Since 2005, the suicide rate among U.S. war veterans has nearly doubled; in the first half of 2012, more service members died by suicide than in combat.
.. The chief downside of these drugs, called monoamine oxidase inhibitors (MAOIs), is that they require a strict diet: no aged cheeses, wine, beer, or cured meats. Combined with these foods, the drugs can cause deadly spikes in blood pressure, a hassle that often inclines patients to ditch them. (The novelist David Foster Wallace took an MAOI for decades; in part to escape the food restrictions, he got off the drug months before his suicide.) On the other hand, tricyclic antidepressants, like imipramine, work by blocking the re-absorption of serotonin and norepinephrine.
.. All of these changes increase the number of glutamate ships left in the synapse, flooding the cell with aberrant signals. Indeed, depressed people’s brains, or at least animal models of depression, show all three of these problems, leading to long-lasting excesses of glutamate in key portions of the brain.
This superabundance of glutamate makes a neuron fire sooner than it should and triggers a cascade of signals inside the cell, damaging its structure.
.. This harmful process, called excitotoxicity, is thought to be involved in bipolar disorder, depression, epilepsy, and neurodegenerative diseases like Alzheimer’s, Huntington’s, and Parkinson’s.
.. The human brain’s flexibility allows regeneration, but also renders it vulnerable to being altered by stress. Subjected to the trauma of war, a bad breakup, or a bout of homelessness, a person with a genetic predisposition may find his mind stuck in a loop of chronic fear or depression.
.. Ketamine also works for bipolar people in depressive phases, without triggering mania, as classic antidepressants sometimes do. The majority of depressed people studied have responded to ketamine. For patients who are often suicidal, this fast response can be lifesaving. Some 50 doctors in the U.S. now offer ketamine infusions for depression.
.. Today ketamine is offered by psychiatrists and anesthesiologists, at prices ranging from $300 to $1,000 per dose, for people who are morbidly depressed or have chronic pain. Insurance doesn’t usually cover the cost of an infusion, because even though it is FDA approved as an anesthetic, it has not been approved as an antidepressant. Each new use of a drug requires multiphase clinical trials for FDA approval, usually funded by pharmaceutical companies, which have little incentive to invest in a drug they can’t monetize. Ketamine got its original patent in 1966, and that expired long ago. So even if drug companies steered ketamine through the expensive approval process as an antidepressant, doctors could still prescribe the cheap, generic versions already available for anesthesia instead of pricier, patented versions intended for depression. This is an old story. Lithium carbonate, which also acts on glutamate receptors, is still one of the most reliable drugs for treating bipolar disorder. But lithium, which is an element, can’t be patented. So, despite their effectiveness, these generic pills do not attract many corporate dollars.
Mary Karr: Paris Review Interview
The following day, on our way to the airport, Karr drove me past the house David Foster Wallace once rented in Syracuse. Wallace and Karr were involved for a time; he proposed to her and had her name tattooed on his arm.
.. She is a controversial figure in the poetry establishment for her Pushcart Prize–winning 1991 essay, “Against Decoration,” in which she lamented the shift toward neoformalism in contemporary poetry: “the highbrow doily-making that passes for art today.” Karr argued that this sort of poetry—allusive, impersonal, obscure—had “ceased to perform its primary function,” which was to “move the reader.” And she named names.
How “The End of the Tour” Nails an Entire Profession
Whether Eisenberg is thumbing the dog-eared book of his interview subject, interleaved with Post-its, on the airplane ride to their first rendezvous; or striding through the bleak parking garage with a hold-all slung over a slumped shoulder and a rental-car key in his hand; or apologizing for pressing the on-button of his hand-held cassette recorder within moments of crossing his subject’s threshold; or ingratiatingly reassuring the subject that his answers don’t sound stupid, not at all; or nervously deflecting questions about himself with jokes about just who is interviewing whom, his delivery of the tropes and gestures of the profile-writing reporter is pitch perfect
.. The pair have internalized the argument of Janet Malcolm’s classic essay “The Journalist and the Murderer” (published in The New Yorker in 1989 and in book form a year later), which analyzes the journalist-subject interaction as a drama of seduction and betrayal. In 1996, the year in which the movie is set, there was not a single magazine journalist at work in New York City who had not read Malcolm’s essay; most of them could approximately quote its opening sentence, which reads, “Every journalist who is not too stupid or too full of himself to notice what is going on knows that what he does is morally indefensible.”
David Foster Wallace: The ‘Fresh Air’ Interview
In 2008, at the age of 46, he hanged himself. Looking back on his work, New York Times book critic Michiko Kakutani described Wallace as having used his prodigious gifts as a writer, his manic, exuberant prose, his ferocious powers of observation, his ability to fuse avant-garde techniques with old-fashioned moral seriousness, to create a series of strobe-lit portraits of a millennial America, overdosing on the drugs of entertainment and self-gratification.