly preliminary, but it's intriguing. When German researchers gave 21 patients either SAMe or a placebo for three months, using MRI scans to monitor the cartilage in their hands, the SAMe recipients showed measurable improvements. That wouldn't surprise Inge Kracke of Cologne. She was an active 48-year-old when a 1996 auto accident mangled her left knee and left her hobbling on a cane. Dr. Peter Billigmann of the University of Landau prescribed a regimen that combined SAMe (1,200 mg a day for three months) with injections of hyaluronic acid, a cartilage component. Cartilage injuries don't normally heal, but a year later Kracke's knee looked better on X-rays. She now plays golf three times a week.

SAMe may have other benefits as well. Studies suggest it can help normalize liver function in patients with cirrhosis, hepatitis and cholestasis (blockage of the bile ducts). SAMe has also been found to prevent or reverse liver damage caused by certain drugs. As patients hear more about this supplement, they may try treating themselves for all these conditions and others. But many of them will be disappointed-either because they expect miracles that SAMe can't deliver, or because they take the wrong dose or form.

The first challenge is to buy full-strength SAMe. "Some companies are very reliable manufacturers," says Dr. Paul Packman of Washington University in St. Louis. "But some aren't. You can't always tell from the label on the bottle how much active ingredient is actually in it." Pharmaceutical-grade SAMe comes in two forms, one called tosylate and a newer, more stable form called butanedisulfonate. Only Nature Made and GNC sell the new butanedisulfonate version, but several U.S. retailers import reliable tosylate products. And because SAMe is absorbed mainly through the intestine, it's best taken in "enteric coated" tablets that pass through the stomach intact. None of the products comes cheap. The price of a 400-mg dose ranges from $2.50 (Nature Made) up to $18.56 for an uncoated Natrol product called SAM sulfate.

Assuming you buy full-strength SAMe, the second challenge is to use it effectively. Experts advise taking it twice a day on an empty stomach, but different people may require different amounts. Though studies suggest that 400 mg a day is an effective dose for arthritis, the daily doses used in depression trials have ranged as high as 1,600 mg. Clinicians generally start people with mood problems at 400 and ratchet up as necessary.

Unfortunately, there is no convincing evidence that SAMe can make healthy people happier or more mobile than they already are. But there are lessons here for everyone. We now know that methylation is vital to our well-being. It's equally clear that the modern Western diet-rich in protein, light on the plant foods that supply folate-is a prescription for stalling that vital process. "SAMe works as a medication to treat certain diseases," says Paul Frankel, a biostatistician at the City of Hope National Medical Center in Duarte, Calif. "But for most people the problem is undermethylation of homocysteine." In other words, many of us could arm ourselves against low moods, bad joints and weak hearts simply by upping our intake of B vitamins. That may sound less exciting than taking a miracle supplement. But with luck, it could keep you from ever needing one.

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By treating children's sleep disorders, parents may find that their child's attention deficit hyperactivity disorder (ADHD) symptoms improve as well, according to a study released during the American Academy of Neurology's 50th Anniversary Annual Meeting April 25-May 2 in Minneapolis, MN.

The study involved children with ADHD as well as restless legs syndrome and/or periodic limb movements of sleep. ADHD is a chronic, neurologically based syndrome characterized by restlessness, distractibility and impulsivity. Restless legs syndrome is a neurological disorder characterized by sensations of discomfort in the legs during periods of inactivity relieved by moving or stimulating the legs. Periodic limb movements of sleep involves episodes of repetitive leg movements causing brief awakenings in brain activity. Both sleep disorders can cause interrupted sleep and fatigue or sleepiness during the day.

In the study, five children were treated with the drug levodopa, which has been shown to improve symptoms of these sleep disorders but not ADHD.

"The children showed marked improvement," said neurologist Arthur S. Walters, MD, of the UMDNJ-Robert Wood Johnson Medical School and Lyons VA Medical Center in New Brunswick, NJ. "Their sleep disorders improved, and so did their behavior and mental acuity."

The children's attention spans improved, along with their memory. And parents also reported that their ADHD children's behavior improved.

Walters said the sleep disruption may cause the children to be inattentive and hyperactive due to sleep deprivation. The children also may have leg discomfort when sitting at their school desks that is relieved only by moving around, he said.

Walters cautioned, "It is not definitely proven that periodic limb movements of sleep leads to symptoms of ADHD. An alternative possibility is that these disorders simply appear together frequently."

Children with ADHD have a higher incidence of periodic limb movements of sleep than children who don't have ADHD, Walters said. Also, the parents of children with ADHD and periodic limb movements of sleep have a higher incidence of restless legs syndrome than other parents.

Researchers also have another theory why levodopa improves the children's ADHD symptoms.

"There may be a common link -- a dopaminergic deficiency in the brain that causes both the sleep disorders and the ADHD," Walters said.

One argument supporting this theory is that Ritalin(r), a common treatment for ADHD, promotes dopamine action in the brain, as does levodopa. "No one understands why a stimulant -- Ritalin(r) -- improves hyperactive behavior," Walters said. "This could be why."

Walters said the benefits of the levodopa appear to last long term. The next step to confirm these results is a double-blind, placebo-control trial, he said. The drug should also be tested with children with ADHD who do not have these sleep disturbances, he said.

COMMENT

Dr. Billy Levin writes in reaction to the above article....

"There is a very clear association between A.D.H.D. and sleep disturbances starting with the infant who just does not sleep until he is exhausted, followed by the toddler who won't go to sleep on his own or will only sleep in the parents bed. The young child who is afraid of the dark, or takes ages to fall asleep or a very restless sleeper. The older child may go late to bed, have nightmares or wake at the crack of dawn. Separation anxieties may manifest here or bed wetting. All these to a greater or lessor degree and some or all may present.

As to Ritalin, the stimulating effect, boosts the immature inhibitory function on the left hemisphere giving the patient on treatment better "brakes". When many young A.D.H.D patients are given a sedative the opposite takes place. That is, they are stimulated and hyperactivity gets worse. Clearly the inhibitory centers on the left hemisphere are sedated with fewer "brakes" and more activity takes place. This is the well known "paradoxical reaction" often seen, to medications, in these children. ADHD must be seen as an over developed right hemisphere giving behaviour problems or and immaturity of the left hemisphere giving rise to learning problems or a mixture of both in varying degrees."

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New scientific studies suggest that by increasing our consumption of certain "good" fats found in fish, flaxseed oil, and walnuts, we may improve the symptoms of a number of psychiatric illnesses, including depression, bipolar disorder, and schizophrenia. For years, investigators have been exploring the link between depression and diet, especially the association between the incidence of depression and fish consumption. Fish and some land-based foods are rich in omega-3-a nutritional building block critical for the healthy development and functioning of the brain and nervous system.

In the past 100 years, the American diet has shifted away from the diet of our human ancestors-wild plants and game, including fish-which was rich in omega-3 fatty acids to one relying on mass-produced and highly processed food. By reducing our consumption of omega-3s in favor of another fat called omega-6 fatty acid, found in vegetable oils such as corn and soy, we have upset a delicate balance that may underlie the increasing rate of depression and other chronic diseases in contemporary American society. In cross-national studies comparing diet, scientists found that in countries where fish is still a large part of the diet, such as in Taiwan and Japan, rates of depression were lower than in American and many European populations.

We spoke with Joseph R. Hibbeln, M.D., about this emerging field of scientific research. Dr. Hibbeln is an internationally recognized authority on the link between essential fatty acids and depression. Chief of the Outpatient Clinic, Laboratory of Clinical Studies at the National Institute on Alcohol Abuse and Alcoholism at the National Institutes of Health in Bethesda, Maryland, Dr. Hibbeln co-organized the first "NIH Workshop on Omega-3 Essential Fatty Acids and Psychiatric Disorders," held last September.

Q: In layman's terms, what are omega-3 fatty acids?

A: Omega-3 refers to a class of polyunsaturated fatty acids that are beneficial to many aspects of health. Polyunsaturated fatty acids are all essential fatty acids in that they must be derived from the diet-they can't be manufactured by the body. Among polyunsaturated fatty acids, there are two classes or families-an omega-6 and an omega- 3.

Balance between these two families is very important to proper human functioning and well-being.

The two families are not interchangeable. For example, if you eat foods high in omega-6 fatty acids, your body composition will change over to have lots of omega-6 fatty acids. If you eat foods high in omega-3 fatty acids, your body tissues will eventually develop a higher proportion of omega-3 fatty acids.

Q: Why are omega-3s so important?

A: Of the omega-3 fatty acids, two are especially biologically important-one is EPA, eicosapentaenoic acid, and the other is DHA, decosahexaenoic acid. In a nutshell, DHA is very biologically important because it is highly concentrated in the brain-in the synapses, where brain cells communicate with one another. And DHA is one of the important fats that make up the wall of the cell.

To illustrate this point, if you are building a house and pouring concrete, DHA would be what the concrete is made of-it is literally the wall of the cell. Depending on what kind of fatty acids you put into that cell wall, the wall or membrane will possess different physical properties. If you make the foundation out of saggy concrete, it will affect many different systems in the house-windows, electrical systems, etc. In a similar manner, the type of fatty acids that you eat will eventually create the cells of your membranes and therefore affect how they function. That is one reason why DHA is important.

Q: What role does the other omega-3 fatty acid - EPA - play in our health?

A: EPA becomes a very potent, biologically active molecule that keeps platelets from coagulating or clotting. When EPA gets into white blood cells, it helps reduce inflammation and immune responses. EPA affects the body in many other ways-sleep patterns, hormones, etc.-serving as a modulator.

Q: What function do omega-6s have in the body?

A: One omega-6 fatty acid, arachodonic acid (AHA), makes biological compounds which have the opposite effect from the compounds made from EPA. For example, if you have a platelet with a lot of arachodonic acid in its cell wall, it will clot more easily and you are therefore more likely to clot off a blood vessel during a stroke. If the platelet has EPA in its cell wall, it is less likely to clot.

Once again, the important factor here is achieving a balance between these two families-the omega-3s and the omega-6s.

Q: So people need both omega-3 and omega-6, but in what proportion?

A: Proportion is a critical question. One way to answer the question is to study human evolution and look at the diet human beings evolved on. It's quite clear that even if you don't account for fish in the diet, the ratio of omega-6s to omega-3s in our paleolithic diet was about one-to-one. During our evolution, we ate a variety of different plant sources and leafy green vegetables, nuts, and free-range animals that ate leafy green vegetables: wild game has about a one-to-one ratio of omega-6 to omega-3.

Q: How has our diet changed?

A: In the past 100 years, the balance of omega-6s to omega-3s has radically changed from the diet we evolved on and what, it could be argued, we are optimally suited for. We now grow seed oils, such as corn and soybeans, in great abundance. As seed oils, they have much higher ratios of omega-6s to omega-3s. Corn oil, for example, has a ratio of about 74 or 75 omega-6s to one omega-3.

Q: Flaxseed is a seed, but it contains more omega-3, right?

A: Yes, flaxseed is an exception.

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Depression

Q: Tell us about your current research findings on depression. Is depression less common in countries where they consume more omega- 3 fatty acids?

A: In April 1998, I published a paper in Lancet in which I compared the annual prevalence of depression across countries to a measure of their fish intake. I took the data points from a paper, published in the Journal of the American Medical Association by Myrna Weissman, M.D.-an epidemiologist at Yale University who is recognized as the world's expert in psychiatric epidemiology; the quality of the epidemiological data is really the gold standard.

The country with the lowest prevalence of depression was Japan at about 0.12, and the highest was New Zealand at almost 6 percent. The paper describes nearly a 60-fold difference in the prevalence of depression-not double or times five-but a 60-fold difference. Virtually all of the differences across those countries appeared to be predicted by how much fish people were eating.

Q: Has the prevalence of depression changed over the past century?

A: I mentioned the differences in incidence of depression across countries, but another way of testing the hypothesis that depression is related to our dietary intake of omega-3s is to look at differences in depression across time, especially in the past century. Long before I began this work, psychiatrists noted, and described very well, that the prevalence of depression has been on a marked increase in the past century depending on what birth cohort you were born in. You are about 100-fold less likely to be depressed by the age of 35 if you were born before 1914, than becoming depressed by the age of 35 if you were born after 1945.

As I mentioned to you, 100 years ago we were eating much closer to our paleolithic diet, because the world was still a much more rural community. We didn't yet have mass agricultural production of corn and soybeans or hydrogenation. My parents still remember when they were eating only butter, which has few omega-6s, instead of margarine.

Q: Have studies demonstrated how depression is affected by fish consumption?

A: I have, for example, done an epidemiological comparison with postpartum depression, although the study is as yet unpublished. It appears that countries where more fish is consumed have much lower rates of postpartum depression. The finding makes sense, because mothers deplete themselves of omega-3 fatty acids while supplying them to the developing infant, presumably for their neuronal development. During gestation and lactation-it is well known-women can become depleted of omega-3 fatty acids. It can take up to 36 months for women to return to their normal levels, so depleted levels of omega-3 fatty acids may very well be one of the factors contributing to postpartum depression. The prevalence of postpartum depression is also much lower in countries where more fish is consumed.

Q: Can omega-3 supplementation help relieve the depression?

A: At the NIH workshop last September, data was presented from a study done by Dr. Antolin Llorente, Ph.D., at Baylor University, where women were given DHA during pregnancy. The study was originally devised to be a biochemical study; it wasn't really designed to study depression or moods. They did, however, recruit depressed women. The women in the study were basically very healthy, normal, upper-class, well-nourished women. Nonetheless, they found that those women receiving the DHA supplements had better measures of attention and concentration than women receiving placebos.

Q: How much DHA were they given?

A: They were given about 200 mg per day of DHA. It was a double-blind, placebo-controlled study in capsules versus a placebo oil.

Q: We've recently read that there is a link between depression and cardiovascular disease. Are the two connected?

A: My data relating countries and their fish consumption, published in the Lancet, suggest that fish consumption protects against depression and cardiovascular disease.

Second, psychologists have known for a long time that there is a link between either depression and/or hostility and cardiovascular disease. If you have one, you are more likely to have the other.

For many years, people have asked the question: Does depression cause cardiovascular disease, or does cardiovascular disease cause depression? What I put forth as a hypothesis is that depression and cardiovascular disease are both manifestations of a common nutritional deficiency.

Depressed patients have been shown to have higher cardiac risk factors from their diets and are, for example, more likely to die of arrhythmias, excessive platelet clotting, or to have elevated cytokines-an immune reaction. All of these conditions parallel what could happen in people with low levels of omega-3 fatty acids.

Most of the work that I have done, and described to you, has largely been theoretical and hypothesis-building. But since that hypothesis, there are five published studies showing that depressed patients have lower levels of omega-3 fatty acids than do control subjects.

Q: Do studies suggest that increasing consumption of omega-3 fatty acids-through diet or supplementation-could have a positive effect for patients with depression?

A: Yes. Some chemistry data also suggest it, as do data among suicide patients and data on hostility and violence. That aside, it took me a while to really come to this opinion. During a conversation with a person at one of the nutritional journals, the interviewer asked, "What's the harm of a depressed patient taking three grams of omega- 3s per day?" Well, there is no harm that we know of. There's no risk and a possible benefit. In other words, it can't hurt and it might help.

Q: How are omega-3 levels measured?

A: Omega-3 levels are measured by analyzing plasma or red blood cells. The test will indicate what concentrations of omega-3 fatty acids are in your blood.

Q: Is the test expensive?

A: It is about a $100 or $150 lab test.

Q: Is the test widely available?

A: No. It is largely a research test at this point. Johns Hopkins' Kennedy Kreger Institute, for example, can do it reliably. The trouble with getting your plasma drawn right now is that while we can analyze the level, we don't know what level is optimal for depressed patients as yet. If you take what is normal for the United States right now in the latter half of the 20th century, I can't tell you if that level is optimal.

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Bipolar Disorder

Q: Are omega-3s helpful for patients with manic-depression or bipolar disorder?

A: The most exciting and best clinical data from double-blind, placebo- controlled treatment trials is in schizophrenia and manic depression.

In manic depression, the treatments of choice with the best record of efficacy are lithium, valproic acid, and carbamazapine. The action of these drugs in these conditions is well known, and they are still the treatments of choice.

Q: But do higher serum levels of omega-3 play a role in efficacy of these treatments for bipolar disorder?

A: Andrew Stoll, M.D., at Harvard did a double-blind, placebo-controlled trial in bipolar disease. In the study, patients had recently been hospitalized and had either a severe mania or severe depression. All the patients were on medications-lithium and valproic acid. One half of the patients were assigned to take six grams of omega-3 fatty acids a day; the other half were assigned to placebos. After four months, researchers did a preliminary review of the data, and the ethics committee made them stop the trial and put everybody on the active agent, because only one out of 16 of the people taking the omega-3s relapsed into a mania or depression, whereas 8 or 9 out of 15 relapsed on the placebo.

Q: Is six grams a very large dose?

A: Yes, but Eskimos ate diets that were almost completely omega-3 fatty acids, and they had low rates of heart diseases and arthritis.

Q: Is depression common among Eskimos?

A: We don't know. I have looked for that data. But by the time people were doing epidemiological studies of Eskimos, they were eating Western diets.

Q: Is there a toxic level of omega-3?

A: The FDA recognizes up to 3 grams per day of omega-3s as GRAS, or Generally Recognized As Safe.

Q: What are the side effects if you consume more than three grams?

A: It will definitely have a greater effect in thinning your blood and making your platelets not coagulate.

Q: If you had a hemorrhagic stroke, you would be in trouble.

A: Right. That's why Japanese people die more frequently of hemorrhagic stroke, but have lower death rates overall.

Q: And lower rates of depression?

A: Right. And apparently also lower hostility and violence.

Q: That finding is very interesting, especially for countries where there is more hostility and violence.

A: One very reasonable question people ask me is, "Isn't it possible that it's just the Japanese culture that is different and less hostile?" I say, "Well, Japan has approximately onehalf the population of the United States living on an arable land mass the size of Connecticut. And it's a stressful society. Just on the basis of crowding, you would expect higher rates of depression and hostility."

One thing also to consider about the culture is what would happen to a culture, or group of people, if you gave them a psychotropic drug that made them calmer for a couple hundred years. It's quite possible that these brain-specific nutrients have had an effect on culture over a long period of time.

Q: We have interviewed researcher and author Kay Redfield Jamison, M.D., who is manic-depressive. She is at Johns Hopkins and would probably be very interested in your work.

A: Some of my data were recently presented to a National Institutes of Mental Health group. Apparently, Kay was there, or heard about it. I have data of EPA levels in suicide attempters. It looks very much like the curve with depression, in that high plasma levels of EPA predict much lower psychological risk factors toward suicide. Dr. Jamison is doing work on suicide right now, so she called me up and we had a long talk. I sent her information. She actually just sent me a copy of her book, so I have had contact with her.

Q: What is rapid-cycling bipolar disease, and is it common?

A: Rapid cycling is anything more frequent than four times per year, but it can be as frequent as every other day or minute-to-minute in some cases. It is not common and very difficult to treat, often treatment-resistant.

Q: In rapid cycling every other day, for example, it is hard to understand how omega-3s could be a factor. If the tissues are deficient in omega- 3s, how would that trigger the depression, then euphoria, every other day?

A: The brain works in a series of interlinked neural networks, trained to cycles of biological rhythms. What occurs in patients with rapid- cycling bipolar disease is that the brake-the modulator of cycles-is gone. Although not well-defined biochemically, the theory is that omega-3s help put back a brake on that cycling or disrupted, endogenous biological rhythm. In no way are omega-3s proven to be effective in rapid-cycling bipolar disorder. All we have are anecdotal reports in rapid-cycling disorder at this point.

Q: What about the influence of omega-3s in schizophrenia?

A: Malcolm Peet, M.D., in England has given omega-3 fatty acids to patients suffering from schizophrenia. He found a good effect in reducing psychosis and negative symptoms, such as diminished social function. Omega-3s improved their social functioning. It has shown very good effect in this regard.

Q: Can it help people with attention deficit hyperactivity disorder (ADHD)?

A: There has been a lot of discussion about using omega-3 fatty acids in attention deficit hyperactivity disorder. At the NIH conference, everybody who has done a clinical study was present. Two of the three studies discussed showed no effect. The third study showed a good effect, using a combination of omega-3s and omega-6s. What was troubling about this study was that they also sell the product that they investigated.

At this point, there is no strong, compelling double-blind data that shows omega-3s are effective for people with ADHD. Scientific data aside, however, I have heard some impressive stories of efficacy from parents in anecdotal reports. The jury is still out on ADHD.

Q: It would seem that if a parent had a schizophrenic child or a child with ADHD, it wouldn't hurt to give omega-3s.

A: Right, it won't hurt and it might help.

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Sources of Omega-3

Q: Do you think people in the United States need to be concerned about getting more omega-3s into their diet?

A: Yes. A very good description of the whole omega-3 phenomenon is in a book called The Omega Plan by Artemis P. Simopoulos, M.D., and Jo Robinson. I don't endorse the book, but I think it is a good layman' s literature and reference. Your readers would probably appreciate it.

Dr. Simopoulos bases much of her work on the Crete diet and study. In the seven-country Crete study, men from the Greek island of Crete had the longest lifespans and lowest incidence of cardiovascular disease of men studied. [The six other countries in the study were Italy, the Netherlands, Finland, Yugoslavia, Japan, and the United States.]

The Crete men basically achieved this state of health and longevity by consuming fish, or foods that contain omega-3s, with almost every meal. Secondarily, they used olive oil for their salad dressings, instead of corn oil or soybean oil, as we do in the typical American diet, in which vegetable-oil-based salad dressings and margarines are rich sources of omega-6s.

Q: If fish are farm-fed using corn, would the fish then contain higher levels of omega-6s?

A: That's quite right. Fish farmers have realized that if they just feed their fish with corn and soybeans, the fish don't grow as well and don't reproduce. Fish farmers now give a minimum amount of fish protein by farming menhaden-a source of fish protein-from the ocean. Apparently, the menhaden provides just enough omega-3s so that the farm-raised fish will reproduce.

Q: What about ersatz, or imitation, fish sold in the fish market as sea legs?

A: Almost any seafood, even if farmed, will probably have more omega- 3 fatty acids in it than will, for example, hamburger meat. Of course, wild seafood will probably have more omega-3s than farmed seafood, but you almost have to analyze omega-3 content on a case-by-case basis.

Overall, you are better off getting omega-3s from seafood.

Q: Are there manufacturers of fish-oil products who are superior to others? Are there products that our readers should look out for?

A: The general rule of thumb is that if you cut the capsule open and it smells like rotten, spoiled fish, it is spoiled fish. When you buy fish from the store and it is fresh, it doesn't smell fishy. I don't feel that I should pick on anybody in particular.

I will tell you that a good, common concentration in a one gram capsule would be 300 mg of EPA and 200 mg of DHA per gram. That's pretty good. That concentration gives 0.5 g omega-3 fatty acids per gram tablet. It makes it pretty easy to calculate. If you take two capsules, you are getting one gram of omega 3s. If you take four of them, you get two grams. With six, you get three grams, etc.

Q: In our grandparents' day, parents gave their children cod liver oil.

A: Yes, but they didn't give six grams. I want to mention that people should not consume large amounts of cod liver oil in order to get omega-3s into their diet. Cod liver oil also contains a lot of vitamin A. If you were going to get three grams of omega-3s from cod liver oil, you would quickly reach toxic levels of vitamin A, so avoid cod liver oil.

Q: Do fish oil supplements provide the same benefits?

A: Your body pretty much doesn't know whether you are getting it from fresh fish or a fish oil supplement.

Q: What about canola oil?

A: Canola oil is better; it has a better ratio of omega-6s to omega- 3s-around five or seven omega-6s to one omega-3.

Q: Is flaxseed oil the best source of omega-3?

A: Right, of the direct oil sources.

Q: What about nuts, such as walnuts?

A: Walnuts are good. I haven't looked at the data carefully. But nuts, in general, are a pretty good bet. If you go with the principles of the paleolithic diet, it's clear that we were eating a lot more fruits and nuts than wild game.

Q: How much omega-3 do you take?

A: I take about one gram per day and eat a lot of different types of fish.

Q: Deep-sea fish, not farm-fed catfish?

A: Farm-fed catfish are going to have less omega-3s, but they are going to have some.

Q: What is your next research project?

A: I am looking at whether consuming these omega-3 fatty acids reduces hostility and aggression. We looked at 235 subjects on whom we have performed lumbar punctures and taken cerebrospinal fluid for analysis. One of the markers of brain neurochemistry in the cerebrospinal fluid is a metabolite, or breakdown, of serotonin called 5HIAA. It is well known in biological psychiatry that people who have low concentrations of this 5HIAA are especially prone to suicidal and impulsive behaviors. What I found among normal subjects was that low concentrations of DHA in the plasma correlated to low concentrations of 5HIAA in their cerebrospinal fluid. This finding is important because 5HIAA predicts serotonin levels, and serotonin is really key to the biochemistry of depression and the biochemistry of suicide and violence.

Q: Serotonin levels should be high, right?

A: Right.

Q: Do you have access to prison inmates who have been given spinal-fluid taps from which you could determine whether the impulsive, violent person is low in omega-3s?

A: We are engaged in that work right now. We are taking cerebrospinal fluid samples before and after giving them either the omega-3s or placebos.

Added Material

Cory SerVaas, M.D., & Patrick Perry

Walnuts are especially good for their omega-3 content.

Flaxseed for salads and baking.

"The research being conducted is fascinating and potentially very important to the understanding and treatment of bipolar disorder," commented Kay Redfield Jamison, M.D., of Johns Hopkins University on the role of omega-3 essential fatty acids and psychiatric illnesses. Dr. Jamison, who controls her manic-depressive illness, is a prominent researcher and has authored several books on the disorder.

An omega-3 fatty acid called DHA is highly concentrated in the synapses where brain cells communicate and plays a key role in brain development and function. A vast communications network within our brain is formed when chemical messengers, or neurotransmitters, are released from the axon, cross the synapse, and bind to receptors on another neuron.

next: Harold Sackeim
~ all Shocked! ECT articles
~ depression library articles
~ all articles on depression

One-third of a group of children involved in traffic accidents display symptoms of post-traumatic stress disorder (PTSD), according to a study in the British Medical Journal (Vol. 317, p. 16191623).

Psychologist Paul Stallard, PhD, and colleagues from the Royal United Hospital in Bath tested for PTSD in 119 children who'd been in auto accidents in 1997. Six weeks after their accidents, 41 of the children showed signs of PTSD symptoms, including sleep disturbance and nightmares, separation anxiety, difficulties concentrating, intrusive thoughts, difficulties talking to parents and friends, mood disturbances and deterioration in academic performance. Only three percent of 66 children involved in sports-related injuries showed signs of PTSD, the researchers found.

Neither the type of accident nor severity of physical injuries was related to the presence of PTSD, the researchers found. However, the more a child perceived the accident as life threatening, the more likely the child was to have developed PTSD. Also, girls were far more likely to develop the disorder than boys were.

The psychological needs of children involved in traffic accidents are largely unrecognized, the researchers contend. But these children are prime targets for psychological interventions, they conclude.

Source: APA Monitor, VOLUME 30 , NUMBER 2 -February 1999

next: Terror Strikes Young: Exposure Therapy Helps Children
~ anxiety-panic library articles
~ all anxiety disorders articles

Press Trust of India

Marriage within close relations or within the same community may increase the risk of hermaphroditism as it helps preserve bad genetic factors responsible for this congenital disorder, doctors have warned.

Hermaphroditism or indeterminate sex is primarily a result of genetic malfunctions, Dr Garry Warne, head of the Endocrinology Department at Royal Children's Hospital in Melbourne, Australia, said at an international workshop on inter-sex disorders here.

"Sex determination is a complex process that involves several genes on the sex chromosome (thread-like cellular structures carrying hereditary information to ascribe the sex)," he said.

Male and female embryos are indistinguishable until 42 days' gestation when 'SRY' -- the gene that releases the initial signal in determining cell fate -- is switched on to assign the sex of a child.

"But about two-third hermaphrodites do not have this important sex determining gene, due to some unknown reasons," Dr Warne said, adding one in 4,500 children around the world is born with such ambiguous sex.

Apart from the genetic predisposition, hermaphroditism could also originate from certain ayurvedic drugs, usually taken during pregnancy, that contain heavy metals, head of the Paediatrics Department at the All India Institute of Medical Sciences (AIIMS), here said.

India has the highest number of babies with indeterminate sex, Dr Gupta said, adding each year about 40 such cases are treated in AIIMS.

The inability to determine the sex of a child usually leads to psychological problems for that child in the following years making it extremely difficult for him to adjust in society, he said.

In India most of the hermaphrodites are reared as `male' by their parents.

"An infertile male is socially more acceptable here than an incomplete woman," he said. The sex could be assigned by surgical methods, he said, adding though the surgical intervention sometimes goes against the 'genetic ruling' it in no way affects the patient because sex isnot controlled solely by genes.

1999 Indian Express Newspapers (Bombay) Ltd.

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next: Intersexuality - A Plea for Honesty and Emotional Support
~ all inside intersexuality articles
~ all articles on gender

On Friday, January 16th, 1999 John Stossel of the ABC 20/20 News team did a story on Brad Blanton's book "Radical Honesty: How to transform your life by telling the truth." I watched it because I wanted to find out what exactly he meant by "radical."

"Have we become so adept at lying, that we've forgotten that we are, in fact, lying?"

As it turns out, Radical Honesty is ....well....honesty. What astounded me most about the program was that people thought telling the truth was a radical idea. Don't you find that just a bit odd?

At the end of the story, Barbara Walters even warned viewers, "don't try this at home without someone trained in this." Tears ran down my face as I rocked with laughter and disbelief. Don't try this at home?!? Honesty?!? Are we so lost that we regard honesty as a dangerous pursuit without a trained "non-liar" at our sides?? Has the world become so warped that we consider telling the truth, a dangerous exercise? It seemed extremely bizarre to me.

But upon reflection, maybe it's not so bizarre. Haven't all of us been taught that it's better to lie to someone than to hurt their feelings? That there are just some things you simply never, never tell another? We're not suppose to tell anyone when we've had an extramarital affair, especially not our spouse. And god forbid we're honest with each other about sexual matters.

But have we become so adept at lying, that we've forgotten that we are, in fact, lying? Have we forgotten how to tell the truth, the whole truth, and nothing but the truth?

Perhaps we were taught to lie because we as a society believe we actually CAN hurt another emotionally. We believe we have the power to make another person feel something emotionally.

"You know how it is when you decide to lie and say the check is in the mail, and then you remember it really is? I'm like that all the time."

- Steven Wright

"You know how it is when you decide to lie and say the check is in the mail, and then you remember it really is? I'm like that all the time." - Steven Wright

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continue story below

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So who's responsible for how we or another chooses to respond to words? If you truly had the power to make people feel certain emotions, then you should be able to create other people's reactions at will. If you said the same thing to a thousand people, you should be able to get an identical emotional response from all of them, right? But the fact is, you'd get as many different responses as there are people. Each would react according to their belief systems and interpretations of your meaning.

Lets do a silly exercise. Lets go around the country saying, "you have a big fat behind" to everyone we meet, regardless of their physical size. Men, women and children, no one escapes our little experiment.

Now, what do you think the reactions would be? You'd think most would be upset, wouldn't you? But you'll find some children will run away, and some will giggle. Some women will breakdown right in front of you and some will smile and say thank you. Some men will knock your lights out, and some will look at you like you've lost your mind. One statement, thousands of reactions.

The surprising thing is, the size of their derrière wont even be the deciding factor in how they respond. Some people think their tuckus is huge, even though they're tiny. In some cultures, large bottoms are considered attractive. Some people LIKE their big butts!

So where is your power? What about your ability to make someone feel angry or hurt?

Seems each individual you spoke to, made the decision about how they would respond. People's responses are based on many factors, all of which are personal and have nothing to do with you.

If people understood everyone is responsible for their own emotions, we'd feel freer to say what we think and feel. Most times, it's our own lack of trust in ourselves to be able to deal with other's reactions, that is the stumbling block to our honesty. "How will I feel if this person reacts badly" we ask ourselves. "I might feel guilty, so I'll tell a little lie."

Because face it, sometimes people will get angry and hurt in reaction to our honesty. But the alternative of living lives filled with lies is not much of an alternative. We end up walking around on eggshells, monitoring our every word, and trying to predict how others might respond. It's a slow, awkward process of communication.

I agree with Dr. Blanton. Honesty about everything truly does open the doors to intimacy, love, and dynamic relationships. Without it, we're all just actors on a stage, reading our scripted lines. And to some degree, I think everyone knows we're pretending to be truthful. It's like we're all walking around holding dead chickens in our hands, making deals with each other. "Pretend you don't see my chicken, and I'll pretend I don't see yours." It's a scam, but one we're pulling over our own eyes.

I have this impossible dream about everyone on earth standing up, and all at the same time shouting out, "I'm a liar!". And as we all look at each other, we could start anew and begin fresh. Then, we could continue our lives with a willingness to trust that its okay to think and feel what we do, and have the courage to speak our truth.

Imagine being real and genuine with each other. Imagine what the world would be like if you could actually believe what people tell you. It might get a bit rocky at times, but it would "radically" change the world.

So maybe honesty is a radical idea in this day and age, but lets do our part in "telling the truth" so honesty becomes common place. The love that would follow would be far from common.

next: An Amazing Coincidence ~ back to: My Articles: Table of Contents

Article on how Ritalin and other stimulant medications work in treating ADHD.

Much concern has been raised over prescribing Ritalin® or other stimulants to control hyperactivity disorders in children. Relatively little is known about the long-term effects of these stimulants or how they alter brain chemistry.

Researchers at the Howard Hughes Medical Institute at Duke University have discovered that Ritalin® and other stimulants exert their paradoxical calming effects by boosting serotonin levels in the brain. Elevating serotonin appears to restore the delicate balance between the brain chemicals dopamine and serotonin and calms hyperactivity, says HHMI investigator Marc Caron at Duke University Medical Center. Caron is an author of the study published in the January 15, 1999, issue of the journal Science.

Attention deficit hyperactivity disorder (ADHD) affects three to six percent of school-aged children. Symptoms include restlessness, impulsiveness, and difficulty concentrating. Stimulants commonly used to treat ADHD are so effective that "researchers haven't really taken the time to investigate how they work," says Caron.

Previous dogma, says Caron, held that the calming action of Ritalin® works through the neurotransmitter dopamine. Specifically, researchers believed that Ritalin® and other stimulants interact with the dopamine transporter protein (DAT), a housekeeper of sorts for nerve pathways. After a nerve impulse moves from one neuron to another, DAT removes residual dopamine from the synaptic cleft-the space between two neurons-and repackages it for future use.

Caron's team suspected that dopamine wasn't the only key to understanding ADHD, so they turned to mice in which they had "knocked out" the gene that codes for DAT. Since there is no DAT to "mop up" dopamine from the synaptic cleft, the brains of the mice are flooded with dopamine. The excess dopamine causes restlessness and hyperactivity, behaviors that are strikingly similar to those exhibited by children with ADHD.

When placed in a maze that normal mice negotiate in less than three minutes, the knockout mice became distracted-performing extraneous activities such as sniffing and rearing-and they failed to finish in less than five minutes. The knockout mice also seemed unable to suppress inappropriate impulses-another hallmark of ADHD.

Surprisingly, the knockout mice were still calmed by Ritalin^®, Dexedrine^® and other stimulants even though they lacked the protein target on which Ritalin^® and Dexedrine^® were thought to act. "That caused us to look for other systems that these stimulants might affect," says Caron.

To test whether the stimulants interact with dopamine through another mechanism, the researchers administered Ritalin^® to the normal and knockout mice and monitored their brain levels of dopamine. Ritalin® boosted dopamine levels in the normal mice, but it did not alter dopamine levels in knockout mice. That result implied that "Ritalin® could not be acting on dopamine," says Caron.

Next, the researchers gave the knockout mice a drug that inactivates the norepinephrine transport protein. With transport disabled, norepinephrine levels increased as expected, but the boost in norepinephrine did not ameliorate the symptoms of ADHD as it should. This suggested to Caron's team that Ritalin^® exerted its effects through another neurotransmitter.

They then studied whether the stimulants altered levels of the neurotransmitter serotonin. The scientists administered Prozac^®-a well-known inhibitor of serotonin reuptake-to the knockout mice. After ingesting Prozac®, the knockout mice showed dramatic declines in hyperactivity.

"This suggests that rather than acting directly on dopamine, the stimulants create a calming effect by increasing serotonin levels," Caron says.

"Our experiments imply that proper balance between dopamine and serotonin are key," says Raul Gainetdinov, a member of Caron's research team. "Hyperactivity may develop when the relationship between dopamine and serotonin is thrown off balance."

The brain has 15 types of receptors that bind to serotonin, and Gainetdinov is now trying to determine which specific serotonin receptors mediate the effects of Ritalin®.

The hope, says Caron, "is that we can replace Ritalin® with a very specific compound that targets a single subset of receptors." While Prozac® calmed hyperactivity in the knockout mice, Gainetdinov says that "Prozac® isn't the best, because it isn't very selective." Caron and Gainetdinov are optimistic that a new generation of compounds that interact more specifically with the serotonin system will prove to be safer and more effective for treatments for ADHD.

Source: Article is an extract from Howard Hughes Medical Institute News.

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