Getting Closer to Personalized Treatment for Teens with Treatment-Resistant Depression

National Institute of Mental Health ~ Some teens with treatment-resistant depression are more likely than others to get well during a second treatment attempt of combination therapy, but various factors can hamper their recovery, according to an NIMH-funded study published online ahead of print February 4, 2009, in the Journal of the American Academy of Child and Adolescent Psychiatry.

Background 
About 40 percent of teens with major depression do not get well after a first treatment attempt with an antidepressant medication. The NIMH-funded Treatment of Resistant Depression in Adolescents (TORDIA) study was designed to test second-step treatment strategies for these teens.

In TORDIA, 334 teens who did not get well after taking a type of antidepressant called a selective serotonin reuptake inhibitor (SSRI) before the trial were randomly assigned to one of four treatments for 12 weeks:

• Switch to another SSRI
• Switch to venlafaxine, a different type of antidepressant
• Switch to another SSRI and add cognitive behavioral therapy (CBT), a type of psychotherapy
• Switch to venlafaxine and add CBT

Results of the trial, which were reported in February 2008, showed that the teens who received medication plus CBT were more likely to get well than those who switched medications only. In this most recent data analysis, Joan Rosenbaum Asarnow, Ph.D., of the University of California Los Angeles, and colleagues aimed to identify how to better predict a teen's response to treatment, and any factors that might affect response.

Results of the Study 

Many predictors were similar to those found in studies of first-step treatments, such as the NIMH-funded Treatment for Adolescents with Depression Study (TADS), underscoring the importance of early treatment before the depression becomes chronic. For instance, like in TADS, teens in the TORDIA study were less likely to respond to treatment if they had very severe depression or higher levels of suicidal thinking. In addition, teens prone to self-harming behavior and family conflict were less likely to respond to treatment.

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Video Games Can Be as Addictive as Illicit Drugs

Addiction Treatment Magazine ~ Getting between someone who is addicted and their drug of choice can prove to be a precarious move. Those struggling with an addiction become so attached to their preferred medium of pleasure delivery that they will often choose it over their own families. It can be alcohol, illicit drugs, prescription drugs, food, and even the Internet and video games.

Image from EvilControllers.com

The American Psychological Association’s diagnostic manual reflects this in its next release in May – violent video games can affect the pleasure center of the brain as intensely as drugs. Doctors have found that the area of the brain that is stimulated so rewarding while playing video games is the same area of the brain pleasured by alcohol and drugs. And, unfortunately, children are the most vulnerable to the powers of this gaming addiction. Some researchers are finding that video game addicts will get violent, physically and/or verbally, when someone puts a halt to their gaming, including their parents or siblings.

One researcher with nearly 20 years of experience in studying Internet-based addictions said violent games are often associated with aggressive behavior. Otherwise well-behaving kids that become addicted to gaming have been known to strike out at his/her parents when they intervene with the gaming.

Video Game Addiction
Researchers are also finding links between Internet addiction and mental issues, such as anxiety, depression and various learning disabilities. Most of the affected are young men or adolescents that are using gaming as an escape. It’s really no different than an alcoholic who finds pleasure in a bottle. But the source of the problem isn’t necessarily the game or the bottle; it’s something inside the brain of the addicted person that researchers are trying to unlock. At the same rate, researchers also warn that introducing youths to electronic gaming devices at an early age, which is a common practice in the developed world, can be as detrimental as handing them an addictive drug.

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Many teens tell survey they’re addicted to social media, texting

By Cecilia Kang

image from mashable.com

Washington Post ~ Nine out of 10 teens text and use social media sites — a good chunk of them daily — but they still prefer communicating face to face, according to a survey.

Many U.S. teens say they are addicted to social media and texting and often want to unplug. But they feel positive overall about how social media sites such as Facebook and text messaging have helped them connect with friends and family.

The mixed feelings that teens have about digital communication sheds new light on a population growing up immersed in online technology. Research is scant on the behavioral and developmental effects of technology on youth.

A national survey of more than 1,000 people between the ages of 13 and 17 by the child advocacy group Common Sense Media shows how pervasive mobile communications has become for that age group.

“Today’s 13- to 17-year-olds are the first generation to go through their entire teen years with such an array of digital devices and platforms,” said Common Sense Media CEO James Steyer. “This report reads like a primer for parents to teens and tweens — to help them understand how their kids are engaging with technology and to highlight any impact it might be having on their social and emotional well being.”

Text messaging is still the favored application of teens for communicating.

Two-thirds of respondents said they text every day and half said they visit social networking sites daily. One-quarter of teens use at least two different types of social media a day.

Facebook, which is considering lowering its age minimum, dominates teens, with seven out of 10 people surveyed saying they have an account compared to 6 percent for Twitter and 1 percent for GooglePlus and MySpace.

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Teens Sleeping with Cell Phones: A Clear and Present

By Suzanne Phillips, PsyD

image via VATOR.TV

PBS This Emotional Life Blog~ You may already know that many teens sleep with their cell phone on or near the bed. As an adult, you yourself may sleep with your cell phone and see no problem with this behavior.

A closer look at the reasons that 4 out of 5 teens sleep with their phone, however, gives cause for concern. While for some teens, the night use of the phone is as a clock or alarm, for most the phone is on all night to connect with peers.

This “on call” status can reflect obligation, anxious need, and even addiction. It jeopardizes physical, emotional and cognitive functioning and limits domains of influence and connection.

Obligation

The peer pressure “to be available” used to mean hanging out after school. It takes on different proportions when it means being available 24/7. Teens in focus groups report that they sleep with a phone under the pillow in case someone contacts them. They report wanting to be available for a friend in need but dislike being called for unnecessary issues, pranks, or by bored friends.

At an age when self-esteem hinges on peer acceptance, being caught in the demands of always being available is difficult. Many teens report stories of friends getting insulted, angry or upset if a text message or phone call is not responded to immediately.

“People will wake me up in the middle of the night and I have to wake up and talk or they will think I’m mad at them or something.”

Sleep Deprivation

Anyone who has dealt with the sleep deprivation of being a new parent or knows the sleep disruption and hypervigilance of being “on call” can appreciate the undue physical and emotional cost of a teen’s all night phone connection.

Medical research increasingly underscores the need for adolescents to get sleep – in fact 9 hours compared with adult’s 8 hours. Teen sleep deprivation has been associated with memory deficits, impaired performance and alertness. The loss of REM or intense sleep can result in increased irritability, anxiety and depression, as well as reduced concentration and creativity.

Do you know if your teen is sleeping?

Does he/she need help protecting their sleep?

The Texting Trap

Cell-phone texting has become the preferred channel of basic communication between teens and their friends. One in three teens sends more than 100 text messages a day or 3000 texts a month.

Teens who use their cell phones to text are 42% more likely to sleep with their phones than teens who own phones but don’t text.

Texting is instantly gratifying and highly anxiety producing. Instant connection can create elation and self-value only to be replaced by the devastation of no response, a late response, the misinterpretation of a punctuation mark, a sexually harassing text, a text sent to the wrong person or a text that is later regretted.

Neuro-imaging has shown that back and forth texting floods the pleasure centers of the brain, the same area that lights up when using heroin. The emotional disruption of a real or perceived negative response, however, necessitates more texting to repair the mood, to fix the feelings of rejection, blame and disconnection. The addictive potential is obvious.

Texting as an addiction jeopardizes sleep, cognitive functioning and real relating- making dependence on it greater and greater.

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Teen Use of Salvia Divinorum Raises Alarms

By Patrik Jonsson

Abilene Report News~ ATLANTA -- Concern about salvia divinorum, a shamanistic herb from Mexico that some U.S. teenagers are using to get a hallucinogenic high, not only is spurring parents to have heart-to-heart talks with kids but also has led some states to outlaw it.

Photo Credit: NPR

A concentrated leaf compound that's usually smoked in water pipes, salvia divinorum -- known as "Sally D" or "magic mint" on the streets -- causes users to briefly lose their grip on reality. Some 3,500 video clips of teens experimenting with the drug have popped up on YouTube, driving up its popularity even as vendors, aware of efforts to ban it, are basically throwing going-out-of-business sales.

The highly concentrated compound made from a kind of mint plant remains legal in all but eight states, available in smoke shops and even gas station mini-marts. It can also be obtained via the Internet. Its easy availability and disorienting properties come as a surprise to parents and many lawmakers, who are asking why the U.S. government has not yet outlawed its sale.

Yet salvia's unusual chemistry, nontoxicity, and potential research benefits have made the compound a cause célèbre among some researchers and spiritualists who say prohibition is the wrong tack for a substance whose effects are so uncomfortable that few people try it more than once or twice.

"Salvia has become an Internet phenomenon where, in talking to kids, their perception around it is, 'Well, it must not be that bad for you because it's legal,' and that's a real dangerous assumption to make," says Jonathan Appel, a criminal-justice professor at Tiffin University in Tiffin, Ohio, who has studied the salvia phenomenon. "The heavy-user group is late adolescents (and) early adults who are experimenting with substances, many of whom are attracted to ... a kind of distorted identity search, sometimes seeking the sacred in a culture where we may have lost some ability to see what is sacred."

The U.S. Drug Enforcement Administration lists salvia as a "drug of concern" -- the first step in classifying a drug as a controlled substance.

But parents and state and local lawmakers, many showing YouTube clips in public hearings, are not waiting for Washington to move. Seven states now classify salvia as a controlled substance, banning its use and sale, and Maine prohibits minors from using it. Delaware banned it after it was linked, at least in part, to a teen's suicide in 2006. As many as a dozen others are considering similar legislation.

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Ex teen addict talks about huffing air freshener

Learn more about one ex addict's story about huffing air freshener

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Vancouver police issue warning after dance party revellers treated for GHB overdoses

By   KIM BOLAN

Image from Addiction Search

Vancouver Sun~  Vancouver police are warning recreational users of GHB — the so-called date rape drug — after two teens and a 20-year-old nearly died of overdoses at a Vancouver dance party on May 31.

Sgt. Randy Fincham said residents living near the Polish Veterans Hall on Kingsway called police about 10 p.m. last Friday to report large groups of young people milling about in the street and in nearby yards and alleys.

When officers arrived, they saw a 20-year-old man — foaming at the mouth and in medical distress — being carried from the hall by friends.

As police patrolled the area, they found a 15-year-old boy and a 14-year-old girl also both foaming at the mouth and unconscious.

All three, who had overdosed on GHB, were taken to hospital and put in the intensive care unit. They have since been released.

"We would like to encourage parents to have a conversation with their children regarding the harmful and potentially lethal consequences of consuming both recreational and prescription drugs," Fincham said. "Police and community resources are available to assist families struggling with both recreational and habitual drug concerns."

He said police have an ongoing investigation into where the GHB came from, although police believe all three victims took it voluntarily.

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Teen Athletes at Risk for Opioid Abuse

By Flor Cianchetti

Yahoo Health~ Sports are a great way for teens to maintain physical and mental health. But teen athletes can get injured. Sometimes, those injuries are so painful that teens are prescribed opioid painkillers, which might introduce the opportunity for drug misuse.

A recent study found that teens who played team sports were at risk for opioid medication misuse.

Teens who participated in sports were more likely to get injured than those who did not play organized sports, and the teen athletes' doctors often prescribed opioid medications (narcotics) to relieve their pain.

But easy access to opioid medications by teen athletes may offer an opportunity for drug abuse, according to the authors of this study.

This recent study — which looked at whether sports participation among adolescents was associated with the use of opioid medications — was conducted by Philip Veliz, PhD, of the Institute for Research of Women and Gender from the University of Michigan, and colleagues.

According to Dr. Veliz, “We should expect that adolescents who participate in competitive sports at the interscholastic level are at a greater risk to get injured and, subsequently, be more likely to be prescribed opioids to manage pain.”

The study included a total of 1,540 adolescent students from schools in Michigan who filled out a survey for three consecutive school years during 2009 to 2012. Students were between 11 and 17 years old (average age 14) when they completed their first survey, between 12 and 18 when they filled out the second survey and between 13 and 19 during the last survey.

The following four questions were included in the surveys to assess the medical use, improper medical use (used too much or too often) and non-medical use of opioid medications:

1. “On how many occasions in the past 12 months has a doctor, dentist, or nurse prescribed the following types of medicine for you?"
2. "On how many occasions (if any) in the past 12 months have you used too much (e.g., higher doses, more frequent doses) of your prescribed medication?"
3. "On how many occasions (if any) in the past 12 months have you intentionally gotten high with your prescribed medication or used it to increase other drug or alcohol effects?"
4. "On how many occasions in the past 12 months have you used the following types of medicines not prescribed to you?"

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Heavy Marijuana Use Alters Teenage Brain Structure

By Christopher Bergland

Photo Credit: Shutterstock/ The Nest

Psychology Today~ It’s common sense that being a heavy cannabis user might make someone more spaced-out and less likely to perform well on memory tasks. Excessive chronic use of any type of drug is going to have detrimental mental and physical side effects.  

In a study published in December 2013, researchers at Northwestern Medicine discovered that the developing teenage brain may be particularly vulnerable to excessive marijuana use. The researchers found that teens who smoked marijuana daily for about three years had abnormal changes in their brain structures related to working memory and performed poorly on memory tasks.

In an alarming twist, the study found abnormalities in brain structure and also identified memory problems two years after the heavy marijuana users had stopped smoking pot as teenagers. The researchers found that memory-related structures in their brains appeared to shrink and collapse inward, reflecting a possible decrease in neuron volume. These findings indicate that there could be long-term detriments of chronic marijuana use as a teenage.

Cannabis use has long been associated with working memory impairments. However, the exact relationship between cannabis use and working memory neural circuitry remains somewhat of a mystery.

Previous research has found that prolonged cannabis use is detrimental to mental health. This Northwestern study is the first to target key brain regions in the deep subcortical gray matter of heavy marijuana smokers using structural MRI and to correlate abnormalities in these regions with working memory.

The Northwestern team examined whether a cannabis use disorder (CUD) was associated with differences in brain structure between control subjects with and without a CUD. The study reports that the younger the individuals were when they started chronically using marijuana, the more abnormally their brain regions were structured. The findings suggest that the brain regions related to memory may be more susceptible to the effects of cannabis if abuse starts at an earlier age.

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My Life on Meth

By Unnamed Author

LA Youth~ Everyone else was doing it, why shouldn’t I?

The first time I used meth was at Birmingham High. My brother Kevin had gone there and people thought I would be like him. At lunch this girl came up to me and we started talking. She asked me what drugs I used. I lied and said meth. We went to the bathroom. We went into a stall, locked the door and she pulled a glass pipe out of her bra and passed it to me and said, “You hit it first.” I didn’t know what I was doing. I smoked it wrong and nothing happened. We hung out for about 10 minutes and she told me to meet her by a tree after school and we could kick it. The next day, I started to get the hang of it. When I smoked I really got high. The world was so different. It felt like I was in a dream. Things I thought I was imaginaing were actually happening. I loved it way too much. Later I was walking home and all I could think about was how good I felt.

I never thought I would get addicted. Seeing what meth did to everybody else, I thought that’s them, I’m a different person. I saw people lose weight fast. Their teeth would rot and they were angrier. I thought I was stronger than that. But instantly, I was using every day. I couldn’t stop. I felt depressed and sick when I wasn’t high. My body told me I needed it to feel better.

I used to be this polite girl—so nice people would take advantage of me. After I started using meth I completely changed. Every day I was fighting people (mostly guys). My knuckles were always bloody. I also wasn’t taking care of myself. I wasn’t eating. I was really skinny. I was like an empty skeleton roaming the world, just taking up space. I didn’t care about how I looked. I would just throw whatever on. I loved to wear tutus. I also remember walking around in a nurse costume with duct tape strapped around me. I had a thing for freaking people out. I would jump in trash cans, say and do anything. I didn’t care how bad it made me look as long as I got a rise out of them. Nothing mattered as long as I was high.

I was talking to people who weren’t there
One day at school I was sitting in the middle of the football field hallucinating. I thought I was talking to people, telling them not to use drugs. School let out and people came outside and saw me. I don’t know how long they were standing there. Then it hit me that I wasn’t talking to anyone. It felt like the whole school was watching. I opened my eyes and saw the world for what it was.

Everything I used to love, I hated. I stopped singing, writing, playing sports and being with my true friends. I just wanted to be with people who were getting high.

I lied to everyone to hide my drug use. I only went to school about seven days a month. I made up friends to talk to my dad about so it would seem like I was going to school. I could tell in his eyes that he knew I was lying. All of us were meth addicts—me, my mother and my two brothers. I think he didn’t want to see my life falling apart, so he played it off as if everything was all right. I wish he would’ve stopped me and helped me get better.

Nine months after I started using meth, I overdosed. I was with a friend and she dropped me off on the street not far from my house at 2 a.m. I started walking home. I started hallucinating. It was scary. I was hiding underneath cars and trying to climb on roofs. I thought a swarm of cops and dogs were after me. I was running. I hallucinated that a cop dog had gotten me and that’s when I fell in the middle of street. I don’t remember what happened after that. Someone called the police. My dad was in the ambulance with me. He told me that my eyes had turned yellow, I wouldn’t stop screaming and I kept throwing up. They thought I was going to die.

At the hospital I woke up in a diaper and thought, “What the hell?” I felt like I was back to being a baby. I couldn’t do anything on my own. Two nurses would come and put me on a plastic toilet and I had to learn how to walk all over again. I had messed up my body so much. After I overdosed I thought, “I’ve just been caught for every bad thing I’d done.”

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JOE: A Teenager's Struggle

By Janet Firshein

WNET Thirteen~ For much of his teenage life, Joe was addicted to drugs and alcohol. Joe, now 19, is a recovered addict who counsels other teens. He knows, he says, that he can't stop someone from using drugs or alcohol, but he hopes his own story can "sort of nudge them into a different direction and explain there's a different way of life." Nobody in his peer group did that for Joe, he says; things might have been different if someone had.

When he was 17, Joe moved with his family to Miami, where getting drugs was a lot easier than in Chile. "Over here, I kind of discovered that you could sort of order stuff like pizza." Joe said he just would get a bunch of beeper numbers and beep suppliers when he needed drugs. 

One of the first friends he made when he first moved to Miami was another teenager who lived down the street and sold marijuana. "He didn't even know me. He just knocked on my door, and he introduced himself, and he offered to smoke me out." Joe says they became great friends, and he began to use marijuana heavily. Eventually, he moved on to other drugs, including LSD and cocaine.

Looking back, Joe says teens have a hard time avoiding drugs because they are so easy to come by and are often supplied by close friends. "In my school alone, there's so many kids that sell, you know, and a lot of time they're friends of yours." Joe says the stereotypical drug pusher whom kids are warned about is the exception. "I used to have this preconceived notion that somebody who sold drugs was, like, some filthy, grungy guy in a parka . . . but some of my first exposure to drugs was [through] close friends, sometimes even immediate family." Joe says it's a mistake for a lot of anti-drug campaigns geared to teens to portray drug dealers as looking like demons. "I think it's a little exaggerated . . . a lot of the kids that I did a lot of the heavy drugs with were just as regular and probably a lot more pleasing to a general crowd to look at than I was."

Ignoring the Problem
When Joe's cocaine use got out of hand, his girlfriend, Amy, became worried. She tried to confront him in a letter, which he dismissed and tossed in one of the many piles of papers in his room. Joe didn't think he had a problem. "I thought cocaine was the most glamorous thing on the face of the planet, even though I was doing it in some rundown, cockroach-filled apartments with some guy who was just living off nothing."
Amy surreptitiously showed the note to Joe's mother, and his parents talked him into visiting a hospital. They admit that they tricked him into the trip by telling him that it would be only for a brief checkup. Once he was at the hospital, they had him kept in the detoxification unit. After several days in the hospital undergoing detox, Joe was sent to an adolescent treatment program. Although he's forgiven his parents, at the time, he says, he was extremely angry at them for taking him away from his "lifeline." "I couldn't imagine a world without drugs. .  . . The way I saw it, I got a lot more out of a movie if I was on acid or drunk. I got a lot more out of everything. To me, drugs were like the spice of life. There was nothing else." Joe says he resented his parents for admitting him to a treatment center and, when he returned home, lashed out at them routinely. "I was just flipping out on a daily basis. . . . I just blamed my parents for all the wrongs in the world."

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Follies of Escapism

By Sara the Stray

All Poetry~ 

Even as the night burns on
And I long to find meaning
In this fleeting sanctuary
I find not a thing profound
In this blur of finality

I know not what I need
Only what I cannot grasp
Another day of this clarity
Prior to the coming haze
Of the editor's floor

The end of this clarity nears
And I only pray sleep will come
To shield me from this hell
I have once more birthed
From this angel's snow.

I have always known my folly
In this venture of escapism
Yet I anticipate the inevitable
Another passage to this station
Of timeless antiquity.

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Study: Teens Addicted to the Internet More Likely to Admit to Drug Abuse

By Join Together Staff 

Drug Free/Join Together~ A new study suggests teenagers with “pathologic” Internet use are more likely to admit to drug abuse.

“Not only did we find that specific personality attributes were important in both substance abuse and Internet addiction, but that Internet addiction remained an important predictor of substance abuse,” study co-author Georgios Floros told ABCNews.com.

The study, conducted by Greek researchers, included 1,271 students ages 14 to 19 on the Aegean island of Kos. They were asked about their Internet use, substance use and personality. The study included an “Internet addiction test,” which asked how often they stayed online longer than they had intended, how often their grades suffered because of the amount of time they were online, and how often they would act annoyed if someone disturbed them when they were online.

The researchers found the teens who reported substance abuse had significantly higher average scores on the Internet addiction test. Those scores were important predictors for past or present substance use, the researchers reported in the Journal of Addiction Medicine. “Targeting the adolescent population that engages in increased Internet use may be of benefit for drug abuse prevention programs,” they wrote.

The article points out that there is no agreed-upon definition of Internet addiction. The article notes the study found links between Internet use, drug use and personality type, but not a cause-and-effect relationship.

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Ecstasy Use on Rise Again Among U.S. Teens: Report

By Dennis Thompson

HealthDay News -- The number of U.S. teens who wind up in the emergency room after taking the club drug Ecstasy has more than doubled in recent years, raising concerns that the hallucinogen is back in vogue, federal officials report.

Emergency room visits related to MDMA -- known as Ecstasy in pill form and Molly in the newer powder form -- increased 128 percent between 2005 and 2011 among people younger than 21. Visits rose from about roughly 4,500 to more than 10,000 during that time, according to a report released Tuesday by the U.S. Substance Abuse and Mental Health Services Administration.

"This should be a wake-up call to everyone, but the problem is much bigger than what the data show," said Steve Pasierb, president and CEO of The Partnership at Drugfree.org. "These are only the cases that roll into the emergency rooms. It's just the tip of the iceberg."

The SAMHSA study comes on the heels of a string of Ecstasy-related deaths. Organizers closed the Electric Zoo music festival in New York City one day early in August following two deaths and four hospitalizations caused by Ecstasy overdoses. The deaths came a week after another young man died from Ecstasy overdose at a rock show in Boston.

Ecstasy produces feelings of increased energy and euphoria, and can distort a person's senses and perception of time. It works by altering the brain's chemistry, but research has been inconclusive regarding the effects of long-term abuse on the brain, Pasierb said.

However, ecstasy abuse can cause potentially harmful physical reactions, Pasierb said. Users can become dangerously overheated and experience rapid heartbeat, increased blood pressure and dehydration, all of which can lead to kidney or heart failure.

Alcohol also appears to be a factor. One-third of the emergency room visits involving Ecstasy also involved alcohol, a combination that can cause a longer-lasting euphoria, according to SAMHSA. Teens can become less aware of how much alcohol they've consumed, and also can be more likely to make poor decisions that lead to bodily harm.

The newest form of MDMA, the powder Molly, appears to be driving the latest surge in Ecstasy use.

The study relied on data produced by the Drug Abuse Warning Network, a public health surveillance system that monitors drug-related hospital emergency department visits and drug-related deaths.

MDMA affects a person's level of serotonin, a hormone that helps regulate sleep cycles and is responsible for feelings of happiness and well-being, said Peter Delany, director of SAMHSA's Center for Behavioral Health Statistics and Quality. Overuse can cause depression, confusion, paranoia, anxiety and sleep disorders.

The Molly that currently is on the streets is usually a very pure crystalline form of MDMA, Delany said. Users can snort it, mix it in alcohol or some other liquid, or take it in a gel cap.

Delany noted that the number of emergency room visits caused by MDMA pales in comparison to the 1.5 million ER visits linked to drug use every year, but said both the rapid increase and the age of the victims are causes for concern.

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Sophie's Story: Surviving Anorexia

My Life With Anorexia~ My daughter started down the path to anorexia nervosa sometime late 2009. I can say that now with hindsight and being able to recognise the symptoms. Compulsive, obsessive, perfectionism, almost hysterical outbreaks if something didn’t suit her. Rarely eating dessert or cake. She was just turning 15.

At the beginning of 2010 Sophie started to make changes to her diet. This is what first alerted me that something wasn’t right. She wanted to eat healthy, questioned what was in each food, refused all ‘junk’ foods. There was a pattern of foods questioned for health purposes suddenly disappearing off her diet even if the food was a ‘good one’. At first she was relatively calm, but as weeks progressed she would react over-the-top if any of the forbidden foods were offered.

I am positive now, that she stopped eating her school lunches sometime around March and just threw them away. I first put her on the scales at home mid March and she had lost around 2-3kg – not a huge loss, not something to really worry about. But the intensity and difference in her was more than enough to say something was different. A doctor wouldn’t have diagnosed anything at this stage either. So I just kept watching.

By the end of April, Sophie stepped up the process. Carbs were now not allowed – no bread, rolls, pizza, fried foods, noodles etc. Lunches were now only a yoghurt and fruit. Her weight by the end of April was now down 4kg. I was now pushing her to eat, trying to break through what was going on. She was getting depressed, had outbursts of anger, and if angry refused to all her food. It was like my daughter was disappearing into another parallel. She was physically present, sometimes her normal self, functioned at school and at home, but mentally and emotionally lived in another world.

Mid May she let slip her last period was in March. Her food portions were slowly getting smaller. The June long weekend was the crunch point. She was very down, ate very slowly, ate not a lot. We were in the doctor surgery on the Tuesday afternoon. Again she didn’t have enough to say she had an eating disorder, the indicators were there but she wasn’t ticking off the main criteria. Her depressive state was also a concern. Thankfully the doctor scheduled weekly visits, I am very grateful he didn’t write Sophie off as a ‘teenage thing’.

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THE AWAKENING

By Amanda FitzSimons

Elle~ Having taken Ambien for insomnia since college, Amanda FitzSimons set out to discover what medical research had to say about the risks of her beloved sleeping pill. The answers just might keep you up at night.

Addiction to sleeping pills. As I type this, that phrase sounds so scary and cliché, the stuff of a Lifetime movie starring Meredith Baxter, crying alone in a dark apartment amid empty bottles of Southern Comfort. What I have, or at least the way I prefer to think of it, sounds a lot less harmful: just one little pill to help me go to sleep at night…every night.

I, like tens of millions of other Americans, take Ambien or its generic equivalents (zolpidem is the active ingredient), which makes the drug by far the country’s most popular sleep aid. When I first got a prescription, I was suffering from what doctors call "acute insomnia," i.e., a string of nights in which I stared at the ceiling for hours before finally being able to get some shut-eye. If this pattern of taking more than a half hour to fall asleep at least three nights a week persists beyond a month, it’s considered chronic. But, honestly, I wouldn’t know if that applies to me anymore. Having taken the pills for three- to six-month stints, with short breaks, over the past five and a half years, I’m like a person who’s been highlighting her hair so long she doesn’t know what her natural color is.

Ambien has gotten a lot of bad press recently for its adverse side effects: Kerry Kennedy crashed into a tractor-trailer on a New York highway, her explanation being that she'd mixed up her pill bottles and taken zolpidem instead of thyroid medication; then there was Tom Brokaw blaming an uncharacteristically loopy TV appearance on being under Ambien’s influence; and, in January, the FDA’s surprising recommendation that dosages be cut in half for female patients based on lab studies and driving tests that confirmed 
a risk of next-day drowsiness. (Women eliminate Ambien at a slower rate than men, the FDA said, and some still have enough in their system after eight hours to impair driving.)

But apart from an isolated incident in which I sent a PDF of a fan letter I'd received from a prisoner to an ex-boyfriend hoping to incite his jealousy (in case you're wondering, it didn't work) and some very vivid dreams, I can't complain about any side effects, not even the next-day hangover experienced by up to 8 percent of users, according to Ambien manufacturer Sanofi. And the truth is, for putting me out of my up-all-night misery, I can't sing the medication's praises enough: Almost every time I pop an Ambien, I fall into a warm, fuzzy, Serta commercial–quality slumber within minutes and sleep soundly for the entire night.

While I've always been a chronic ruminator—and had the occasional sleepless night throughout my adolescence—taking prescription sleeping pills never occurred to me until my senior year of college, when the uncertainty of postgraduation life sent me into an insomnia tailspin. After watching me repeatedly take Tylenol PM in vain (my body felt like it had been hit with a tranq dart, but my mind was still racing), one of my suite mates, who was something of a psychopharmaceutical adventuress, told me to look into Ambien. Her delivery—calm, nonchalant, no fine print—sold me. The way she made it seem, taking Ambien was about as risky as taking a daily vitamin. Why hadn't I thought of this before? I wondered, and made an appointment to see a doctor the next day.

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