Recently, I treated a patient struggling with depression and substance abuse who had found a legal way to get high.  He had ordered Kratom capsules on the Internet.  Lots of his friends have ordered up supplies, too. I hadn’t heard of Kratom, and you probably haven’t, either, but I think you will.  

It mimics some of the effects of opiates (like morphine and opium) and can relieve physical pain and produce a sense of increased well-being and increased energy. Depending on the dose taken and the way it is used (smoking versus chewing leaves versus drinking Kratom tea), it can cause anything from euphoria to sedation.

Kratom trees are native to Southeast Asia, including Thailand and Malaysia, but plants can be and are being grown in this country, as well. While Kratom may turn out to have medicinal uses in treating chronic pain, helping people detox from heroin and even in controlling anxiety and depression, very little is known about its real risks and benefits. It can certainly be addictive, especially for those who end up using Kratom on a daily basis.  Abruptly stopping it can lead to severe depression and severe anxiety.

With marijuana decriminalization potentially on the horizon across the country, I expect to see even more of the long-term effects of daily marijuana use in my psychiatric practice.  I have treated many patients who have lost motivation, succumbed to chronic depression and found it difficult to focus their attention after months or years of smoking marijuana. Kratom could be another “quick fix” that young people flock to in order to avoid their complicated emotions and the complex realities of the world in which we live.  

Only time will tell, but I can tell you this:  My patient didn’t limit his substance abuse to Kratom. He ended up using cocaine, too.  And Oxycontin.   Underneath it all, there’s an epidemic of anxiety and depression in our population. Ultimately, that epidemic will only be addressed through introspection, counseling and the judicious use of approved medications. Kratom, alcohol, marijuana and the rest of the quick fixes for unwieldy feelings are really only roads to my office and those of my colleagues.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement including www.livingthetruth.com. Dr. Ablow can be emailed at info@keithablow.com.

In early September, the Food and Drug Administration said it would release its first list of 20 drugs that are being investigated for possible side effects. The agency’s new policy of regular quarterly releases of drugs under investigation is the result of 2007 mandatory congressional legislation. There are potential pros as well as cons:

Pros:
* Public awareness may grow about drugs that are commonly misused. Oxycontin, a narcotic with a very high potential for overdose and addiction, was listed as being under investigation.
* The FDA is being held to a higher standard of disclosure, and this way the public can track its thinking and investigative processes rather than just being shocked by news reports of unpredicted black box warnings.
* Physicians may be more cautious to prescribe new treatments without considering potential side effects.

Cons:
* Patients may abruptly stop treatments that are working without checking with their physicians.
* The lists are cursory – they don’t include all drugs under investigation or complete information of the drugs being investigated. Statistics on deaths, hospitalizations,  or even numbers of reported side effects are not included.
* Knowing that a drug is being reviewed may create fear, and a public perception that is out of proportion to the actual risk. Tysabri is a very effective drug for the treatment of Multiple Sclerosis that is now being investigated for association with skin cancer. Cymbalta is a powerful anti-depressant that is being investigated for urinary complications. Public awareness of these ongoing investigations may severely limit patient willingness to take very effective treatments.

Suspicion of prescription drugs is the prevailing trend, despite the fact that many of these treatments are lifesaving. A case in point is Byetta, a diabetes drug that has been on the market since 2005 with close to a million patients benefitting from its biochemistry. Byetta is an incretin mimetic, which means it is a synthetic hormone which stimulates insuin secretion in response to meals. Not only is this often a smart treatment, and a good arrow to add to the medical quiver, but it also can cause weight loss, which in itself can help to improve glucose control in diabetics.   

But news reports of a rare death from pancreatitis (the rate of pancreatitis associated with Byetta is only one in 10,000 cases, and has not been proven as due to the Byetta) has led to public fears of the drug. The drugmaker, Amylin, has seen its stock drop 43 percent in the month since the FDA announced that it was considering a stern warning in response to the potential risk of pancreatitis.  

Warnings can be helpful. But fear of essential treatments can also be harmful.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News Medical Contributor and writes a health column for LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: the Truth About the Epidemic of Fear” and “Bird Flu: Everything You Need to Know About the Next Pandemic”. Read more at www.doctorsiegel.com

The late Heath Ledger’s performance as the Joker in the newest Batman saga, “The Dark Knight,” helped push the movie into the record books, with a first-weekend take of more than $155 million.

Critics and audiences agree that Ledger brought life to the Joker as no one has before, making a comic book character seem real. That’s good news for Warner Brothers, the studio that made the movie.

That is good news for the movie industry, in general. And it is touted as good news for the Ledger family—whose grief might be tempered with understandable pride for an actor whose gifts will likely now be compared with another great artist who died tragically — James Dean.

 There is one problem, however, with all of the excitement. Ledger didn’t do nearly as good a job in his real-life role as a boyfriend and father, it turns out, as he did as an actor. His death has been ruled an accidental overdose of the anti-anxiety agents Valium and Xanax, the sleep aids Restoril and Unisom, and the painkillers OxyContin and hydrocodone (the active ingredient in Vicodin). This accident took place in the setting of Heath reportedly abusing these drugs—kind of like crashing into a wall while driving 100 miles an hour.

We don’t know why. We don’t know the demons that inhabited the conscious and unconscious parts of Ledger’s mind. But those demons require real courage and character to face and overcome. You can’t act your way around them.

Whatever painful dramas roiled Ledger’s psyche, he wasn’t willing or able to insulate his little daughter Matilda Rose from the grief now written into her life story. And there will be no audiences to applaud her performance in dealing with the loss of a parent, no Academy Award for how well she plays the role of brave girl and young woman, no $155 million in tickets to her wedding without a dad to walk her down the aisle.

In real life, you have to own your own suffering and come to terms with it in order to win the awards really worth winning — real self-possession and self-esteem and the certain knowledge that you have brought the best of yourself to those you love.

The entertainment industry understandably wants to turn Heath Ledger’s death into a kind of heroic poetry, a journey through a hall of mirrors in which an actor with demons plays a villain with demons and is lost forever in the maze. But that poetry misses one critical fact: In his role as a father, Heath Ledger walked off stage a long time ago, leaving a little girl to cry tears of grief that not even a Joker’s palette of makeup could turn into a smile.

A DVD of her dad’s full-screen image, maybe one with a colleague tearfully accepting the Oscar for him, might be something she can hold onto – but it won’t be the same. She won’t have a dad to hug and to hold.

Dr. Keith Ablow is a psychiatry correspondent for FOX News Channel and a New York Times bestselling author. His newest book, “Living the Truth: Transform Your Life through the Power of Insight and Honesty” has launched a new self-help movement. Check out Dr. Ablow’s website at livingthetruth.com.