–by Vincent Shu, MD —
I am saddened anytime someone commits suicide, especially when this happens in our community.
A memorial celebration for one of our own was held last weekend. In San Juan County in 2016, we know about 19 suicide attempts resulting in six suicides. In 2017 there were 21 attempts and four suicides. Think about this ratio of about 4:1. It suggests that we have to identify and treat at least 4 individuals in order to save one life.
It is a very complex problem with many sides, but there are things that doctors can do to help. Our clinic integrates Eastern and Western medicine in this effort. As a local primary care physician just like other medical providers, our clinic can prescribe anti-psychotic/anti-depressants in collaboration with mental, behavioral health providers. Ironically, it should be stressed that antidepressants increase the risk compared to placebo of suicidal thinking and behavior in children, adolescents, and young adults in short-term studies of major depressive disorder (MDD) and other psychiatric disorders.
There has been a FDA-issued black box warning of suicidal ideation. Hence patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for signs of trouble, or unusual changes in behavior. Families and caregivers should be advised of the need for close observation and communication with the prescriber.
Furthermore, common side effects include trouble sleeping, nausea, sexual problems, and feeling tired which can jeopardize their quality of life. To reduce the adverse effects of antidepressants, our clinic recommends and provides acupuncture to achieve synergistic effects by maintaining the minimal and effective dosage of anti-depressants, which would translate into reducing side effects.
Acupuncture can stimulate and increase the production of our own body’s natural neurotransmitters that create the feeling of wellbeing. These natural chemicals are found in the central nervous system and plasma. Examples are enkephalin, epinephrine, endorphin, serotonin, norepinephrine, and dopamine (see reference at end of article). Acupuncture also stimulates the body’s natural anti-inflammatory compounds. In other words, acupuncture can facilitate the better usage of the body’s own natural chemistry, creating the potential for similar or sometimes better benefits than synthetic drugs, without the risks of addiction or side effects. Acupuncture can empower patients to help them get back on the path of well-being.
After sessions of acupuncture, I have seen that individuals may let go of their emotions in a way that she or he starts to cry in tears. Depression/anxiety are lessened over time after several acupuncture sections.
There are several protocols we implement in the clinic, such as Yang Ming-Jue Yin, Shao Yang-Shao Yin, and/or Shao Yang-Jue Yin protocols according to which meridian channels are involved as well as clinical symptoms and physical examination. The effect of acupuncture is cumulative so that many sessions of acupuncture may be required over a period of time.
Numerous researches continue to suggest a significant role for modifiable lifestyle factors and offer several avenues for improving brain health associated with depression, particularly nutrition. I offer home care visits and provide nutritional counseling. It is important to eat healthy food. This can make a difference.
While collaborating with mental healthcare providers, our clinic is willing to help out the individuals in need through this difficult time of their life. Knowing that they may have financial difficulties, they may be incapable of paying for acupuncture sections. If this is the case, the clinic will offer acupuncture sections for free.
In the meantime, our clinic institutes this fundraising letter. I urge you to help us in any way if you are able and assist us in this project. Our clinic is determined by Internal Revenue Service to be exempt from federal income tax under Internal Revenue Code Section 501(c)3. It is also classified as a public charity under the IRC section of 509(a)2 and registered as a charitable organization in the State of Washington. All donations over $75 will be sent a tax deductible receipt from our clinic (or by request).
Under these circumstances, if you would like to help by making donation, please write payable to Washington Institute of Natural Sciences and send it by mail in one of three ways:
1. Key Bank, P.O. Box 30 Eastsound, WA 98245, or
2. Sent directly to Washington Institute of Natural Sciences, 97 Yellow Brick Road, Eastsound, WA, 98245, or
3. Sent directly to Washington Institute of Natural Sciences, 685 Spring Street #158, Friday Harbor, WA 98250.
Our Board wishes to convey our heartfelt thanks to dedicated, caring donors (whether small or large) to help out this project.
If you have any questions or concerns, please feel free to contact Integrative Medicine Clinic at 360-376-2564 or e-mail donation@wins-medicine.org.
Dr Shu:
I don’t envy your having to broach this very difficult subject. While reading above I note how well and carefully you present your heart-felt message. Looking for root causes in your writing, I don’t envy your having to tread carefully and competently as you do. Your task is to first address saving a life. Helping one to covert “a life” into a more deeply fulfilling experience without judgment and comparison may be part of the secret preventative ingredients in addressing deeper root causes, but, again, when conditions are acute you do what you can as quickly as you can to save a life.
It’s almost as if you need a side-kick, someone whom you don’t know, to add some ingredients into this discussion from the proverbial peanut gallery so as to broaden it to include deeper root causes (that may exist in some instances (usually always, to be honest)).
As one who’s always had a natural penchant and almost necessary disposition for self-reflection as to why we do what we do, who has some advanced education, who’s in the daily continuous presence of very stressed-out human beings from all corners of the globe here in the truest of all urban jungles– coupled with continuous world travel principally in the East for the last 25 years– this person has observed the very natural tensions between what’s “nature” and what’s “nurture,” when discussing this subject and other matters going to the core of a person’s mental well-being.
If one has an acute or not so acute chemical imbalance that manifests itself into a mild or more severe form of depression, as clinically defined, conventional medicine moderated by a more holistic understanding of the entire person appears one of the best possible avenue of treatment (as you describe).
When the imbalance is caused by a mix of factors, including environment (“nature,” which I experience in client behavior daily), deeper discussion to get to the root of a person’s low self esteem, insecurity, lack of self-love or self-respect can likewise address the very fundamental assumptions this person makes to arrive at their rationale or self-belief system.
I’ll follow up with you in the near future and end by saying that I’m glad you’re on Orcas and look forward to supporting your efforts.
oops, second to last paragraph above in the parenthesis…”nurture” (not nature)…
As a triple board certified psychiatrist I am somewhat dismayed by the bias shown in this post. I appreciate the value of treatment that integrates allopathic and alternative medical approaches and endorse a combined approach is that is what the patient desires. But, all readers should note that while some antidepressants have been shown to increase suicidal thoughts in some people, the FDA and other researchers have repeatedly shown that this does NOT result in any increase in attempts at self harm. And, while any treatment (eg: medication, diet, psychotherapy, or acupuncture) has POTENTIAL side effects, most patients experience few if any and treatment drop out rates are thus quite low. More importantly, the use of antidepressants and proper mental health treatment can substantially lower the risk of suicide. I am not aware of any double-blind, randomized, prospective trials of acupuncture for suicidal thinking or attempts, or any head-to-head trial of acupuncture vs medication in moderate to severely depressed people and would welcome any such references the author can provide.
In short, if you have depression please seek out treatment immediately. Combined treatment (therapy/medication/acupuncture/diet/exercise/lifestyle changes/etc.) is likely to be the most efficacious, but I personally recommend starting with a good assessment by a well educated and qualified psychiatrist or psychologist.
Dr Kaye,
I can’t speak for Dr Shu, the author of this post, but when talking about an ego-centric, self-centered species (that’s us), traditional medicine does not operate from a framework that addresses the deeper elements of mental illness and imbalance.
It focuses on symptoms instead of causes. When cases are acute and past the point where greater self-awareness and humility are no longer able to timely correct imbalance, intervening medication is often the only choice; but it’s very unsatisfactory in that it focuses on damage control instead of preventing the damage in the first place. These are usually the cases where dysfunctional adults are raising their children to follow in their footsteps. How do you treat that in your line of work? Do you even acknowledge it as a problem, or is this normal from your lens? Can you even see the difference?
In fact, traditional medicine doesn’t have the lexicon to identify the root causes of a person’s much deeper disconnect. Most mental illness is not acute and remains undiagnosed not because of its non-existence, but due to traditional medicine’s inability to see what has not been taught in contrived and constructed labs called medical schools.
People in the medical profession are no more exempt from the violence caused by being self-centered and ego-centric than the rest of us. Perhaps one needs to more deeply understand the meaning of violence? Ya think? If you fail to see the human condition as problematic helped greatly through greater self-awareness then you simply lack the deeper human experience to see the gray between the black and white lines in your world. This is not teachable.
I don’t mean any disrespect but being a self-sentient being in a world populated by irrational belief systems IS problematic. To the extent this level of self-awareness is not part of your treatment, said treatment reinforces the deeper underlying causes of delusion and a cognizant disconnect from reality. But then I doubt a traditional approach can even make such a diagnosis much less treat it.
Just look around you. Irrational violence both verbal and physical, discord, varying levels of undiagnosed pathological behavior, etc….do you really think a pill or traditional medicine has the capacity much less the wherewithal to acknowledge and recognize the many existing social illnesses much less an ability to treat them? Acute conditions, yes. But the much greater violence caused daily by the cognizant disconnect of many otherwise “average people” is not even on your medical radar. In fact, the deeper serious issues of pathology and violent behavior the world over isn’t recognized by traditional medicine as problematic in any formal way much less addressed.
I could go deeper and deeper but suffice it to say that we will end talking past each other while mental illness, violence and the disconnect grow, not improve, despite the contrived traditional medicine that forgets it’s terminally incomplete and incapable of treating a whole person given that it’s simply a part of the greater whole and thus remains forever blind to the root causes it professes to address. Hence the need for some humility and out-of-the-maze thinking.
There are lenses that peer deeper through which once can see than those from a single compartmentalized field of study based on an Aristotelean model that was designed to aid humanity in the accumulation of a referential knowledge-based system– a system of always incomplete knowledge– so that human society could better organize itself, communicate and further develop. This model upon which Western education was built was never meant to represent complete knowledge or equip one for deeper levels of self-awareness.
Many inside society’s bubble have never realized that the world in which they live is truly contrived, forever without complete answers and requires a healthy dose of humility to cope, obtain greater clarity about the reality around them and then hopefully better reconcile and find their “human” condition within the “real” world. Hence, a more complete and reality-based path towards mental health; and this is path is by definition post formal education.
There comes a time when the training wheels come off and each person is to be encouraged to fly without the artifice if they wish to live in the real world able to see the construct built up around them, learn how to respect and appreciate it but more deeply understand that it is not the be all, end all of reality…that theirs are contrived beliefs. Who’s living in a fantasy world? Does this even compute?
Traditional medicine simply lacks the vocabulary, experience and framework to discuss these issues at a deeper level.
Again, I can’t speak for the author of this post but relax; there are other points of view and please remember that EVERY point of view is biased. A little humility, not a pill, is often more helpful for a better view of reality….a rare sight indeed for most who simply struggle to survive at the expense of clarity– and then we wonder why the world is as violent as it is.
Hi, Chris and Dr. Kaye: Thank you for your comments:
Randomized double blind placebo control (RDBPC) studies are considered the “gold standard” of epidemiologic studies. Is this model really gold standard? What are the problems associated with this model? I would like to share with you an example of well-known herbs, Ginkgo biloba to make my point.
Ginkgo biloba has been extensively studied in vitro, vivo, cell cultures and animal experiments with more than 2,500 research papers, most of which are consistently demonstrating neuroprotective properties in preventing dementia. However, when came to a clinical trial, The GEM ( Ginkgo biloba for the Evaluation of Memory ) study—the largest of its kind to date—was a randomized, double-blind, placebo-controlled clinical trial of 3,069 community-dwelling adults aged 72 to 96, conducted in multiple academic medical centers in the United States between 2000 and 2008. The median follow-up time was 6.1 years. Participants, who had normal cognition or mild cognitive impairment when they entered the study, received 120 mg of ginkgo or an identical-appearing placebo twice daily, and underwent a variety of cognitive tests over the course of the study. Ginkgo Evaluation of Memory (GEM) Study Fails To Show Benefit in Preventing Dementia in the Elderly (11/18/08), Why? What is the possible explanation for inconsistent results?
To understand this, we have to understand what inherent issues exist with ” placebo ” and ” randomization”. A placebo is an “inert” substitute for a treatment or intervention. “Inert” means the compound has no known activity that would be expected to affect the outcome. This is very fundamental assumption which I think is incorrect. I would explain to you why I say that.
There are several factors such as dietary habits, nutritional status, and inflammation can influence the genetics ( for example, methylation of DNA, modifications of histone proteins ) ultimately affecting cell signaling without alteration of the DNA sequence. This is what we refer to as epigenetic phenomenon. The presence of inter-individual variation among placebo and control in terms of epigenetic phenomenon which potentially affects clinical outcome may have been contributed to inconsistent results. The placebo is no longer a placebo affecting by other factors which haven’t been addressed. Placebo and control groups would be unlikely to have same dietary habits, nutritional status which may be potential compounding factors affecting outcome.
Furthermore, intrahepatic microsomal p450 enzyme system such as the cytochrome P450 isozymes CYP1A2, CYP2C9, CYP2E1 and CYP3A4/5 is never being addressed among placebo and control which can be potentially varied among placebo and control. For example, a subject in placebo may have a “ cold “, his PMD prescribes Ciprofloxacin which is a potent inhibitor of CYP1A2. Coadministration of drugs which depend on this pathway may lead to substantial increases in serum concentrations and adverse effects.
In other words, Randomized double blind placebo control (RDBPC) supposedly compares Apples to Apples. In true sense, it compares Apples to Oranges. How would you expect its “ conclusion” to be scientifically valid without bias? No, It can’t.
Perhaps, the appropriate model is “ single subject crossing over study “ which will eliminate all the compounding factors as stated above because we use the same subject as a control. Let me give you an example: Do you know how acupuncture was invented 3000 years ago? Just like us, our ancestors made a living by hunting. One day ( 3000 years ago ), our ancestor who suffered from severe migraine headache was riding a horse out for hunting. He threw up and fell out of his horse. His ankle sustained a strain from landing to the rock. And then, he said” Oh, My God, My headache is gone! “ This was how acupuncture was being invented because of a careful, thoughtful observation ( No genius was needed ). Do you think we need randomized double blind placebo control to prove that acupuncture was working dating back 3000 years ago?
Chris, your lengthy post is interesting but in no way on topic to the issue of does acupuncture work for depression or to prevent suicide. Serendipitously, this morning the respected Cochrane review group published this:
https://www.ncbi.nlm.nih.gov/pubmed/29502347?dopt=Abstract
I take no issue with your views about how people chose to view allopathic medicine or western approaches to life. We all have the right to live wherever we can afford and by a variety of different belief systems. But yes, I am a scientist in my core and I look for proof to support the approaches that I recommend.
One last thing, please don’t lump mental illness and violence together as that creates the false impression that they are in any way related, and there is no good evidence for such linkage. Violence is behavior, not mental illness. And I readily will claim that there is no pill to correct violence, but then again I haven’t seen any literature showing acupuncture does that either. Further, solving the societal problems of your concern is not the place of the medical profession. Perhaps society, or religion or politicians can handle that, but it’s certainly not in the medical wheelhouse.
Always a delight to chat with the thinkers on Orcas.
Thank you, Neil.
While not wholly convinced that doing so is justified, scientifically or otherwise, I tend to separate out mental illness based on chemistry, or even perhaps something as broad (and potentially misleading) as the phrase “genetic predisposition.”
Though, the deeper I drill down into the conversation I begin to see that the lines which govern our formal “professional” education begin to blur much like the quantum world fails to be accurately described by Newtonian physics.
A few decades ago a person would be laughed out of the room if they seriously suggested “thought” affected neruo-transmitters. Now, brain chemistry science shows otherwise.
As one who holds science in the highest regard, I eschew “conclusions” and prefer standing in a place best described as a “working hypothesis.” The better answer or better understanding is constantly in motion as perhaps it should be for a species which is in constant motion (evolution).
Above all else, this is why I’m hesitant about hardened definitions when it comes to mental illness or anything else for that matter. As I’ve suggested, much is neither seen through the lenses we wear, nor therefore fully understood (i.e., our understandings are relative).
I understand the fear and insecurity behind the instinct to gravitate towards finding a box into which we place our temporary understandings. Therefore, I respect definitions up to a point for pragmatic reasons; this is why you and I can have a conversation.
Nevertheless, words are representational tools; some would go further and describe our entire encyclopedic world of acquired knowledge as nothing more than self-referential, not I (and for reasons based on logic and science).
But when I stand outside the (choose your metaphor), I see and experience more clearly that what was assumed to be distinct and discrete is often but a part. Not dealing with acute situations of mental illness for a living grants me this flexibility; but does that alone invalidate the observation? Perhaps our journey is best approached as a collaborative one.
Some of us are less restrained in life and vocation and a bit freer to wander; yet we nonetheless respect the boundaries of reason and logic lest the quality of our understanding suffers and renders itself useless or worse still, misleading.
I, too, enjoy the quality minds found on Orcas, or those who gravitate towards it later in life. It’s impressive.
Neil, Chris : I would be more than delightful to chat with you when such time comes.
Hi, Neil & Chris: I would be more than delightful to chatting with you when such time comes in the near future.
Thank you, Dr Shu. Likewise.