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For generations, many traditional healers have used botanical hallucinogens, such as ayahuasca and peyote, to induce transpersonal experiences in their patients. Transpersonal experiences tap into a realm beyond ego and personality; they can bring about a release from tension and buried trauma, generate new insights, and open the door to healing. Western research indicates that inducing transpersonal states with traditional hallucinogens or chemicals such as LSD, DMT, and MDMA can be therapeutic; but cultural misuse of these substances has led to a "war" on these drugs. As an alternative, psychiatrist Stanislav Grof, MD, PhD, who engaged in medical LSD research during the 1950s and 1960s, and his wife Christiana Grof, PhD, developed Holotropic Breathwork, a nondrug method for inducing transpersonal experiences. Grof is considered a founder of transpersonal psychology.
Holotropic Breathwork was offered to psychiatric patients at the Stress Center of Hyland Behavioral Health, Saint Anthony's Medical Center (St. Louis, Missouri), from 1989 through 2001, according to a report by board-certified psychiatrist James Eyerman, MD. Twenty patients met for two-hour group sessions before the Tuesday evening meal. A trained facilitator and four "sitters" monitored four patients each, offering assistance if needed. Each Holotropic Breathwork session consisted of a 5-minute introduction during which patients were advised of possible effects. Patients then engage in 90 minutes of "enhanced breathing," consisting of continuous full breaths taken faster and deeper than normal. "Evocative" music was played throughout this time. Blocked energy held in the body was released with bodywork, if necessary. Afterwards, patients were given 10 minutes to draw a mandala related to their experience. They were then given an opportunity to share their experience with the group.
Eyerman estimates that about 11,200 inpatients (± 200) took part in a Holotropic Breathwork session over the years. These adult and adolescent patients had a range of diagnoses including sexual trauma, dual diagnoses, chemical dependency, anxiety, depression, and psychoses. Holotropic Breathwork, which can produce physically and emotionally intense responses, was contraindicated for patients with severe cardiac disease, severe musculoskeletal disorders, and paranoid ideation as well as pregnant women. Patient interest in attending a session was very high: "The groups were oversubscribed and filled every week," writes Eyerman.
Holotropic Breathwork provoked transpersonal experiences in 82% of 482 patients. Another 16% reported prior life experiences, including perinatal experience; and 2% reported having "no experience." "'No experience,' or consciousness without content, is a description of the yogic state of turiya (Sanskrit, fourth state)," says Eyerman. "Turiya occurs in Holotropic Breathwork sessions with some frequency." Patients reported no adverse effects during the sessions, and staff nurses observed no negative effects after the sessions.
More information is available from Association for Holotropic Breathwork International (ABHI; http://grof-holotropic-breathwork.net) and from http://holotropic.com.
Eyerman JA. Clinical report of Holotropic Breathwork in 11,000 psychiatric inpatients in a community hospital setting. MAPS Bulletin: Psychedelics in Psychology and Psychiatry. Spring 2013;23(1):24–27.
Grof S, Grof C. Principles of Holotropic Breathwork. Available at http://www.grof-holotropic-breathwork.net/page/2182480:Page:678. Accessed July 20, 2013.
How to do Holotropic Breathwork [online article]. http://holotropicbreathworkla.com/how-to-do-holotropic-breathwork. Accessed July 9, 2013.
Iatrogenic Mental Illness Epidemic?
The idea that mental illness is a biological condition that can be corrected with medication – just as diabetes can be treated with insulin – was a boon to pharmaceutical companies and to the American Psychiatric Association. Psychiatrists can prescribe medication; psychologists cannot. Unfortunately, the widespread use of pharmaceutical drugs to treat depression and attention deficit disorder has led to a huge increase in serious mental illness, says science writer Robert Whitaker. Whitaker wrote Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America (Crown Publishers; April 2010). "In 1987, prior to Prozac hitting the market and the current ubiquitous use of antidepressants and other psychiatric drugs," Whitaker said in a 2010 interview, "the U.S. mental illness disability rate was 1 in every 184 Americans, but by 2007 the mental illness disability rate had more than doubled to 1 in every 76 Americans."
Medications may initially relieve depression or ADHD, but they can also produce negative effects that doctors tend to with more drugs. For example, drugs given to children for hyperactivity and depression can produce "manic" symptoms. Instead of recognizing the medications' negative effect, doctors too often diagnose the child with bipolar disorder and prescribe more drugs that have serious physical side effects, leading to chronic illness. Whitaker is not against using psychoactive drugs. Rather, he advocates the "selective, cautious" approach of Finnish practitioners when prescribing drugs for first-episode patients: "… their long-term outcomes are, by far, the best in the Western World."
Irish psychiatrist David Healy has been warning about the harmful effects of prescription drugs for over three decades. Healy, who teaches at Cardiff University School of Medicine in Wales, has written extensively about the history and science of neurochemistry and psychopharmacology. Recognizing that doctors are either too indoctrinated by pharmaceutical companies or too fearful to question today's standard of care, Healy cofounded www.Rxisk.org, a nonprofit website for consumers. The site provides data about prescription drug side effects for over 35,000 drug names. Patients can add their own reports of adverse effects and create a "Rxisk Report" to share with their health practitioners. Patients' reports are typically more detailed than MedWatch reports submitted by practitioners, so the website may eventually provide researchers with useful raw data.
Rxisk also intends to post research studies that drug companies want to hide. Pharmaceutical companies tend to bury studies that question a drug's effectiveness or safety. Easy access to positive and negative studies would give a more accurate picture of a medication's effects. Such information is useful to investors who want to avoid bad investments and to insurers that want to cut drug and hospital costs. With Rxisk.org, Healy and colleagues intend to challenge the pharmaceutical industry's control over mental health.
Levine BE. A Conversation with Robert Whitaker: the astonishing rise of mental illness in America. Counterpunch.org. April 28, 2010. Available at http://www.counterpunch.org/2010/04/28/the-astonishing-rise-of-mental-illness-in-america/. Accessed Oct 14, 2013
Straus T. Meet the doctor Big Pharma can't shut up. AlterNet.org.May 30, 2013. Available at www.alternet.org. Accessed July 5, 2013.
Mercury Amalgams and Neuropsychiatric Illness
For decades, the American Dental Association has asserted that mercury amalgam fillings pose minimal health risk. A new study involving general practice dentists contradicts this claim. Many general practice dentists in the US place and remove mercury amalgam fillings, exposing themselves and patients to mercury vapor. A 2012 study found that a larger percentage of general practice dentists take prescription medicine for psychiatric, neurologic, respiratory, and cardiovascular illness compared with an age- and gender-matched cohort.
Mercury is a potent neurotoxin. Several studies conducted in the 1980s showed that amalgam fillings continuously release low levels of mercury. Later studies revealed that dentists have a higher urine mercury level and mercury body burden than the general population.
In this new study, Thomas G. Duplinsky and Domenic V. Cicchetti criticize the quality of studies that reported greater life expectancy and better health in dentists compared with the general population. Many of these studies used subjective patient surveys or hospital chart reviews to assess health. To avoid such weaknesses, the two Yale University School of Medicine researchers obtained data from a pharmaceutical benefits manager (PBM) serving over 200,000 people living in the northeastern US. The PBM provided data on filled prescriptions, prescribed by a physician, for neuropsychological, neurological, cardiovascular, and respiratory illness for 396 general practice dentists (all male) and 708 age-matched male controls. (Dentists who self-prescribed were excluded from the study.) All subjects had the same prescription drug card and card restrictions. The two groups were subdivided into age groups: 25 to 34 years, 35 to 44 years, 45 to 54 years, and 55 to 64 years.
Duplinsky and Cicchetti hypothesized that dentists would be taking more prescription medication than controls and that prescription medication use would increase with age (as mercury damage would accumulate). In fact, general practice dentists were significantly more likely to be taking pharmaceuticals belonging to the targeted disease categories than controls. The greatest difference in use appeared in the neurological category. Only 6 of 708 men in the control group (0.8%) were taking drugs prescribed for neurological conditions such as epilepsy, Parkinson's, and migraine headaches. In comparison, 24 of 396 (6.1%) of dentists were taking the same type of drugs (p < 0.0001; relative risk 7.63). An additional 61 dentists (15.4%) were taking both neurologic and psychiatric drugs, compared with 39 controls (5.5%; p < 0.0001; relative risk 2.80). Also, more dentists were taking drugs for psychiatric disorders alone (depression and bipolar disorder), cardiovascular illness (ischemic heart disease, atrial fibrillation, and malignant hypertension), or asthma than those in the control group.
When comparing these five drugs categories (neuropsychological, neurologic, combined neuropsychological and neurological, respiratory, and cardiovascular) using the four age groupings, dentists used more of these prescription drugs in 16 of the 20 groupings. Controls, aged 25 to 34 years, had a slightly higher use of neuropsychological drugs alone and neuropsychological combined with neurological drugs, compared with dentists of the same age (1.0% vs. 0.00%). In the three older categories, however, more dentists than controls took neuropsychological and neurological drugs. Also, controls (25–34) and (35–44) took more cardiovascular drugs than dentists in the same age categories. However, more dentists in the two highest age groupings (45–54 and 55–64) bought medications for each of the five illness categories than controls did – a direct contradiction to the belief that dentists are healthier than the general population.
This study does not prove that mercury from amalgams causes neurological, neuropsychological, cardiovascular, and respiratory illness among general practice dentists. Duplinsky and Cicchetti offer this study as an example of how prescription data can be used in research. The study was published in the International Journal of Statistics in Medical Research, not in a dentistry journal. The authors suggest two avenues for further investigation. First, correlations between mercury exposure levels at dental offices, dentists' mercury body burden, and their disease incidence need to be examined. In addition, Duplinsky and Cicchetti would like to see comparisons of general practice dentists with specialty dentists who do not work with amalgams (e.g., orthodontists).
Duplinsky TG, Cicchetti DV. The health status of dentists exposed to mercury from silver amalgam tooth restorations. Int Jour Stat Med Research. 2012:1:1–15. Available at http://iaomt.org. Accessed July 9, 2013
Pharmaceutical-Induced Violent Behavior
Although the FDA has released warnings about suicide and suicide ideation in people using SSRI antidepressants, associations between pharmaceuticals and violence toward others have been virtually ignored. Thomas J. Moore, Joseph Glenmullen, and Curt D. Furberg decided to use the FDA Adverse Event Reporting System data to identify pharmaceuticals with a disproportionally high number of violent behavior reports. They searched the data bank for any drug with at least 200 serious adverse events reports from January 2004 through September 2009; 484 medications with a total of 780,169 adverse event reports met this criterion. Using the terms homicide, physical assault, physical abuse, homicidal ideation, and violence-related symptom, the authors identified 31 drugs in the group with a disproportionate association with violence. Moore and colleagues defined disproportionate as any drug having five or more violence case reports, at least twice the number of reports expected given the volume of overall reports for that drug, and a c2 statistic indicating that violence cases were unlikely to have occurred by chance (p < 0.01). These 31 drugs account for 1527 out of a total 1937 (79%) violence cases. Since few practitioners report violent thoughts or actions as a possible drug response, the actual incidence of violent acts/thoughts may be greatly understated.
The smoking cessation aid varenicline (Chantix) showed the greatest risk for violence. The proportion of violence cases for varenicline (drug violence events/all drug events) was 18 times greater than the proportion of violence events/all other drug events for the remaining 483 drugs combined. Varenicline has the highest number of reported violence cases (n = 408) and the highest c2 (5172 df = 1 p < 0.01). Fluoxetine (Prozac) and paroxetine (Paxil) were second and third with proportional reporting ratios of 10.9 and 10.3, respectively. In addition to these three, the other drugs associated with violence toward others include nine antidepressants, six sedative/hypnotics, and three attention deficit/hyperactivity disorder medications. As a group, antidepressant drugs had a higher risk of violent thoughts/actions than any other class of psychoactive drugs, including mood stabilizers/anticonvulsants, antipsychotics, and hypnotics/sedatives.
A 2011 case series article, written by Australians Yolande Lucire and Christopher Crotty, reviewed 10 of 129 patients who had committed homicide or serious violence while taking or withdrawing from antidepressants. All patients had been diagnosed with akathisia/serotonin toxicity (characterized by agitation) and had undergone testing for variant alleles in CYP450 genes (CYP2D6, CYP2C9, CYP2C19). All but 1 of the 10 patients had variant genes that inhibit the Phase 1 metabolism of antidepressants and other drugs. "Extrapyramidal side effects … including akathisia, may develop very fast in persons with slower CYP450 metabolism [and] in children whose cytochrome systems and other metabolic pathways were not yet fully developed or may have not yet been induced," the authors state.
Although genetic variants associated with inhibited drug metabolism may be one contributor to akathisia-related homicide, the authors explain that drug interactions are another. The patient without CYP450-inhibting variants was a normal metabolizer for the initially prescribed fluoxetine, but he was given valproate (800mg/day) in addition to a series of other psychoactive drugs (amitriptyline, venlafaxine). He shot two strangers while driving in his sleep. At that time, he was taking valproate, ciprofloxacin, a vitamin mixture containing serotonin (replacing venlafaxine on his own), and zolpidem (Ambien). Valproate inhibits CYP2C9, one of the enzymes that break down fluoxetine. Ciprofloxacin inhibits metabolism of zolpidem. Zolpidem interacts with venlafaxine (along with other serotonin-boosting drugs) to produce a buildup of serotonin. "Serotonin toxicity," the authors state, "is associated with violence." Other common CYP inhibiters include alcohol, cannabis, citalopram, escitalopram, estrogen, fluoxetine, fluvoxamine, nortriptyline, paroxetine, sertraline, and valerian. (The authors cite Clinical Manual of Drug Interaction Principles for Medical Practice by Wynn et al. as their resource.)
Lucire and Crotty state: " … prescribing antidepressants without knowing about CYP450 genotypes is like giving blood transfusions without matching for ABO groups. … it is essential that other drugs in the patient's drug regimen be understood in terms of interacting with CYP450 enzymes as substrates, inducers, or inhibitors."
Lucire Y, Crotty C. Antidepressant-induced akathisia-related homicides associated with diminishing mutations in metabolizing genes of the CYP450 family. Pharmacogenomics Pers Med. 2011:4;65–81. Available at www.dovepress.com/articles.php?article_id=7993. Accessed July 5, 2013.
Moore TJ, Glenmullen J, Furberg CD. Prescription drugs associated with reports of violence towards others. PLOS ONE. 2010:5(12); e15337. doi:10.1371/journal.pone.0015337. Available at www.plosone.org. Accessed July 5, 2013.
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