#this song has fundamentally altered my brain chemistry

[weird-life-of-a-closet-fangirl]

I keep thinking about the line "the tomb won't close" from would've could've should've in relation to Lazarus from the bible. For Lazarus to come back to life, he had to be sealed in that tomb. He spent four days in that tomb, dead, before he was brought back to life. Taylor says "the tomb won't close" and asks "why won't it die" and I keep thinking about Lazarus, and how he had to die and his tomb had to be sealed before he was brought back to life, and how this tomb isn't closing, isn't sealing, isn't letting her come back to the world of the living. She's stuck in limbo, half dead and half alive, half damaged and half healed, and the tomb isn't closing.

#midnights #midnights 3 am version #taylor swift #would've could've should've #GOD REST MY SOUL I MISS WHO I USED TO BE #this song has fundamentally altered my brain chemistry #also lets not think too much about 'you're a crisis of my faith' and how lazarus was actually one of jesus' most faithful friends #and how it implies that he shook her faith so much that its disrupting her entire lazarus process #no healing through faith #in something #doesnt necessarily have to be religion #but she has no faith in anything that could help her heal because he shook her up so much #I COULD GO INTO DETAIL WITH ALL THE RELIGIOUS IMAGERY IN THIS SONG #but i wont i have a surgery due at 11:59

[aromanticannibal]

Hello I am once again asking you to listen to Feldup's new album (edit: ive made a rec post)

#I just listened to stared at from a distance the song (after waters which I had already listened to) and it has fundamentally altered my #brain chemistry #some info on the guy : he's french and also does YouTube videos on horror and internet horrific phenomenona but his music is in english #it's indie alternative rock for the most part #in stared at from a distance (the album) some songs are pretty long. I advise you to have lyrics under your eyes #his singing isn't for everyone but I personally love it #big tw warning for csa and sa in general in some of his songs because he's a survivor and sings about it. General warning for mental illnes #ig. don't listen when you're in a bad place I'm not even feeling that bad and started at from a distance (song) just killed me #he's really really really good and he deserves to have more fans of his music pls give it a try #if you don't want to bother with the full almums I'll make a rec list of my favorites from his two albums once I'm done listening #feldup #stared at from a distance #a thousand doors just one key #French artist #music recs

[malinaa]

TOP 9 BOOKS

tagged : @hmsharmony ty jennifer this was SOOO hard oh my god like. genuinely agonized me for days to think about what to choose but it was SOOO fun tho <3 tagging : @rosesau | @evcndiaz | @pendrgcn | @gayarthur | @the-tenth-arcanum | @oretsev | @wherepoetsdie | @bellamyblakru | @ryekat & anyone else who wants to do it !!! rules : list your top 9 books obviously. i cheated a little and put series as as one option because that's just who i am as a person. most of these i chose at random from my 5 star reads from the past few years btw

1. percy jackson and the olympians (series) by rick riordan

i was never a big reader in elementary school—or at least not to the extent that my classmates had been. my sixth grade english class required us to bring a personal book from home for silent reading and i stole my brother's spine-cracked copies of pjo and brought them to class. i finished the whole series in less than a school week (i had to scramble to the library to pick up another series because the single novel should have lasted me at least three weeks). pjo literally kickstarted my love for reading as a hobby and i truly don't know how to state the importance it had on my little ten-year-old brain fr

2. on earth we're briefly gorgeous by ocean vuong

i have never read a book more beautiful in prose and so uncommonly human than this. there's just something so incredibly heartbreaking knowing this whole book is the narrator's letter to his mother who can't read! like what the fuck

3. alone with you in the ether by olivie blake

this came as a surprise to Me when i first read it. i meandered through the first quarter, loving the writing style but feeling disconnected from the characters until the Church Hand Scene™ and it was hook, line, and sinker at that point (i have since come to love the disconnectedness in subsequent rereads, knowing that the feeling was the Point). i have read this book four (4) times since i read it first last year. LAST YEAR!!! olivie has like... fundamentally altered my brain chemistry or something because i feel like everything i have written since having read this book has been somewhat influenced by it.

4. much ado about nothing by william shakespeare

what can i say! this is theeeeeee romcom ever. i have watched so many adaptations of this play, read it countless of times and can recite some iconic lines, and still the banter between benedick and beatrice is sooo elite. cannot be topped!!

5. a place for us by fatima farheen mirza

fun fact: seed rec'd this book to me and has been reccing it to anybody who would listen. the prose is so lush and melancholic. it's one of those books where nothing Really happens, but you feel Every Emotion Under The Sun and you're just like. altered by reading it

6. the song of achilles by madeline miller

obviously.... OBVIOUSLYYYYYYY this had to go here. if i had two nickels for every greek myth retelling i read during school that fundamentally changed me etc etc u get it. i read this as a junior in high school when we, yet again, had to bring a personal book to read durin class. i think at that point of my life, i've never read something that tragic yet so beautiful at the same time and now i am always looking at the beautiful and tragic in media. so! there u go! brain cells rewired and whatnot!

7. the grisha trilogy by leigh bardugo

this is funny because i . technically did not rate any of these books 5 stars i'm sobbing. but like, considering the fact that my url is what it is and the way i always have them in the back of my mind, it's no wonder that i put them here. i have such an odd attachment to these books and these characters. i had copies of these books since their release but didn't touch them until ... before the sab tv release which is so fucking funny. like i don't know what i would be like if i read this as a t(w)een. i would've been so fucking insufferable ngl

8. when my brother was an aztec by natalie diaz

i actually read this for an assignment and had to write a report on it and i had SO much fun doing it. diaz plays a lot with hunger and her imagery is literally unmatched. i think about the way she contructs sentences and am filled with such envy. my beginning sentence for my paper was a nod to her style (though i failed miserably). it was: "in a paradoxical sleight of hand, hunger feeds in natalie diaz's debut." she is just. so fucking good at words i need to CHOMP on it

9. sharp objects by gillian flynn

you know the thing where you see a really popular author for a really long time and they have their work adapted to the screen and it's so good but you still haven't read their actual writing? yeah, that was me with gillian flynn (specifically about gone girl). i read gone girl, i read sharp objects, i read her short story the grownup, i'm currently reading the last novel of hers that i haven't read, dark places, and flynn is just so... incredibly good at constructing harrowing stories. it's no wonder why all three of her novels got adapted to the screen! her prose is so grounded. vivid. there's this ease to her writing that, whenever i concurrently read another novel, i always find the other piece to be lacking. i slink back to flynn's prose and immerse myself in her awful, human worlds.

#tag games #book recs #text #tais toi lys

[shitpostingkats]

QUICK TELL ME IN EXTREME DETAIL EVERYTHING YOU LIKE ABOUT EVERY YUGIOH PROTAGONIST

PROTAGS WHOSE SHOWS I HAVE SEEN:

Yugi: SHORT KING. He is very smol and he weighs ninety pounds soaking wet and he will KICK YOUR ASS like the worlds most high school aged chihuahua. Always the friend who offers to dm when everyone talks about starting a dnd campaign. Despite what canon has gone on to say, I choose to believe he maintained his King Of Games title while using his cutesy deck we see in the Yami v. Yugi fight. Doesn't wear heels to events (that was Yami's thing) and always takes time to talk to fans, even if they run up to him on the street.

Jaden: Altered my brain chemistry on a fundamental level. Depressed and queer and a failure, proving you don't have to be innocent to deserve innocence. Does not pay his taxes. The character for anyone who's ever felt monstrous, alien, foreign in their own skin, then breaking down that none of those things make you less human, less deserving of love. Reads comic books and will enthusiastically lend you 300 issues if you even casually mention you've been thinking of doing the same.

Yusei: My son. My boi. I can say so much on him that I haven't even touched on in my numerous essays rambling about this funky little mechanic. If the ygo shows tend to focus on forms of love that aren't romantic, then 5Ds is about familial love. Yusei is passionate and caring and a bleeding heart. The only shonen protag to ever get told by his mom "You're grounded." and say "Okay." and NOT go fight space gods until his mother gives him the go ahead. He's a revolutionary. He knows the trash collector by name. He's a planet. He's a star with gravitational pull strong enough to change the world. He's Just A Guy.

PROTAGS WHOSE SHOWS I HAVE NOT SEEN

Yuma: Bisexual colored hair. Continuing the proud yugioh tradition to be adhd af. I know he sleeps in a hammock so I'm gonna go ahead and call that he's the kid always rocking in place. Leg bouncer. Dyslexic and doesn't know it, just knows that words are easier to read when looking through the blue tinted screen of his weird visor thing. Possibly kills satan? Good for him. Watches telenovellas and gets overly invested in the plotlines. Would probably eat the popsicle stick because he thinks it's part of the experience. He is NOT stupid he is just a dumbass.

Yuya: Tomato head. Looks somehow exactly like three different people I worked with when I did theatre, right down to the googles perched on the forehead with mismatched lenses. I've seen arc-v's opening and idk why but I really like the animation of him slinging his jacket over his shoulder. Really wonderful gender. One of those kids that didn't know about heterosexuality until he was at least ten, then proceeded to be very upset and confused by the concept. The guy leading the rowdy table at waffle house at 10pm that will at some point burst into song and disturb every patron's night but their own.

Yusaku: The kid at the same waffle house just trying to order a coffee. Draws in the margins of his notebook. Skateboards. He does not like to talk about either of these things, but then one day you show him a video with like a million views of some guy inking a giant masterpiece, or doing a backside tailslide off a shipping container and he'll just casually go "Oh hey that's me." Desperately in need of a stim toy and a hug.

Yuga: Had a phase where he was obsessed with firefighters. Also likes to light things on fire. Is shocked everytime when the result of lighting a thing on fire is Thing: *Is On Fire*. I don't think he uses hair gel I think he just scrunches up his eyebrows and concentrates really hard and his hair just Does That. Really wants a dog. Shockingly good at math, favorite number is 25. All of his pencils have bite marks and the erasers are completely chewed off.

Yudias: Looks like a glaceon. It's really heartwarming to see yugioh continually get autistic representation right; a lot of stories don't include the fact that we carry swords and can fire lasers from our eyeballs. Every time I see him I want to hand him a wrapped sandwich, a babybel cheese, and a clementine. Would probably enjoy keeping plants on the windowsill. Every picture I see of him, he is either wondrously excited, or completely baffled, to find himself in the situation he is currently in.

#answered asks #yugioh #ygo #ygo dm #ygo gx #ygo 5ds #ygo zexal #ygo arc v #ygo vrains #ygo sevens #ygo go rush #yugioh dm #yugioh gx #yugioh 5ds #yugioh zexal #yugioh arc v #yugioh vrains #yugioh sevens #yugioh go rush #yugi muto #jaden yuki #judai yuki #yuki judai #yusei fudo #yuma tsukumo #yuya sakaki #yusaku fujiki #yuga ohdo #yudias velgear

[obiwanwhat]

9 people you'd like to know more

Thanks for tagging me, @stellanslashgeode

Last song: Casseopia by Layla

Currently reading: Thrawn Ascendancy: Chaos Rising. I was going to read the Thrawn books before the Ahsoka show came out but am only just finishing the first book now. I've seen people rave about the Thrawn books for years so it's been fun to see what all the fuss is about

Currently Watching: The new Ahsoka show!! I also just finished the latest season of Strange New Worlds. Oh, I guess I'm also in the middle of watching Carnival Row with some friends.

Next on my Watchlist: Not a lot of shows at the moment - at some point I need to watch season 3 of Picard. Movie wise, I still need to watch Everything Everywhere All At Once and Guardians of the Galaxy 3.

Current Obsessions: Ahsoka show brainrot is STRONG, I caught covid two weeks ago and i think being in isolation for the 10 days leading up to the show's release and not having anything to think about but the show fundamentally altered my brain chemistry lol.

I'm also getting deeper and deeper into the AU idea of "Luke and Ahsoka meet and don't get along" (see this post), I think Disney really missed so many opportunities for character development and just fascinating interactions between the two of them with the one scene we got of them together in BOBF. I also wanna spend some time exploring "Leia and Ahsoka meet and it's a little less sad because they don't have the same clashes over the Jedi thing but still ~complicated~" after I've beat the Ahsoka and Luke interactions to death. I'm starting to tag everything related to that as "#Nothing Can Ever Be Simple AU" if anyone wants to follow along!

Wolfwren is also starting to get my attention because holy shit that fight was so fucking gay. Like I've never seen a lightsaber fight with That Much Homoerotic tension holy shit. Not getting super into fic yet because I don't think we know enough about Shin's character yet (or even about how Sabine has changed and who she is now) for a romance to be believable or interesting, but I suspect I'll get there as the show goes on.

Tagging anyone who wants to do it!

#tag game #star wars #lilac accidentally talks personal #lilac accidentally talks writing

[tenjiiku]

do u have any movie / song recs atm 🥰?? i wanna be inspired to write like you do... but not in that sense if ykwim haha!! i just really love the way you write !! so im looking for inspiration,, if thats okay with u ofc ☝️

Heyyy lol ofcc I love talking abt media I love! Tbh I do not watch a lot of movies but I do have a lot of book recs some of which have movie adaptations.

Movies/Books;

The Hunger Games series, Suzanne Collins. Katniss and Peeta invented love and romance. I can go on about these two forever, but I will simply mention the beach scene b/t them in Catching Fire. That changed me fundamentally, altered my brain chemistry permanently, etc etc. Also of course the critique on capitalism in a Western society and how despite the violence such a system can breed Love will ever and remain forever as long as hope prevails.

Strange Weather in Tokyo, Hiromi Kawakami. I love dialogue, and this story has so much of it. And also I adore stories of the mundane. The fact that the protagonist is a woman in her late 30s brings such a refreshing perspective on the woes and joys of life. I read this book last Fall when it was a particularly rough time for me and I was going through a lot of changes. This really grounded my feelings.

Norwegian Wood, Haruki Murakami. I know Murakami gets a lot of shit for how he writes female characters but I adore the female characters in this novel, particularly Naoko and Midori. I love how he describes their emotions through dialogue. It is so cut and dry at times it hits straight to my gut. The conclusion and resolution left me thinking for months.

Flowers for Algernon, Daniel Keyes. Until recently I just discovered this was a required reading in a lot of American schools, which was a surprise because I thoroughly enjoyed reading this and quite frankly most of my assigned readings in school were not as interesting. I really really really enjoyed learning more about the character of Charlie through diary entries. And how his style of writing changes as he goes through so many trials and tribulations to only end up back to where he started. Really a think piece for me.

Snow Country, Yasunari Kawabata. I absolutely adored the imagery in this novel. It also left me thinking for days, and I still cannot articulate myself properly to describe it. Wonderful read.

Bones and All, Camille DeAngelis. I hold Maren so near and dear to my heart. The idea of using cannibalism as an allegory for coming-of-age brings such a unique and powerful perspective to girlhood, something I had been searching for in so many novels but never quite received. Maren and Lee’s relationship is both sweet and tragic. The movie is also wonderful.

All About Lily Chou Chou. I first watched this movie when I was 14 or 15, which I should not have done lol. Its subject matters are so dark, and I feel so badly for all the female characters in this movie. The message it sends is so simple, but the cinematography is both beautiful and haunting.

Artists/Songs;

Ethel Cain. By far my number one inspo lol. I do not use Spotify regularly besides to create playlists but I feel like she would be my number one listened to. I adore her ep Inbred, particularly the songs Michelle Pfeiffer and Crush. They are such yearning songs, and describe how I love so so personally. Of course, Preacher’s Daughter is a masterpiece of an album. Strangers and Family Tree are my favourites

Mitski. I honestly do not know how to express how much of an influence she has been on everything I produce. I’ve raved about her so much. Puberty 2 will always, always, always be the soundtrack to my highschool life lol it is honestly concerning how much I was listening to her in year 9. Bury me at makeout creek will always inspire me to write romance. It just gets me into the mood to both drown and create.

Gracie Abrams. I love the simplicity of her lyrics, and some of my works are written honestly based on one lyric that I might find out stuck out to me for many of her things. I find her music so universal and open to interpretation, and I love that! I think that it leaves a lot of room to think, it can apply to so many people and touch so many topics. I particularly love songs from the deluxe version of her album Good Riddance (405, Two People, Unsteady) I listened to Two People writing the hanshin expressway lol.

Beabadoobee. I love Beatrice, I have been listening to her for so long. I love how she is so expressive with all of her songs and genres and lyrics. Honestly, I love her entire discography. Like I do not think I do not have a song of hers I skip.

Japanese Breakfast. I love Michelle. Her songs all feel like warm hugs! And also some of them want to make me dance! I listened to her so much taking the train home back from uni when I needed a pick me up lol.

#inbox #I went kind of crazy here but I loveee consuming media and discussing abt it!!

[organabanana]

(if i can) light the world up || supercorp

Chapters: 1/?

Fandom: Supergirl (TV 2015)

Rating: Explicit

Warnings: None

Relationships: Kara Danvers/Lena Luthor, Alex Danvers/Kelly Olsen

Characters: Kara Danvers, Lena Luthor, Alex Danvers, Kelly Olsen, Andrea Rojas

Additional Tags: Alternate Universe - Soulmates, Soulmate Color AU, Canon Divergence, Friends to Lovers, Lena Luthor Doesn't Know Kara Danvers is Supergirl, mentions of past rojascorp, Rated for future chapters.

Summary: Lena Luthor sees the world in black and white. Like everyone else, she'll see colors for the first time when she meets her soulmate. And though she's not exactly convinced this system makes scientific sense, she's (mostly) made peace with it. When a fateful meeting with Supergirl makes her world burst into color, Lena is sure the amount of nonsense in her life has reached critical mass. But in just her first morning in National City, Lena manages to also be associated with a spacecraft explosion, and attract the journalistic attention of one Clark Kent and his sidekick, CatCo Magazine's Kara Danvers. And the worst part is, meeting Supergirl may have given Lena's world color, but she's sure it's Kara Danvers brightening it up. It's that 'all the world is in black and white until you meet your soulmate AU', with Supercorp.

Notes: Written for FlashFictionFridays prompt 'undiscovered colors' as a tiny oneshot, but the idea wouldn't leave my head so I decided to turn it into a Proper Fic. It's all outlined and planned but I'm not sure how many chapters it'll end up being in the end so I'm leaving that up in the air for now!

[Part 1 on AO3]

Lena Luthor sees the world in black and white.

It’s not a metaphor, mind you. She literally sees the world in black and white. There are shades of gray, of course, but that’s it. That’s all.

And she knows, because she’s been told countless times, that it’s normal. It’s simply the way the world works. From infancy, she’s heard all about it in fairy tales and movies, in songs and in books and in conversations around her: you get your colors when you meet your soulmate.

And it’s not that Lena doesn’t believe it. It’d be illogical not to at this point. This isn’t an elaborate lie thought up by adults to keep children on their best behavior, like Father Christmas and the Tooth Fairy. The whole world can’t be in on a lie. So it must be the truth. It’s just that it doesn’t make any sense.

How can meeting someone alter the way you perceive the world? And she doesn’t mean in the sense that the sun shines brighter and the birds chirp louder because you’re in love, or whatever nonsense people are trying to sell in Valentine’s Day cards these days.

No.

She means, how can meeting someone fundamentally alter the way your brain processes   the information from your optic nerves? It doesn’t make any sense.

So she’s been trying to cheat the system for years. Ever since she realized just how ridiculous this whole thing was when she had to console a heartbroken Andrea in their dorm room after their first kiss didn’t result in a chromatic explosion for either of them.

What’s a soulmate, anyway? What is a soul, even?

Lena may have never seen the color green, but she’s learned its wavelength is between 500 and 565 nanometers. She’s built glasses that can tell you exactly the colors you’re looking at, even if you can’t see them. She knows colors objectively exist even if she’s never seen one, so it’s not that she needs visual proof to believe in the existence of something.

Well, then. What’s a soul? What’s its wavelength? Where’s the chemical footprint it leaves on the brain? How can you have a soulmate if there’s no such thing as a soul?

How can your full perception of the world hinge upon meeting someone whose alleged connection to you is based upon something that may very well not even exist? How can something so important — the ability to fully see the world as it is — hinge on something as arbitrary as meeting your so-called soulmate?

(No, sixteen-year-old Andrea Rojas was not particularly comforted by this speech.)

So this has always been a sort of side project for Lena. Figuring out how to cheat this nonsensical system. Whatever happens when you meet your alleged soulmate, there has to be a way to boil it down to its bare essentials. We’re made up of organs made up of tissues made up of cells. It’s chemistry, all of it. And if it’s chemistry, she can figure it out.

But not today.

Today is a big day. It’s the day Luthor Corp becomes L-Corp, and that’s far more important than debunking this soulmate nonsense everyone keeps eating up. It’s her first day in National City, and she’s so excited — so nervous, deep down — that she’s walking to work instead of taking her usual car. She wants to feel the city around her. Feel how different it is from Metropolis and let herself have the true fresh start she very much needs.

She’s so focused on all that, in fact, that she may not be paying too much attention when she crosses a street. She hears the screeching of rubber on asphalt, a loud horn… and suddenly she’s safe and sound on the other side of the street.

“Wh—“ Lena’s heart races as she looks at the car speeding through the crossing where she was a split second ago, and tries to make sense of how she managed to apparently teleport to the safety of the sidewalk. “What—?”

“Are you all right?” A woman’s voice snaps Lena out of her daze. “You really should pay more attention!”

Lena looks up to see a bright wide smile and a set of blue eyes staring back at her, not an ounce of judgment in them even though—

Wait.

Blue eyes.

Lena blinks, eyes widening at the realization that the woman’s hair is golden blond as it shines under the sunlight. There’s the lightest pink on her cheeks, which Lena takes as the result of saving someone’s life, and she’s wearing—

Oh.

“Supergirl,” Lena breathes out, and she’s not sure whether she’s having more difficulty wrapping her mind around suddenly seeing color, suddenly meeting Supergirl, or both of those things happening at the same time.

“Are you sure you’re all right?” Supergirl looks slightly concerned. “You look like you’re about to pass out.”

“No!” Lena shakes her head. This is all a bit too much. Humans don’t have souls. Aliens likely don’t, either. Can Supergirl see colors, too? “No, I’m fine. I’m— thank you, Supergirl. I appreciate your help. Thanks.”

Supergirl doesn’t look too convinced, but she can’t ask any further questions before she hears something — she mutters something that sounds to Lena like ‘explosion’ — and flies away.

Lena wishes she could say she’s figured things out in the couple of hours between her near death experience and Clark Kent walking into her office with a young woman in tow, but she’d be lying.

There’s been an explosion, and she’s — of course — somehow linked to it via the never-ending source of issues that is her last name, and now Clark Kent is here to be an extremely unbiased reporter, she’s sure. With everything that’s going on, the last thing on her mind has been Supergirl and the colors she’s somehow brought into Lena’s life.

Mind you, she’s sure it’s all as simple as the force of being moved at superspeed having knocked something around in her nervous system and made a new connection somewhere. She’s sure she’ll figure it out as soon as she can focus on it for a moment. But right now she has far more important things in her mind.

Except.

If her theory is right, it was Supergirl’s superspeed making her see colors by accident. And if the generally accepted theory is right (but it is absolutely not), then it was meeting Supergirl, her soulmate (oh, good grief), what caused it.

So.

Why does meeting Kara Danvers, not-a-reporter-just-tagging-along, make every color around her suddenly more vibrant than before? Why has she just realized the green on the succulent by the window is not the exact same shade as the green on the folder on her desk?

Lena Luthor hates when things don’t make any sense.

#supercorp fanfic #supergirl fanfic #supercorp #supergirl fic #supercorp fic #fic

[bluewatsons]

Ronald W. Pies, Devil or Angel? The Role of Psychotropics Put In Perspective, Psych Central (March 3, 2008)

Back when I was growing up in the early 1960s, there was a popular song out by Bobby Vee, called “Devil or Angel”. I believe it contained lyrics along the lines of, “Dear, whichever you are, I need you.” The title of the song might also be a good summation of the way psychotropic drugs are portrayed in the popular press and other media. And, sad to say, even some of my colleagues in the mental health profession fall into one of two armed camps, when it comes to the role of medications for mood and behavior. This dichotomy parallels the schism described in Tanya Luhrmann’s influential study of psychiatry, aptly entitled, Of Two Minds. Very roughly, Luhrmann argued that the field of psychiatry is still divided between those who see mental illness as a psychological problem amenable to psychosocial therapies; and those who see it as a problem of abnormal brain chemistry, best treated by pharmacotherapy. Despite many attempts to bridge this conceptual chasm — Dr. George Engel’s “biopsychosocial model” is one example — the schism persists to this day.

And this is truly a shame. The “Angel or Devil” dichotomy does nobody any favors, and certainly does not help patients with serious emotional disturbances. In truth, the human brain is the crucible in which all the elements of our experience and sensation are transformed into thought, feeling, and action. We can affect the function and structure of the brain directly, by altering its chemical constituents; or we can affect its function and structure indirectly, by pouring helpful words into the ear of the patient. Speech, music, poetry, art, and a myriad of other “inputs” are all transduced into neuronal connections and electrochemical processes in the brain.

This does not mean that we ought to greet our patients by asking, “How are your serotonin molecules this morning, Mrs. Jones?” Part of our shared behavior as human beings is the use of language that speaks to our felt experience, not our neurons. But this does not mean that our experience is ultimately something over and above the workings of our brains. Moreover, far from being “cosmetic” in nature, many psychotropic medications work at the most fundamental level of the gene, actually increasing the production of nerve growth factors.

These are all reasons why we should not dismiss psychotropic medications out of hand. They are neither agents of the devil, as some extremist factions argue; nor are they angels of redemption, as one might conclude from the “rainbow and butterfly” ads put out by some pharmaceutical companies. Psychotropic medications, as I tell my patients, are neither a crutch nor a magic wand; they are a bridge between feeling bad and feeling better. The patient must still walk — sometimes painfully — across that bridge. This means doing the hard work of changing thoughts, feelings, and behaviors. Medications can often aid that process, and are sometimes needed to get the patient’s work in therapy moving. For example, some patients with very severe depression are so lethargic and cognitively impaired that they can’t fully engage in psychotherapy. After three or four weeks of antidepressant treatment, many of them are able to benefit from “talk therapy”, which then may provide long-term protection against depressive relapse. Some evidence suggests that initial antidepressant treatment can help “set up” the patient for subsequent long-term psychotherapy. As a recent review by Dr. Timothy J. Petersen [1] concluded,

“…sequential use of psychotherapy after induction of remission with acute antidepressant drug therapy may confer a better long-term prognosis in terms of preventing relapse or recurrence and, for some patients, may be a viable alternative to maintenance medication therapy.”

Other evidence indicates that talk therapy and medication work synergistically — one reinforcing the other. Medications may help more with “somatic” aspects of depression, such as impaired sleep and appetite; psychotherapy, more with cognitive aspects, such as guilt or hopelessness. Evidence from brain imaging studies suggest that each intervention may work through overlapping but somewhat different mechanisms: antidepressant medication seems to work “from the bottom up”, arousing lower brain centers associated with emotion. Psychotherapy appears to work from “the top down” by changing neural patterns in higher brain centers, such as the prefrontal cortex.

Given the huge literature on psychotropic medications, I am focusing on antidepressants in this essay — a diverse group of agents that has been the focus of tremendous controversy. In recent years, for example, questions have been raised regarding both the efficacy and safety of antidepressants. There is a voluminous literature on these topics, but here is my best professional synopsis. Antidepressants seem to “show their stuff” more robustly in cases of severe depression, but this may be partly an artifact of how most studies are designed and analyzed. For example, the most recent review from Kirsch and colleagues [2] suggests that in mild-to-moderate depression, antidepressants do not work better than a sugar pill (placebo). In very severe depression, Kirsch et al found, the newer antidepressants outperform placebo, though their benefits are not as robust as in earlier studies (1960s-70s) of the “old” tricyclic antidepressants.

However, we need to put these recent findings in perspective. Numerous posts on the internet have declared, based on the Kirsch et al study, that “Antidepressants Don’t Work!” But this is not what the study showed. Rather, it lumped together results from 47 antidepressant trials and found that the active drug showed a clinically significant “separation” from placebo only in the most severe cases of depression. This is actually much better than finding that antidepressants work only for very mild depression! That said, the Kirsch study attributed the apparent benefit of antidepressants in the most severely ill patients to reduced responsiveness to placebo rather than to increased effectiveness of the drug.

There are a number of problems with the Kirsch study, many of which are nicely discussed in Dr. Grohol’s recent blog (2/26/08) on this website. For one thing, the entire Kirsch study turns on whether a 2-point improvement in a single depression rating scale (the Hamilton Rating Scale for Depression, or HAM-D) amounts to a “clinically significant” (not just statistically significant) change. That is, of course, a matter of judgment. Second, the Kirsch study looked only at antidepressant trials in the FDA data base done prior to 1999; an analysis of more recent trials might have produced different results. Third, the kind of “number crunching” that goes on in any meta-analysis (basically, a study of studies) can obscure not only individual differences, but also subgroup differences. That is, a given patient with certain depressive symptoms—or a subgroup with certain features—may do quite well on an antidepressant, but the results are “submerged” in the overall mediocre success rate in the study as a whole.

There are many other reasons why studies of antidepressants may be yielding less than spectacular results in more recent decades, and the interested reader can find details in an editorial by Kobak and colleagues, in the February 2007 Journal of Clinical Psychopharmacology. These authors point out, among other things, that if the interviews producing HAM-D depression scores are not performed skillfully, the results of the study may be distorted. Kobak and colleagues pointed to several instances in which poor interviewing technique led to outcomes showing little difference between the antidepressant and placebo; conversely, good interviewing technique led to a more robust improvement rate (“effect size”) for the antidepressant. It is not clear how many such “junk interview” studies were included in the Kirsch et al meta-analysis.

Part of the relatively weak showing of antidepressants in recent studies (compared with those done in the 1960s and 70s) may be due to the increasingly “good show” put on by the placebos. What might account for this? My colleague David Osser MD, Associate Professor of Psychiatry at Harvard Medical School, observes that placebo response rates have actually been rising in recent years, as confirmed by Dr. B. Timothy Walsh and colleagues (JAMA Vol. 287 No. 14, April 10, 2002 ). Dr. Osser thinks it likely that this “placebo inflation” is due, in part, to recruitment of less severely ill subjects for study. The less ill the subjects, the more likely a “sugar pill” is going to work for them. Dr. Osser points out (as suggested by Walsh et al) that subjects in modern studies are often recruited from ads in magazines, rather than from samples of “real” patients, who are often much sicker.

There is a larger point to be made about the kind of analysis Kirsch et al have done. Basically, it involved crunching numbers on trials in which, usually, a single antidepressant was tested over a period of a few weeks. But when psychiatrists use a “full court press” and treat depressed patients over many months, using various combination and augmentation strategies, we often see better results with medication. For example, a recent series of carefully-controlled, multi-stage studies known as STAR*D, sponsored by the National Institute of Mental Health, looked at remission rates in patients with resistant major depression. These patients had gone through several levels of intensive antidepressant treatment, without full recovery. After the fourth and final “hoop” was jumped through, the cumulative rate of remission (few or no symptoms) was about 67% [3]. The nature of the STAR-D study precluded use of a placebo group. However, the cumulative remission rate of 67% is certainly much higher than generally reported rates of remission with placebo, which average around 30%.

To be sure, non-specific interventions, such as talking to a friend, taking up a hobby, joining a club, etc. might work as well as an antidepressant for many patients with mild depressive symptoms. (Many individuals with “normal sadness”, of course, will feel better simply by waiting a few weeks). But for those with the most severe types of depression — and certainly for those with psychotic depression — medication is often required, at least in the early stages of treatment. Patients with depression due to bipolar disorder (“manic-depressive illness”) will require special treatment using a “mood stabilizer”, and may actually become agitated or manic if treated with an antidepressant. It is critically important that the patient with depression is carefully evaluated to rule out a bipolar disorder [4].

With regard to safety, there is probably a very small subgroup of depressed patients who will worsen with an antidepressant. Data from the U.S. Food & Drug Administration (FDA) suggest that a small minority of children and adolescents may develop suicidal thoughts or behaviors (“suicidality”) when treated in the short-term with an antidepressant. About 4 in 100 taking an antidepressant may develop these thoughts or behaviors, versus about 2 in 100 taking a placebo [5]. No actual suicides occurred, in the studies reviewed by the FDA.

Indeed, other lines of evidence from other countries call into question the association between antidepressants and suicidal behavior. For example, several studies from the Netherlands and other European countries suggest that as prescriptions for serotonergic antidpressants (“SSRIs”, such as Prozac and Zoloft) declined from 1998-2005, suicide rates actually rose in children and adolescents. Conversely, increased prescription of SSRIs is associated with decreased suicide rates in several European countries [6]. Moreover, results of a comprehensive review of pediatric trials conducted between 1988 and 2006 suggest that the benefits of antidepressant medications greatly outweigh their risks to children and adolescents with major depression and anxiety disorders [7]. Another study of over 226,000 depressed veterans found that SSRIs actually had a protective effect against suicide attempts, in all adult age groups [8].

In my own experience over the past 25 years, antidepressant treatment — usually in combination with talk therapy — may literally be life-saving for seriously depressed adult patients. I have also found that in many cases of “paradoxical” or adverse reactions to antidepressants, the patient actually suffers from an undiagnosed bipolar disorder. Although the use of antidepressants in bipolar disorder is controversial, I try to avoid it whenever possible.

So– “devil or angel”? Asking this of psychotropic medication is a bit like asking, “Will fire burn down my house, or will it warm it in the winter?” In this piece, I have focused almost entirely on antidepressant medication. If I were to go on at even greater length — discussing mood stabilizers, antipsychotics, and anti-anxiety agents — we would see that pharmacotherapy is neither devil nor angel. It is merely one instrument in service of helping the patient. As such, it may do good or ill, depending on the skill of the physician, the constitution of the patient, and the nature of the illness. Medication may be over-sold and “hyped”, as it is by many in the pharmaceutical industry; or it may be vilified and disparaged, as it has been by some vociferous anti-psychiatry groups in this country. In the end, as physician and educator Alfred Stille (1813-1900) observed: “It is quite as necessary for the physician to know when to abstain from the use of medicine as it is…[to know] when medication is necessary…”

References

Petersen TJ: Enhancing the efficacy of antidepressants with psychotherapy Journal of Psychopharmacology, Vol. 20, No. 3 suppl, 19-28 (2006)

Kirsch I, Deacon BJ, Huedo-Medina TB et al: Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration. PLoS Medicine. Accessed at:

Rush AJ, Trivedi MH, Wisniewski SR et al: Acute and longer-term outcomes in depressed outpatients requiring one or several treatment setps: a STAR*D report. Am J Psychiatry 2006;163:1905-17.

Ghaemi, SN, Miller CJ, Berv DA, Klugman J, Rosenquist KJ, Pies R: Sensitivity and Specificity of a New Bipolar Spectrum Diagnostic Scale. Journal of Affective Disorders 2005; 84:273-77.

URL

Gibbons RD, Brown CH, Hur K et al: Early Evidence on the Effects of Regulators’ Suicidality Warnings on SSRI Prescriptions and Suicide in Children and Adolescents. Am J Psychiatry 2007; 164:1356-1363.

Bridge JA, Iyengar S, Salary CB et al: Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. 2007; 297:1683-96.

Gibbons RD, Brown CH, Hur K et al: Relationship between antidepressants and suicide attempts: an analysis of the Veterans Health Administration Data Sets. Am J Psychiatry 2007;164:1044-49.

#medicine #psychiatry #controversy #competing paradigms #debate #healthcare #psychopharmacology #STAR*D #SSRIs #psychotropic medications

[capedcruzadormusic-blog]

Remember All The Above, Till I Collapse

Why is it that people have become so infatuated with music?  Let’s be clear, we enjoy listening to music, but no one actually listens to music for the sole purpose of listening to music. We rather listen to music for the many feelings it evokes. We listen to feel and to escape for a moment. This is similar to the reasons we enjoy exercising, so it only makes sense, that the two would become the perfect marriage. According to,a study conducted by Stanford shows that listening to music increases the ability to focus and improves cognitive brain function just as exercising does. So how do we decide to facilitate this marriage?

As individual’s overall preferences differ, so do their tastes in music, so naturally everyone will have a very different “gym playlist.” I personally prefer something upbeat and up-tempo, something that really puts me in the zone while pumping iron. My preferred song to start a workout, or for doing anything for that matter, would be something like “Ooh Ahh” by The Grits off of their 2007 Greatest Hits album. The song's elusive message of getting back up after being knocked down would motivate anyone to power through a tough workout. It’s a song that anyone can relate to, illustrating the “highs and lows,” fundamental characteristics of life. The beat alone provides an adrenaline rush that forces anybody to focus on the task at hand, not wanting to stop. The tempo forces you to work harder and faster to put up those last few reps to the sounds of “Ooh Ahh!”

To follow up such an energetic song, the ideal song would be something of the very same nature. “All the Above” by artist Mano, featuring T-Pain would fit these criteria perfectly. This one hit wonder from the 2009 album “If Tomorrow Comes,” does all it needs,to inspire an individual during the struggle of strenuous exercise.Mano's lyrics, “Tell me what do you see when you’re looking at me, see me coming from nothing, to me living my dreams” brings about a sense of resilience and gains an individual that same sense of freedom experienced after hitting rock bottom,to realizing triumph.Subliminally, it makes you feel that if he can do it, then you can too, even though you’re just exercising.

As fatigue becomes all too much to handle, “you just feel tired, feel weak, and when you feel weak, you feel like you just want to give up.” One of the greatest songs to propel you through, to retrain that focus and to revitalize that can-do mentality is Eminem’s “Till I Collapse” featuring Nate Dogg off of his 2002 album, curtain call. This song is so intense that it was the theme song to the movie “Real Steel,” a 2002 movie about boxing robots! Marshall’s hard hitting bars sends anger and frustration radiating through your body; that last rep does not stand a chance! This track, with its extremely edgy beat, ensures that until your legs give out, you “will not fall,” you “will stand tall.”

If there is anything left at all or you are just running on pure heart, the most prolific song on anyone’s playlist will undoubtedly be Fort Minor’s “Remember the Name” 2005’s “The Rising Tied.” This song needs no explanation; the lyrics speak for themselves. With David Campbell on the strings, the cellist in the background, and Linkin Park’s Mike Shinoda on the keyboard, the chemistry is magical. So do you want your name remembered? Fort Minor assures that this will happen.

When Fort Minor plays their final note, and the sweat settles, it’s time to relax and recuperate to the sound of Starset’s “Let it Die” off of their “Transmissions” album released in 2014. It’s not the vocals, but the smooth, soothing melody that makes you feel like you have just conquered the world. The aw-inspiring sense of accomplishment that takes over your very being is unbeatable. The lyrics “I’ve been looking for a way to bring you back to life,” seem all too real at this point as you gasp for air.

Music has the ability to make the mortal immortal. It can give people herculean strength or manipulate their subconscious into making them feel the way it wants them to feel We listen to influence these moods, to alter reality if only for a moment.

#“Ooh Ahh” #The Grits #All the Above #Mano #Eminem #Till I Collapse #Nate Dogg #Real Steel #The Rising Tied #Remember the Name #Fort Minor #Mike Shinoda #David Campbell #Starset #Let it Die #Transmissions