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.
Colorado Shooting Suspect Declares ‘I’m Guilty’ in Court
During the hearing, a pattern developed. As the lawyers discussed finer points of various motions, Mr. Dear seemed to wait for moments in which he could inject a comment based on a theme or a word that had come up.
The Hypomanic Entrepreneur
Successful entrepreneurs are not just braggarts. They are highly creative people who quickly generate a tremendous number of ideas — some clever, others ridiculous. Their “flight of ideas,” jumping from topic to topic in a rapid energized way, is a sign of hypomania.
.. He spoke so rapidly — jumping from topic to topic as if he were hyperlinking — that it was hard to keep up with him, and had so much energy he seemed constantly on the verge of jumping out of his skin. He bubbled over with irrepressible optimism.
And his brain! That’s what really set him apart. You could practically see the ideas bursting out of it, one after another, each more offbeat, more original, more promising than the last. The sheer profusion of ideas — and the way he got excited as he described them — was a large part of his charisma.
.. If a scientist wanted to design a giant petri dish with all the right nutrients to make hypomanic genius flourish, he would be hard-pressed to imagine a better natural experiment than America. A “nation of immigrants” represents a highly skewed and unusual “self-selected” population. Do men and women who risk everything to leap into a new world differ temperamentally from those who stay home? It would be surprising if they didn’t. “Immigrants are unusual people,” wrote James Jaspers in Restless Nation. Only one out of a hundred people emigrate, and they tend to be imbued “with special drive, ambition and talent.”
.. A small empirical literature suggests that there are elevated rates of manic-depressive disorder among immigrants, regardless of what country they are moving from or to. America, a nation of immigrants, has higher rates of mania than every other country studied (with the possible exception of New Zealand, which topped the United States in one study).
.. While we have no cross-cultural studies of hypomania, we can infer that we would find increased levels of hypomania among immigrant-rich nations like America, since mania and hypomania run together in the same families. Hypomanics are ideally suited by temperament to become immigrants. If you are an impulsive, optimistic, high-energy risk taker, you are more likely to undertake a project that requires a lot of energy, entails a lot of risk, and might seem daunting if you thought about it too much. America has drawn hypomanics like a magnet. This wide-open land with seemingly infinite horizons has been a giant Rorschach on which they could project their oversized fantasies of success, an irresistible attraction for restless, ambitious people feeling hemmed in by native lands with comparatively fewer opportunities.
Tales of the Super Survivors
.. Researchers have found that people who thrive after a shock are able to tell clear, forward-looking stories about themselves, while those who don’t thrive get stuck ruminating darkly about the past.
.. Viktor Frankl survived the Holocaust and concluded that those who could best survive the camps were those who could satisfy their hunger for lives of meaning. Even if they were suffering, they could direct their attention toward those they loved and those they would serve in their future lives.
.. Frankl, who went on to become a professor of neurology and psychiatry, cited Nietzsche’s dictum that he who has a why to live for can endure almost any how.
.. This is why foreign policies that pursue amoral realpolitik are always impractical. If a country can’t discern a moral purpose in its foreign policy, it will lack resilience.