Monday, April 8, 2024

By Don Sapatkin

Plus, a young Dutch woman talks about her requested euthanasia next month because she’s tired of living with multiple psychiatric diagnoses. A sheriff’s department dispatched a drone to find a suicidal person and get help. Flotation therapy may ease mental health symptoms. And the biggest reason that a law easing restrictions on prescribing buprenorphine has done little? Stigma – by pharmacists and providers against opioid users.

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Prozac prescriptions for dogs are on the rise. What does that say about us?

The increase may say more about Americans’ own mental health crisis than that of our pets. (Full disclosure: I took my cat to a pet psychiatrist in the 1980s because he constantly peed on the front door. The first thing the vet said when I came in with Alyosha in the pet carrier was: “You didn’t have to bring your cat.”)

“The human world has become more attuned to mental health. Since Covid, we’re talking about it,” Melissa Bain, a veterinarian focused on behavioral medicine at UC Davis, told Stat. “When we start to recognize things in humans, we recognize it in our dogs too.”

The pattern is similar in another way: Talk therapy for people is time-consuming and can be costly, especially when it’s hard to find clinicians who accept your insurance, but generic pills are easy and inexpensive. Likewise, obedience training courses or boutique behaviorist practices take time and lots of money, while pet-size generic versions of psychiatric drugs retail for $10 to $15 a month. Dogs are basically taking the same drugs for depression and anxiety as humans. Reddit boards for reactive pets and veterinary questions host hundreds of posts about successes or struggles with Zoloft, Paxil, Celexa, and their generics. (The FDA approved a version of Prozac called Reconcile specifically for separation anxiety in dogs.)

Veterinarians cite several reasons for the rise in pet psychiatry: As a culture, we care more about animal welfare than in the past. Large numbers of rescue animals from rural areas of the South are shipped to cities with more capacity for adoption but also far more environmental stressors, noises and people. Adoption rates skyrocketed during the pandemic.

And then there’s Americans’ own mental health. Psychologists are increasingly studying how pets impact our health and how we impact theirs. “There’s so many similarities in people’s emotions towards their children and emotions towards their pets,” Lori Kogan, a Colorado State University psychologist who chairs the human-animal interaction department of the American Psychological Association, told Stat. “We might be, for example, overly anxious about their well-being, just as a lot of people are about their children.”

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Want to improve your mental wellbeing? Expand your circle of love

Countless studies over the years have found that religious or spiritual people tend to be happier. A new report finds the same thing but comes with a notable twist: What’s most important isn’t spiritual belief or church attendance per se but loving and caring for a large community of people. Churchgoers who don’t do that miss out on the benefits, while atheists who do, reap them.

A report by Sapien Labs for the Global Mind Project defines mental wellbeing as “our mental capability and functioning, as well as our ability to navigate and cope with life’s stresses.” One could be experiencing a hard patch that causes unhappiness but still have full coping capabilities and, as a result, a high level of mental wellbeing. The report, Mental Wellbeing, Religion and the Love You Give, is based on online self-assessments by about 240,000 people in 65 countries over the past year.

Its four main findings:
1. People who are spiritual love and care for the wellbeing of a wider circle of people, while those who are atheist are five times more likely to love no one.
2. The increase in mental wellbeing gained through spirituality arises through the increase in one’s feelings of love and care for others, and spirituality without love and care for others does not have mental wellbeing benefits.
3. Active religious practice is associated with a higher likelihood of spirituality and love for others, regardless of religious affiliation.
4. More religious regions of the world have greater love for others, led by Latin America, South-East Asia, and Sub-Saharan Africa. Europe and Oceania have the least love for others with the United Kingdom and Germany having the lowest among all countries from which data was collected.

The United States is an interesting case. There the survey gave a slightly higher mental wellbeing score than the average of all participating countries (68 vs. 65 globally). In the U.S., the percentage is higher than worldwide for atheists (27% vs. 23%), the same for agnostics (26%), and lower for those who identify with a religion (65% vs. 79%) for “spiritual” (47% vs. 50%) and for those who actively practice (34% vs. 46%).

Yet the disparities in religiosity did not have that great an impact on the measures most closely associated with mental wellbeing – the degree of love felt for others. All were close to the global average: love no one (11% U.S. vs. 10% global), love family (36% vs. 35%) and love community (53% vs. 55%). As the report concludes: “Spirituality and active religious practice appear to enhance your mental wellbeing by expanding the love you feel for others. And while one can come to love and care for the wellbeing of others by various paths, active religious practice is a relatively reliable one, but is by no means a guarantee.”

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‘I’m 28. And I’m Scheduled to Die in May’

“’We have not picked an urn yet, but that will be my new house!’ She added an urn emoji after ‘house!’” Ter Beek lives in the Netherlands, the first country to legalize euthanasia, in 2001. She once wanted to become a psychiatrist but said she was hobbled by her depression and autism and borderline personality disorder. Now she’s tired of living, despite being in love with her boyfriend, a 40-year-old programmer, and living in a nice house near the German border with their two cats.

The story shares ter Beek’s thoughts about dying, both factual – a doctor will administer a sedative, followed by a drug that will stop her heart – and personal – “I’m a little afraid of dying, because it’s the ultimate unknown,” she said. “We don’t really know what’s next — or is there nothing? That’s the scary part.” The story also says increasing numbers of young people in the West are choosing to die (although few countries allow it for mental illness; a law that would in Canada has been delayed several times and is now set to take effect in 2027.)

Professionals treating young people with psychiatric disorders seem “to give up on them more easily than before,” Stef Groenewoud, a healthcare ethicist at Theological University Kampen, in the Netherlands, told The Free Press. Theo Boer, a healthcare ethics professor at Protestant Theological University in Groningen, served on a euthanasia review board from 2005 to 2014. He said he “saw the Dutch euthanasia practice evolve from death being a last resort to death being a default option,” and ultimately resigned. Critics argue that people like ter Beek have been tacitly encouraged to kill themselves by a social media culture that glamorizes suicide, laws that destigmatize it, and radical right-to-die activists who insist we should be free to kill ourselves whenever our lives are “complete.” They see it as a kind of suicide contagion.

Advocates argue that people with terminal illness should be empowered to have control over their final days. Aid-in-dying due to mental illness is even more controversial, partly because it is not as well understood as physical illness, but the reasons they support it are essentially the same. “When people are desperate for relief from torment that we do not understand well enough to effectively treat, giving them the right and the expert medical assistance to end that misery is caring for them,” Clancy Martin wrote in a guest essay last year for the New York Times when Canada’s provision extending medical assistance in dying to mentally ill people was being debated. He’s a philosophy professor at the University of Missouri in Kansas City and Ashoka University in New Delhi and the author of “How Not to Kill Yourself.”

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In other news…

Drone to the rescue. When rural dispatchers received “specific, credible, and time-sensitive information about a person that was suicidal,” Minnesota’s Chisago County Sheriff’s Office sent up a drone, CBS News Minnesota reported. The drone pilot canvassed the park where the individual was said to be located and eventually found a person pacing back and forth, approaching and moving away from a ledge, said Sgt. Kyle Puelston. The person was connected to support and to family members.

Track opioid settlement payouts to your state, county and city using the KFF Health News tracker, part of the news organization’s ongoing project into how the money – $4.3 billion through late February – is being used and misused. Most localities are not required to make their settlement amount public, but KFF Health News negotiated with the court-appointed firm administering the settlements to obtain it last year. The tracker itemizes amounts to states, counties and cities, depending on which is the direct recipient. California, for example, has received $419.6 million so far, with an estimated $1.7 billion (with a b) coming over the next 16 years. Los Angeles County has received the most so far – $47 million – while Farmersville City in the San Joaquin Valley (population 10,324), expects to bring in $3,912 this year on its way to a total of  almost $40,000.

Flotation therapy may ease a variety of mental health conditions, according to a small but growing body of research reported by the Washington Post. Like it sounds, flotation therapy involves floating in a tank of warm water saturated with Epsom salt. It’s a popular and often expensive form of relaxation, with float-tank sessions typically lasting about an hour in an oversize hot tub in a pod whose lid can be open or closed to create an environment without light and sound. Some of the mixed and limited research has found that float therapy may reduce symptoms of anxiety and depression, and possibly reduce cravings in addiction-related disorders. 

Opioid overdoses could be slashed through a combination of public health interventions, researchers conclude. Creating a model based on interventions given to more than 17 million people over three years, the authors of a JAMA Network Open study estimated that fatal opioid overdoses could be reduced by 37% and non-fatal ODs by 35%. The interventions would lead to a 137% increase in the provision of medication-assisted treatment for the disorder and a 23% reduction in the prevalence of opioid use disorder. The model would include things like naloxone distribution and overdose education. Meanwhile, Nora Volkow, the longtime director of the National Institute on Drug Abuse, says prevention and targeted interventions can help beat the overdose crisis that killed nearly 110,000 Americans last year. “We are much better than fentanyl, we are much, much better than the drug dealers,” Volkow told participants at the Rx and Illicit Drug Summit in Atlanta, the Politico Pulse newsletter reported. 

Stigma by doctors and pharmacists against people with opioid use disorder is one of the biggest reasons why policy changes intended to increase the number of buprenorphine prescriptions has barely moved the needle, according to Thomas Prevoznik, deputy assistant administrator of the Drug Enforcement Administration. He spoke at the Atlanta summit, which was covered by Politico. Both prescribers and pharmacists continue to call people who suffer from opioid use disorder “them” – as in they don’t want to treat “them” in their practice, Prevoznik said. Another factor: reimbursement rates for buprenorphine were so low that pharmacists complained that they lost money filling them. A third was fear of the DEA, which controls access to buprenorphine because it’s an opioid. Prevoznik said pharmacists and distributors of the medication fear running afoul of DEA thresholds on the amount of buprenorphine that can be bought. He said the federal agency has no such thresholds, but states still may.

If you or someone you know is in crisis or experiencing suicidal thoughts, call or text 988 to reach the 988 Suicide & Crisis Lifeline and connect in English or Spanish. If you’re a veteran press 1. If you’re deaf or hard of hearing dial 711, then 988. Services are free and available 24/7.

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