Chapter 4. The Chemistry of Behavior: Neurotransmitters and Neuropharmacology

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By Elisabeth Egan BEVERLY HILLS, Calif. — When I pictured Matthew Perry, the actor frequently known as Chandler Bing, I saw him on the tangerine couch at Central Perk or seated on one of the twin recliners in the apartment he shared with Joey Tribbiani. In September, after arriving at his 6,300-square-foot rental house and being ushered through a driveway gate by his sober companion, I sat across from Perry, who perched on a white couch in a white living room, a world away from “Friends,” the NBC sitcom that aired for 10 seasons and catapulted all six of its stars into fame, fortune and infinite memes. Instead of the foosball table where Chandler, Joey, Monica, Phoebe, Rachel and Ross gathered, nudging each other through the first chapters of adulthood, Perry, 53, had a red felt pool table that looked untouched. There was plenty of light in the house, but not a lot of warmth. I have watched every episode of “Friends” three times — in prime time, on VHS and on Netflix — but I’m not sure I would have recognized Perry if I’d seen him on the street. If he was an ebullient terrier in those 1990s-era Must See TV days — as memorable for his full-body comedy as he was for the inflection that made “Can you BE any more [insert adjective]” the new “Gag me with a spoon” — he now seemed more like an apprehensive bulldog, with the forehead furrows to match. As his former co-star Lisa Kudrow confesses in the foreword to his memoir, “Friends, Lovers and the Big Terrible Thing,” the first question people ask about “Friends” is often “How’s Matthew Perry doing?” Perry answers that question in the book, which Flatiron will publish on Nov. 1, by starkly chronicling his decades-long cage match with drinking and drug use. His addiction led to a medical odyssey in 2018 that included pneumonia, an exploded colon, a brief stint on life support, two weeks in a coma, nine months with a colostomy bag, more than a dozen stomach surgeries, and the realization that, by the time he was 49, he had spent more than half of his life in treatment centers or sober living facilities. © 2022 The New York Times Company

Keyword: Drug Abuse
Link ID: 28524 - Posted: 10.26.2022

by Carey Gillam and Aliya Uteuova For decades, Swiss chemical giant Syngenta has manufactured and marketed a widely used weed-killing chemical called paraquat, and for much of that time the company has been dealing with external concerns that long-term exposure to the chemical may be a cause of the incurable brain ailment known as Parkinson’s disease. Syngenta has repeatedly told customers and regulators that scientific research does not prove a connection between its weedkiller and the disease, insisting that the chemical does not readily cross the blood-brain barrier, and does not affect brain cells in ways that cause Parkinson’s. But a cache of internal corporate documents dating back to the 1950s reviewed by the Guardian suggests that the public narrative put forward by Syngenta and the corporate entities that preceded it has at times contradicted the company’s own research and knowledge. And though the documents reviewed do not show that Syngenta’s scientists and executives accepted and believed that paraquat can cause Parkinson’s, they do show a corporate focus on strategies to protect product sales, refute external scientific research and influence regulators. In one defensive tactic, the documents indicate that the company worked behind the scenes to try to keep a highly regarded scientist from sitting on an advisory panel for the US Environmental Protection Agency (EPA). The agency is the chief US regulator for paraquat and other pesticides. Company officials wanted to make sure the efforts could not be traced back to Syngenta, the documents show. And the documents show that insiders feared they could face legal liability for long-term, chronic effects of paraquat as long ago as 1975. One company scientist called the situation “a quite terrible problem” for which “some plan could be made … ”

Keyword: Parkinsons; Neurotoxins
Link ID: 28522 - Posted: 10.22.2022

By Fenit Nirappil A national shortage of Adderall has left patients who rely on the pills for attention-deficit/hyperactivity disorder scrambling to find alternative treatments and uncertain whether they will be able to refill their medication. The Food and Drug Administration announced the shortage last week, saying that one of the largest producers is experiencing “intermittent manufacturing delays” and that other makers cannot keep up with demand. Some patients say the announcement was a belated acknowledgment of a reality they have faced for months — pharmacies unable to fill their orders and anxiety about whether they will run out of a medication needed to manage their daily lives. Experts say it is often difficult for patients to access Adderall, a stimulant that is tightly regulated as a controlled substance because of high potential for abuse. Medication management generally requires monthly doctor visits. There have been other shortages in recent years. “This one is more sustained,” said Timothy Wilens, an ADHD expert and chief of child and adolescent psychiatry at Massachusetts General Hospital who said access issues stretch back to spring. “It’s putting pressure on patients, and it’s putting pressure on institutions that support the patients.” Erik Gude, a 28-year-old chef who lives in Atlanta, experiences regular challenges filling his Adderall prescription, whether it’s pharmacies not carrying generic versions or disputes with insurers. He has been off the medication for a month after his local pharmacy ran out.

Keyword: ADHD; Drug Abuse
Link ID: 28520 - Posted: 10.22.2022

By Jyoti Madhusoodanan Q: I recently started taking an S.S.R.I. antidepressant, but I have been confused about whether it’s safe to drink alcohol. Some internet sources say it’s fine, others say to avoid drinking completely. Help! For many health care providers who treat anxiety and depression, the concern about whether it’s safe — or even advised — to drink alcohol while taking an antidepressant is a common one. “Patients tell me all the time, ‘I’m going to be drinking with friends tonight, so I skipped a dose,’” said Dr. Sarah Ramsay Andrews, a psychiatrist at the Johns Hopkins University School of Medicine. But skipping a dose is never a good idea, said Dr. Jody Glance, an addiction medicine specialist at the University of Pittsburgh Medical Center Western Behavioral Health — even if you’re going out for cocktails with friends. “When people stop taking their medicines for a day or two, they often don’t resume, and that can lead to a relapse of anxiety or depression.” Besides, she added, how safe it is to drink while on antidepressants depends on the kind of antidepressant you’re taking — and for most people taking selective serotonin reuptake inhibitors (or S.S.R.I.s), an occasional drink likely won’t do much harm. There are, however, caveats to keep in mind. S.S.R.I. medications — which include citalopram (Celexa), sertraline (Zoloft) and escitalopram (Lexapro) — are the most commonly prescribed class of antidepressants. They are typically used to help treat depression, and can also be effective for other conditions like anxiety, obsessive compulsive disorder, certain phobias and even premenstrual dysphoric disorder. They work by increasing the levels of the brain chemical serotonin — which is thought to influence your mood and emotions, among other things — by blocking its removal after it carries messages in the brain. But unlike many other medications used to treat mood disorders — like the anxiety medication alprazolam (Xanax) or the tricyclic antidepressant amitriptyline (Elavil) — S.S.R.I.s are less likely to interact with alcohol than other kinds of drugs, Dr. Glance said. © 2022 The New York Times Company

Keyword: Depression; Drug Abuse
Link ID: 28517 - Posted: 10.19.2022

Daniel Merino & Josjan Zijlmans As research into psychedelics and their medical uses makes a comeback, scientists are having to deal with the legacy – both scientific and social – of a 40-year nearly total freeze on psychedelics research. In this episode of “The Conversation Weekly” podcast, we speak with three experts about the early rise and fall of psychedelics in Western science and culture, how the mystical and often vague language of the ‘60s and '70s still pervades research today and what it’s like to actually run clinical trials using psilocybin. According to a poll done in the summer of 2022, nearly 30% of U.S. residents have tried at least one psychedelic drug in their lifetime. Whether from personal experience, hearing about the experiences of friends or widespread depictions in the media, many people will have either tried to describe a psychedelic trip or heard someone else describe one. The language commonly used in these descriptions is, for lack of a better word, often quite trippy. “A key function of the ego is to identify differentiation,” says Robin Carhart-Harris, a neurologist and psychologist at the University of California, San Francisco, and one of the world’s leading psychedelics researchers. “And when that function breaks down, it’s replaced with a sense of de-differentiation, a sense of unity, like everything is interconnected in a web of relationships. That’s not nothingness, it’s sort of everythingness.” Many psychedelics researchers use an approach called “the mystical framework” to assess psychedelic experiences. Researchers who use this framework give participants in psychedelics studies a survey as a way to define and categorize the experience. The survey asks participants to rate how strongly they felt certain phenomena during their trip, including feelings like the “certainty of encounter with ultimate reality (in the sense of being able to 'know’ and ‘see’ what is really real at some point during your experience).” © 2010–2022, The Conversation US, Inc.

Keyword: Depression; Drug Abuse
Link ID: 28496 - Posted: 10.01.2022

By Ted Alcorn Oregon is a drinker’s paradise. The state boasts more craft distilleries than Kentucky and is second only to California in the number of wineries. Some call Portland “beervana” for its bevy of breweries. But Oregon also has among the highest prevalence of problem drinking in the country. Last year, 2,153 residents died of causes attributed to alcohol, according to the Oregon Health Authority — more than twice the number of people killed by methamphetamines, heroin and fentanyl combined. Sonja Grove, a retiree in Portland whose adult son drank himself to death in April 2020, feels the toll is overlooked compared with those of other drugs. “Alcoholism has sort of taken a back seat.” In 2021, confronted by these conflicting trends, as the pandemic raged on, Oregon lawmakers made it easier to drink. They permanently legalized the sale of to-go cocktails, which the Distilled Spirits Council of the United States called a “lifeline,” and increased the number of cases that wineries could ship directly to consumers. Reginald Richardson, director of the state’s Alcohol and Drug Policy Commission, described the policies as incongruent. “We obviously want to create an environment that’s pro-business, that helps the state to develop, but we’ve got this other thing,” he said. That disconnect is typical: Before Covid lockdowns, no state permitted bars or restaurants to deliver liquor to customers at home, according to a trade association. Now, 28 have relaxed the rules. In contrast, policies that experts consider most effective at curbing excessive drinking have been ignored. For example, even as alcohol-related deaths soared to record highs in the last few years, alcohol taxes have fallen to the lowest rates in a generation. Americans drank more during the pandemic, but national data on the change have only recently become available. Alcohol tax revenues collected by the U.S. Treasury Department rose by eight percent in the fiscal year that ended on Sept. 30, 2021, compared with the previous year, and remain well above pre-pandemic levels. © 2022 The New York Times Company

Keyword: Drug Abuse
Link ID: 28482 - Posted: 09.17.2022

By Jackie Rocheleau After experimenting on a hen, his dog, his goldfish, and himself, dentist William Morton was ready. On Oct. 16, 1846, he hurried to the Massachusetts General Hospital surgical theater for what would be the first successful public test of a general anesthetic. His concoction of sulfuric ether and oil from an orange (just for the fragrance) knocked a young man unconscious while a surgeon cut a tumor from his neck. To the onlooking students and clinicians, it was like a miracle. Some alchemical reaction between the ether and the man’s brain allowed him to slip into a state akin to light sleep, to undergo what should have been a painful surgery with little discomfort, and then to return to himself with only a hazy memory of the experience. General anesthesia redefined surgery and medicine, but over a century later it still carries significant risks. Too much sedation can lead to neurocognitive disorders and may even shorten lifespan; too little can lead to traumatic and painful wakefulness during surgery. So far, scientists have learned that, generally speaking, anesthetic drugs render people unconscious by altering how parts of the brain communicate. But they still don’t fully understand why. Although anesthesia works primarily on the brain, anesthesiologists do not regularly monitor the brain when they put patients under. And it is only in the past decade that neuroscientists interested in altered states of consciousness have begun taking advantage of anesthesia as a research tool. “It’s the central irony” of anesthesiology, says George Mashour, a University of Michigan neuroanesthesiologist, whose work entails keeping patients unconscious during neurosurgery and providing appropriate pain management. Mashour is one of a small set of clinicians and scientists trying to change that. They are increasingly bringing the tools of neuroscience into the operating room to track the brain activity of patients, and testing out anesthesia on healthy study participants. These pioneers aim to learn how to more safely anesthetize their patients, tailoring the dose to individual patients and adjusting during surgery. They also want to better understand what governs the transitions between states of consciousness and even hope to crack the code of coma. © 2022 NautilusThink Inc, All rights reserved.

Keyword: Sleep; Consciousness
Link ID: 28480 - Posted: 09.17.2022

By Christina Jewett Juul Labs, fighting for its survival in the United States, on Tuesday tentatively agreed to pay $438.5 million to settle an investigation by nearly three dozen states over marketing and sales practices that they contend set off the nation’s teenage vaping crisis. The company said that it did not acknowledge any wrongdoing in the settlement, but that it was trying to “resolve issues from the past” while awaiting a decision by the Food and Drug Administration over whether it would be permitted to continue to sell its products. Juul has been trying to reposition itself as a seller of vaping products that could help adults quit smoking traditional cigarettes, in an effort to rehabilitate its tarnished reputation and improve its diminished market value. The tentative settlement prohibits the company from marketing to youth, funding education in schools and misrepresenting the level of nicotine in its products. But Juul had already discontinued several marketing practices and withdrawn many of its flavored pods that appealed to teenagers, under public pressure from lawmakers, parents and health experts a few years ago when the vaping crisis was at a peak. “We think that this will go a long way in stemming the flow of youth vaping,” William Tong, Connecticut’s attorney general, said at a news conference on Tuesday. “We are under no illusions and cannot claim that it will stop youth vaping. It continues to be an epidemic. It continues to be a huge problem. But we have essentially taken a big chunk out of what was once a market leader.” The multistate investigation found that the company appealed to young people by hiring young models, using social media to court teenagers and giving out free samples, he said. And, he added, the inquiry revealed that the company had a “porous” age verification system for its products and that 45 percent of its Twitter followers were ages 13 to 17. Jason Miyares, the attorney general for Virginia, pointed out in a statement that the company’s former strategy of selling flavors like mango and crème brûlée appealed to youth as did the sleek design of its device that was easy to conceal. One term of the settlement banned the company from depicting anyone under 35 in its marketing images, Mr. Miyares’ statement said. © 2022 The New York Times Company

Keyword: Drug Abuse
Link ID: 28464 - Posted: 09.07.2022

Perspective by Steven Petrow A few weeks ago, I mentioned to a friend that I was interested in learning more about psychedelics, especially how they might help me with depression and anxiety. That’s a broad category of plant medicines including psilocybin (“magic”) mushrooms, MDMA (ecstasy), DMT (Dimitri or the Businessman’s Trip), ketamine (“special K”) and some others. I’d been hesitant to be open about my search, because I’m old enough to remember the warnings about “bad trips” that scramble your brain. Imagine my surprise when my friend told me he’d recently taken his first “trip,” which he described as life-changing. I asked him — a real estate developer living in Northern California, married with kids — why he decided to try a psychedelic substance. “My work felt increasingly stale and meaningless,” he explained to me over a beer. “Despite a massive amount of reflection and coaching around how to break the rut, I felt as though I was still off track.” He and the others who have used these medicines spoke on the condition of anonymity because most of these psychedelics are Schedule I substances, meaning they are illegal to manufacture, buy, possess or distribute. When I confided my interest in psychedelics to a few other friends, several said they had tried the drugs and experienced several benefits: from easing anxiety to finding spiritual insights to combating depression and, among some with cancer, helping to reduce the fear of dying. They are hardly outliers. According to a new YouGovAmerica study, “one in four Americans say they’ve tried at least one psychedelic drug,” amounting to some 72 million U.S. adults. (The study included the medicines mentioned earlier, plus LSD, mescaline and salvia.) Was I missing a beat by not getting onboard?

Keyword: Depression; Drug Abuse
Link ID: 28463 - Posted: 09.07.2022

By Matt Richtel This article examines the increase in anxiety, depression, self harm and suicide among U.S. adolescents. Parents and teenagers dealing with these issues can find resources here. One morning in the fall of 2017, Renae Smith, a high school freshman on Long Island, N.Y., could not get out of bed, overwhelmed at the prospect of going to school. In the following days, her anxiety mounted into despair. “I should have been happy,” she later wrote. “But I cried, screamed and begged the universe or whatever godly power to take away the pain of a thousand men that was trapped inside my head.” Intervention for her depression and anxiety came not from the divine but from the pharmaceutical industry. The following spring, a psychiatrist prescribed Prozac. The medication offered a reprieve from her suffering, but the effect dissipated, so she was prescribed an additional antidepressant, Effexor. A medication cascade had begun. During 2021, the year she graduated, she was prescribed seven drugs. These included one for seizures and migraines — she experienced neither, but the drug can be also used to stabilize mood — and another to dull the side effects of the other medications, although it is used mainly for schizophrenia. She felt better some days but deeply sad on others. Her senior yearbook photo shows her smiling broadly, “but I felt terrible that day,” said Ms. Smith, who is now 19 and attends a local community college. “I’ve gotten good at wearing a mask.” She had come to exemplify a medical practice common among her generation: the simultaneous use of multiple heavy-duty psychiatric drugs. Psychiatrists and other clinicians emphasize that psychiatric drugs, properly prescribed, can be vital in stabilizing adolescents and saving the lives of suicidal teens. But, these experts caution, such medications are too readily doled out, often as an easy alternative to therapy that families cannot afford or find, or aren’t interested in. © 2022 The New York Times Company

Keyword: Drug Abuse; Depression
Link ID: 28450 - Posted: 08.27.2022

By Andrew Jacobs A small study on the therapeutic effects of using psychedelics to treat alcohol use disorder found that just two doses of psilocybin magic mushrooms paired with psychotherapy led to an 83 percent decline in heavy drinking among the participants. Those given a placebo reduced their alcohol intake by 51 percent. By the end of the eight-month trial, nearly half of those who received psilocybin had stopped drinking entirely compared with about a quarter of those given the placebo, according to the researchers. The study, published Wednesday in JAMA Psychiatry, is the latest in a cascade of new research exploring the benefits of mind-altering compounds to treat a range of mental health problems, from depression, anxiety and post-traumatic stress disorder to the existential dread experienced by the terminally ill. Although most psychedelics remain illegal under federal law, the Food and Drug Administration is weighing potential therapeutic uses for compounds like psilocybin, LSD and MDMA, the drug better known as Ecstasy. Dr. Michael Bogenschutz, director at NYU Langone Center for Psychedelic Medicine and the study’s lead investigator, said the findings offered hope for the nearly 15 million Americans who struggle with excessive drinking — roughly 5 percent of all adults. Excessive alcohol use kills an estimated 140,000 people each year. “These are exciting results,” Dr. Bogenschutz said. “Alcohol use disorder is a serious public health problem, and the effects of currently available treatments and medications tend to be small.” The double-blind randomized trial followed 93 participants for 32 weeks and divided them into two groups: One received psilocybin and the other a placebo in the form of antihistamine pills. The participants, all of whom struggled with excessive drinking, also took part in 12 therapy sessions that began several weeks before they received their first doses and continued for a month after the final dose. The psilocybin dosage was determined according to participants’ weight, and their heart rate and blood pressure were monitored during the eight-hour sessions. © 2022 The New York Times Company

Keyword: Drug Abuse; Depression
Link ID: 28448 - Posted: 08.27.2022

By Andrew Jacobs Marijuana and hallucinogen use among young adults reached an all-time record last year after having leveled off during the first year of the coronavirus pandemic, according to federal survey data. The findings, part of the government’s annual survey of drug use among young Americans, also found that nicotine vaping and excessive alcohol consumption continued to climb in 2021 after a brief pause. Another worrying trend among young people, ages 19 to 30: mounting consumption of alcoholic beverages suffused with THC, the psychoactive ingredient in cannabis. But there were some bright spots in the survey. Cigarette smoking and opioid abuse among young adults dropped last year, a continuing trend that has heartened public health experts. Taken in its entirety, the report provides a mixed picture of substance use in the United States that experts say reflects a number of disparate trends affecting young Americans: the devastating mental health effects of the pandemic; the increased availability of legal marijuana; and the emerging therapeutic embrace of psychedelics to treat depression, post-traumatic stress disorder and other psychological problems. “Overall, the results are very concerning,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse, which publishes the annual Monitoring the Future survey. “What they tell us is that the problem of substance abuse among young people has gotten worse in this country, and that the pandemic, with all its mental stressors and turmoil, has likely contributed to the rise.” The online survey of people ages 19 to 60 was conducted from April to October 2021. Substance use research experts said the mounting use of marijuana in young adults was especially notable. The survey found that 43 percent in the 19-30 age group had used cannabis 20 or more times over the previous month, up from 34 percent. In 2011, that figure was 29 percent. Daily marijuana consumption also jumped significantly, to 11 percent from 6 percent in 2011. © 2022 The New York Times Company

Keyword: Drug Abuse
Link ID: 28443 - Posted: 08.24.2022

By Emma Yasinski In the years since a family member of mine started taking methadone, a drug that helps him avoid the excruciating withdrawal symptoms and intense cravings that come with an opioid use disorder, he’s attended the funerals of three of his closest friends with whom he used to use drugs. The number of acquaintances he’s lost is in the double digits. Methadone might have saved them — if only they could have picked it up from their local pharmacy. Like heroin or oxycodone, methadone stimulates the opioid receptors in the brain. The difference is that while heroin rapidly floods these receptors leading to an intense high, the effect of methadone is more gradual and long-lasting. At the appropriate dose, my family member (whom I’m not naming due to the continued stigma surrounding opioids) and other patients can get full days of relief from pain, withdrawal, and cravings, without the intoxication. But methadone is tightly regulated. Rather than pick it up from the local pharmacy, patients have to visit a specialized clinic — often daily — to get each individual dose. In March 2020, concerns about Covid-19 led the Substance Abuse and Mental Health Services Administration, or SAMHSA, to relax those restrictions. The agency announced that states could request an exception allowing clinics to offer a greater amount of take-home doses— up to 28 days — for patients the clinical team believed were stable and could safely handle the medication. Some clinics embraced the opportunity. In a multistate survey of 170 opioid treatment programs, about half followed the relaxed SAMHSA guidelines for newly enrolled or less stable patients. And two-thirds of the clinics surveyed offered their stable patients a full four weeks of take-home doses. The pandemic provided the natural experiment to demonstrate that loosening regulations on methadone in the U.S. was safe for both patients and communities. More than two years later, on July 13, researchers at the National Institute on Drug Abuse and the National Center for Injury Prevention and Control published some of the most powerful results of that experiment. While deadly overdoses involving opioids rose to staggering heights in the U.S. during the first year of the pandemic, the percentage of overdose deaths involving methadone decreased.

Keyword: Drug Abuse
Link ID: 28435 - Posted: 08.13.2022

Adam Miller · CBC News · A new analysis of the cause of depression has seemingly upended what we know about this common condition and challenged the use of antidepressants. But it may also leave patients with more questions than answers as the science evolves. A systematic umbrella review of 17 studies published in Molecular Psychology on July 20 looked at the decades-old theory that depression is caused by low serotonin, and found there was "no consistent evidence" of "an association between serotonin and depression." The theory that depression is caused by a chemical imbalance in the brain has been around since the 1960s. But for years, many experts have doubted this, feeling it oversimplified a complex condition. "The serotonin theory is very old and has been very popular since the '90s, when the pharmaceutical industry started promoting it," said Dr. Joanna Moncrieff, a psychiatry professor at University College London and lead author of the study. "But since about 2005, probably a bit before then, there's been sort of rumours that actually the evidence isn't very strong, or it's inconsistent. Some studies are positive, some studies are negative, but no one's really got that evidence together anywhere." Moncrieff and her team set out to challenge the serotonin theory in a systematic review of available research. They also went a step further in their conclusion by suggesting that antidepressants are ineffective at treating depression — and have largely worked as a placebo. ©2022 CBC/Radio-Canada.

Keyword: Depression
Link ID: 28434 - Posted: 08.13.2022

Martha Bebinger Approaching a van that distributes safe supplies for drug use in Greenfield, Mass., a man named Kyle noticed an alert about xylazine. "Xylazine?" he asked, sounding out the unfamiliar word. "Tell me more." A street-outreach team from Tapestry Health delivered what's becoming a routine warning. Xylazine is an animal tranquilizer. It's not approved for humans, but it's showing up in about half of the drug samples that Tapestry tests in the rolling hills of western Massachusetts. It's appearing mostly in the illegal fentanyl supply but also in cocaine. Kyle rocked backward on his heels at the mention of cocaine. He and his friends regularly use cocaine, but lately, they had suspected that something else was in the bag. "The past week, we've all been just racking our brains, like 'What is going on?'" he said. "Because if we cook it up and we smoke it, we're falling asleep after." Kyle's deep sleep might have been triggered by fentanyl too, but Kyle said one of his buddies used a test strip to check for the opioid and none was detected. Xylazine surged first in some areas of Puerto Rico and then in Philadelphia, where it was found in 91% of opioid samples last year, the most recent reporting period. Data from January to mid-June shows that xylazine was in 28% of drug samples tested by the Massachusetts Drug Supply Data Stream (MADDS), a state-funded network of community drug-checking and advisory groups that uses mass spectrometers to let people know what's in bags or pills purchased on the street. Some areas of the state, including western Massachusetts, are seeing xylazine in 50% to 75% of samples. In Greenfield, that's a big change from last year, when xylazine wasn't a concern. © 2022 npr

Keyword: Drug Abuse
Link ID: 28423 - Posted: 08.06.2022

By Andrew Jacobs At some point in the next few years, the 30 million smokers in the United States could wake up one day to find that cigarettes sold at gas stations, convenience stores and smoke shops contain such minuscule amounts of nicotine that they cannot get their usual fix when lighting up. Would the smokers be plunged into the agonizing throes of nicotine withdrawal and seek out their favorite, full-nicotine brand on illicit markets, or would they turn to vaping, nicotine gum and other less harmful ways to get that angst-soothing rush? Such scenarios inched closer to the realm of possibility in June, when the Food and Drug Administration said that it would move toward slashing nicotine levels in cigarettes in an effort to reduce the health effects of an addiction that claims 480,000 lives a year. The agency set next May as its timetable for introducing a fully developed proposal. But many experts hope regulators will champion an immediate 95 percent reduction in nicotine levels — the amount federally funded studies have determined is most effective for helping smokers kick the habit. It could be years before any new policy takes effect, if it survives opposition from the tobacco industry. Even so, health experts say any effort to decrease nicotine in cigarettes to nonaddictive levels would be a radical experiment, one that has never been implemented by any other country. The science of nicotine addiction has come a long way since 1964, when a U.S. Surgeon General report first linked smoking to cancer and heart disease, although it would take another two decades for the mechanics of nicotine dependence to be understood and widely accepted. Tobacco contains more than 7,000 chemicals, many of them harmful when burned and inhaled, but it is nicotine that keeps smokers coming back for more. Nicotine stimulates a surge of adrenaline in the brain while indirectly producing a flood of dopamine, the chemical that promotes feelings of contentment and relaxation. The effects, however, are short-lived, which is why heavy smokers need a fresh injection a dozen or more times a day. © 2022 The New York Times Company

Keyword: Drug Abuse
Link ID: 28418 - Posted: 08.03.2022

By Sarah Wild In 2015, psychiatrist Mark Horowitz tried to come off his antidepressants. He reduced his dosage by a set proportion over the course of several months, which is much longer than what the United Kingdom’s guidelines recommended. But in the process of tapering, he experienced a storm of new symptoms, including anxiety, dizziness, and bouts of insomnia. “I’d wake in the morning, feeling like I was being chased by an animal on the edge of a cliff,” he says. Ultimately, he felt he had no choice but to go back on his medication. As it happened, Horowitz had recently completed a Ph.D. on the neurobiology of antidepressants. During his training, he recalls, his professors had told him that stopping antidepressants was fairly easy. Their view was supported by the scientific literature, which had found that any withdrawal symptoms were minor and faded quickly. Experiences such as Horowitz’s were considered an anomaly. But a series of widely reported studies published over the past seven years suggest that discontinuation symptoms are common and can be severe, including everything from panic attacks and flu-like symptoms to electric shock sensations in the head. The longer people remain on antidepressants and the higher their dose, the more likely they are to experience withdrawal symptoms. Each year, millions of people begin taking antidepressants. They have been shown to help anxiety sufferers feel calmer and lift the moods of those with severe depression and balance their emotions. For many, the intervention is lifesaving. Yet even today, few physicians inform their patients about the potential difficulties of coming off the medication. Most national guidelines suggest a slow taper, but there is little to no guidance on precisely how to do this. Patients who experience intense withdrawal symptoms may end up remaining on antidepressants or turning to online peer support groups for help.

Keyword: Depression
Link ID: 28414 - Posted: 07.30.2022

Ismaeel Yunusa Taking oxycodone at the same time as certain selective serotonin reuptake inhibitors (SSRIs), a commonly prescribed class of antidepressant, can increase the risk of opioid overdose, according to a study my colleagues and I published. Doctors prescribe the opioid oxycodone to treat moderate to severe pain after surgeries and injuries or certain conditions like cancer. Opioids are also a common drug of abuse. In the U.S., over 70% of drug overdose deaths in 2019 involved an opioid. Because many patients with depression also experience chronic pain, opioids are often coprescribed with antidepressants like SSRIs. Prior research has shown that certain SSRIs, namely fluoxetine (Prozac or Sarafem) and paroxetine (Paxil, Pexeva or Brisdelle), can strongly inhibit a liver enzyme crucial to the proper breakdown of drugs in the body, including oxycodone. The resulting increased concentration of oxycodone in the blood may lead to accidental overdose. To see whether different types of SSRIs might affect a patient’s risk of overdosing on oxycodone, my colleagues and I examined data from three large U.S. health insurance claims databases. We included over 2 million adults who began taking oxycodone while using SSRIs between 2000 and 2020. The average age of the group was around 50, and a little over 72% were women. A little over 30% were taking the SSRIs paroxetine and fluoxetine. We found that patients taking paroxetine or fluoxetine had a 23% higher risk of overdosing on oxycodone than those using other SSRIs. © 2010–2022, The Conversation US, Inc.

Keyword: Depression; Drug Abuse
Link ID: 28413 - Posted: 07.30.2022

By Linda Searing People who drink a moderate amount of coffee — up to 3½ cups a day — might have a better chance at a longer life span, even if their coffee is lightly sweetened with sugar, according to research published in Annals of Internal Medicine. For about seven years, the researchers tracked the coffee consumption and health of 171,616 participants, who were an average of nearly 56 years old and were free of cancer and cardiovascular disease when the study started. They found that those who regularly drank 1½ to 3½ cups of coffee a day, whether plain or sweetened with about a teaspoon of sugar, were up to 30 percent less likely to die in that time frame from any cause, including cancer and cardiovascular disease, than were those who did not drink coffee. The type of coffee — whether instant, ground or decaffeinated — made no difference, but the results were described as inconclusive for the use of artificial sweeteners. The latest research does not prove that coffee alone was responsible for participants’ lowered mortality risk. Still, over the years, research has revealed a variety of health benefits for coffee, linking its consumption to a reduced risk for Type 2 diabetes, Parkinson’s disease, depression and more. Nutritionists often attribute the benefits of coffee to the abundance of antioxidants in coffee beans, which may help reduce internal inflammation and cell damage and protect against disease. Drinking caffeinated coffee also provides an energy boost and increased alertness. Caffeine, however, can disrupt sleep and be risky during pregnancy.

Keyword: Drug Abuse; Obesity
Link ID: 28406 - Posted: 07.23.2022

By Chris Vognar Sign up for the Watching newsletter, for Times subscribers only. Streaming TV and movie recommendations from critic Margaret Lyons and friends. Get it in your inbox. In late 2012, the best-selling author and journalist Michael Pollan (“The Omnivore’s Dilemma”) was at a dinner party in Berkeley, Calif. Among his fellow diners was a prominent developmental psychiatrist, in her 60s, who spoke at some length about a recent LSD trip. This pricked up Pollan’s ears. His first thought, as he shared during a recent video interview: “People like that are taking LSD?” The psychiatrist went on to explain that the drug gave her a better understanding of the way children think. “Her hypothesis,” Pollan said, “was that the effects of psychedelics, LSD in that case, give us a taste of what child consciousness would be like — this kind of 360-degree taking-in of information, not particularly focused, fascinated by everything.” Pollan had already heard about clinical trials in which doctors were giving cancer patients psilocybin to help them deal with their fear of death. Now, he was really curious about psychedelic therapy. That curiosity became an article in The New Yorker (“The Trip Treatment,” 2015). The article became a book, “How to Change Your Mind” (2019). And now the book has become a four-part Netflix series of the same name, which debuted Tuesday. Pollan is an executive producer (along with the Oscar-winning filmmaker Alex Gibney) and the primary on-camera presence. A thoughtful and wide-ranging look at psychedelic therapy, the series is grounded in accounts of their centuries-long sacramental use and of their uneasy history in modern society, especially in the United States. In particular, it focuses on four substances — LSD, mescaline, MDMA (known as Ecstasy or Molly) and psilocybin (the active ingredient in magic mushrooms) — and the ways in which they are being used to treat patients with maladies including post-traumatic stress disorder, addiction, depression, anxiety and obsessive-compulsive disorder. © 2022 The New York Times Company

Keyword: Drug Abuse; Depression
Link ID: 28401 - Posted: 07.16.2022