Monday, November 13, 2023

By Don Sapatkin

Good Monday morning! New York Gov. Kathy Hochul named “Dr. Ruth” Westheimer, 95, the longtime celebrity sex therapist, as the nation’s first (honorary) Ambassador to Loneliness, CNN reported. In today’s Daily: U.S. soldiers who fired massive quantities of artillery at ISIS in Syria harmed their brains in the process.

Scientists are working to develop vaccines and antibody treatments against addictive drugs – but there are many skeptics. “Psychosocial”  care provided in groups holds promise for treating mental health conditions in developing countries. And the trauma felt by child survivors of gun violence spreads through their families, too.

A secret war, massive bombardments and the damage to brains and lives

Via X (formerly Twitter)

In 2016 and 2017, the US military embarked on a secret and deadly strategy: using a small number of Marines to send an onslaught of round-the-clock artillery fire against the Islamic State in Syria (ISIS). The strategy avoided U.S. deaths by keeping soldiers out of direct combat, but had devastating effects on members of Alpha Battery, 1st Battalion, 11th Marines, the New York Times reports. 

Marines Javier Ortiz and Austin Powell believe they are being haunted by the ghosts of those they killed, now seeking revenge. Brady Zipoy dealt with sudden waves of overwhelming, inexplicable emotion. Many of those involved in the secret missions have been afflicted by nightmares, panic attacks, depression and hallucinations. Some have died by suicide. 

The military surveyed 40 gun-crew veterans and their families to make sense of what looked like PTSD and traumatic brain injuries in troops who hadn’t engaged in direct combat but were required to fire tens of thousands of rounds of high-explosive shells day after day. Though military guidelines said doing so was safe, it turns out that the blasts from hurling 100-pound shells up to 15 miles shook the soldiers’ bodies and brains with each shot. More than half of the troops assigned to Fox Battery, 2nd Battalion, 10th Marines were later diagnosed with traumatic brain injuries. An investigation by the military found the capacity for harm to be so great that crews subjected to repeated blast exposure would be injured “faster than combat replacements can be trained to replace them.” 

Military leaders failed to inform the commanders and troops involved of the findings in the report, leaving the soldiers to suffer on their own, prescribed medications for psychiatric disorders like ADHD or depression that they didn’t have and engaging in irrational, sometimes violent behaviors. As a result, many got kicked out of the service with less-than-honorable discharges, leaving them ineligible from benefits from the country they had fought for, in service to whom they had damaged their brains. –Courtney Wise

Investment rising into vaccines and antibodies that may counter addictive drugs. Critics question utility.

With overdoses continuing to kill more than 100,000 Americans a year, researchers and drug companies are examining experimental vaccines and antibody therapies against deadly street drugs like fentanyl, the Washington Post reported, helped by millions of dollars in federal funding.

Scientific interest in immune treatments against addictive drugs like heroin and cocaine goes back more than a half-century but waned after low-cost methadone was introduced to treat opioid addiction and became widespread in the 1970s. Newer drugs like buprenorphine and naltrexone also reduce cravings and eliminate the euphoria produced by opioids.

But some addiction specialists question the wisdom of spending money to develop vaccines and expensive antibody treatments. “The vaccines do nothing to reduce craving or withdrawal or to motivate anyone to return for more care,” said Keith Humphreys, a Stanford University professor of psychiatry and former White House drug policy adviser.

Still, the notion of amping up the immune system to prevent drug overdose deaths continues to intrigue researchers despite multiple failed clinical trials. The federal government in recent months has awarded nearly $22 million in grants to develop a monoclonal antibody that would target fentanyl by binding to its molecules before they can invade the brain and shut down breathing. The first clinical trial has just begun. Trials of therapies against cocaine, oxycodone and methamphetamine are farther along. But nothing is likely to be available for several years at least.

Can peer-led group therapy be an answer to global mental health crisis?

Via Facebook

In the West, we generally think of mental health care as individual visits to a clinical professional and/or prescription drugs. But with mental health needs growing worldwide, treatment costs increasing and clinicians in short supply, “We need a new approach and it should focus on communities, scalability and equity.” So writes Kaaren Mathias, a physician and senior lecturer in public health at the University of Canterbury in New Zealand, in an article for The Conversation republished by MindSite News.

This approach should be built around “psychosocial” care that “meets individual needs but also considers social factors such as housing, income or relationships” and group “interventions” that could be facilitated by trained peers or community members.

Mathias recently published a study in PLOS Global Public Health that reviewed and synthesized findings about group-based interventions from 42 previous studies in poor communities in Nepal, India and Bangladesh. Groups offers five key advantages, Mathias wrote. They produce new friendships that continue when the meetings are over. They also increase a sense of social inclusion and support, offer opportunities to “rehearse” and use mental health skills in a safe space, trigger a sense of belonging and provide a sense of “collective strength” that can lead to collaborative action. Read the full article.

For child survivors of gun violence, the trauma continues and spreads

Gun violence most often makes the news when it involves mass shootings or children’s deaths. In 2020, gun injuries became the leading cause of death among children and adolescents. But non-fatal shootings are far more common than deaths, and the trauma spreads from survivors through entire families, according to new research covered by the New York Times. Health care costs soar, adding to the stress and anxiety for families who can’t afford them.

The study, published in Health Affairs, found that pain, substance abuse disorders and psychiatric disorders increased sharply among child and adolescent survivors in the year after the shooting, rising even more when kids had more serious injuries that required treatment in the ICU.

Among parents of survivors, psychiatric diagnoses rose by nearly a third, and more if their children were in the ICU. While mothers of surviving children had a 75 percent increase in mental health visits, their routine medical office visits and use of imaging and lab tests declined – probably because they had “decreased engagement with their own health care” in the aftermath of family trauma, the researcher wrote. Overall, survivors’ health-care costs increased by about $35,000 the year after a child’s injury.

“We can’t think about this as a problem that starts and ends with the bullet going in and then the acute surgical care,” co-author Chana Sacks, a physician who co-directs the Gun Violence Prevention Center at Massachusetts General Hospital, told the Times. “Leaving the hospital is just the beginning of that family’s journey, and I think we need to treat it that way.”

In other news…

“Hey Siri, I’m feeling depressed,” I spoke into my iPhone – and was pleased to get the same efficient response that  Politico’s Future Pulse newsletter described. The disembodied assistant said it was sorry to hear that, offered to help me call a friend or family member and provided a link to the National Alliance on Mental Illness HelpLine page. Siri’s non-judgmental voice was nice, too.

Mental health-related hospitalizations – and evacuations – of active-duty troops are rising even as hospitalizations decline overall, Military Times reported, citing newly published military survey data for the past five years. Mental health-related events were the biggest category of evacuations in Central Command last year. In-theater medical encounters attributed to mental health problems grew from 4.4% to 6.2% – equal to a 41% increase – between 2018 and 2022. “Adjustment disorder with mixed anxiety and depressed mood” was the most common mental health condition cited.

William E. Pelham Jr., a child psychologist who challenged his field’s approach to ADHD in children, died last month at 75, a New York Times obituary reported. Pelham argued for behavioral interventions first, with medication as an optional supplement – but largely lost that fight for all but the youngest children. Although not opposed to low doses of the stimulants used to treat attention-deficit/hyperactivity disorder, Pelham believed strongly that the order mattered. He argued that behavioral therapy equipped children with the skills they needed to manage what was often a lifelong struggle. His influence is reflected in the American Academy of Pediatrics’ clinical guidelines for treating ADHD, which recommend either parent training in behavior management and/or behavioral classroom interventions as the first line of treatment for pre-school children aged 4 to 6.

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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Type of work:

Don Sapatkin is an independent journalist who reports on science and health care. His primary focus for nearly two decades has been public health, especially policy, access to care, health disparities...