Mental Health News Updates – October ’22

Adderall Shortage

The FDA has confirmed an Adderall shortage, and people are directed to contact their mental health professionals if they are affected. So what do we need to know?

Neuroscientist and founding CEO of SyneuRx Guochuan Emil Tsai, MD, Ph.D., notes that Adderall is currently being prescribed more than ever. According to Bloomberg reporting, amphetamine sales surged more in the second quarter of 2021 than in nearly a decade. And when demand increases while supply stays the same, we're left with a shortage.

Dr. Tsai discussed possible factors that could explain the unprecedented surge of ADHD diagnoses during the pandemic.

He mentions social media as one potential factor in the surge, as more people are being exposed to the symptoms of ADHD via Instagram and TikTok and then reaching out to their primary care provider for medication. Another possible reason for the increased prescribing of Adderall could be the rise of online mental health care start-ups.

One such telehealth service, Cerebral Inc., is now under investigation by the U.S. Department of Justice for its prescription practices of substances like Adderall and Xanax.
The service, which offers therapy and counseling for numerous mental health conditions and medications for those conditions, has since paused all prescriptions for new users. But in just two years, Cerebral has already registered more than 200,000 patients.

Former employees of Cerebral allege that the company prioritized profits over patient safety by overprescribing medications, providing little to no counseling, and targeting new customers with misleading social media ads. This level of wrongdoing may be unique to one company, but it's representative of a lack of adequate care when it comes to mental health—especially for those who are most vulnerable.

So, suppose you have a client who cannot obtain their regularly prescribed Adderall. In that case, they might experience withdrawal symptoms such as mental and physical exhaustion and feelings of depression within several hours of the last dosages and continue for up to 2 days. Experts also recommend drinking plenty of fluids, eating healthy meals, exercising, and giving yourself time to rest and recuperate if you're experiencing withdrawal symptoms. Over-the-counter painkillers and sleep aids can also provide some relief.

Additionally, you should offer alternatives in symptom management and look into additional support at school, work, and home. The National Center for Complementary and Integrative Health evaluates the evidence of integrative approaches for ADHD, including Omega 3 Fatty Acids and melatonin for sleep disturbances. James Lake, the integrative psychiatrist, includes zinc, iron, Pinus marinus (French maritime pine bark), and a Chinese herbal formula (Ningdong).

I would also recommend assessing and discussing with your client the dangers of purchasing Adderall without a prescription, specifically the distribution of fake pills that include fentanyl which can be highly deadly.

Sources: Verywell mind, NCCIH, and James Lake, MD.

988 Update

The 988 Suicide & Crisis Lifeline (formerly known as the National Suicide Prevention Lifeline) went live July 16th of 2022 and offers 24/7 call, text, and chat access to trained crisis counselors who can help people experiencing suicidal, substance use and mental health crisis, or any other kind of emotional distress. People can also dial 988 if they are worried about a loved one who may need crisis support.

New data released Friday by the U.S. Department of Health and Human Services show that in August – the first month that 988 was operational — the Lifeline saw a 45% increase in the overall volume of calls, texts, and chats compared to August 2021.

But, while 988 is undoubtedly helping more people overall, we don't know yet how the system is faring in individual states, says psychologist Ben Miller, a mental health policy advocate. The newly released data doesn't have a state-by-state breakdown.

"There's going to be massive disparities across the states," he says.
While the 988 Lifeline is accessible nationally, with a national network of call centers, it essentially functions as a state-run system. And states vary vastly in how much they have invested in the former 10-digit Lifeline and associated services. According to a recent National Institute of Mental Illness analysis, very few states have passed legislation to supplement the current federal funds into 988.

There have also been warnings regarding dialing 988, notably from social media users. Many people are cautioning people from calling the hotline due to the possibility of involuntary hospitalizations and the possibility of police interactions, which can be dangerous as 1 in 5 police shootings involve an individual with mental illness.

Emily Krebs, a suicide researcher and assistant professor joining Fordham University this fall, said that involuntary treatment is viewed as a necessary part of suicide prevention in the U.S. but that other countries don't see it that way. The United Nations has called forced mental health treatment a human rights abuse and asked countries to ban it.

Officials from 988 say they recognize the risks of having law enforcement officers involved in mental health emergencies. That's why 988 was created as an alternative to 911, said John Draper, executive director of the hotline and a vice president at Vibrant Emotional Health, the company tasked with administering it.

988 does not have geolocation (like 911). However, crisis counselors can use the client's area code to find local resources. In cases where the caller cannot or will not collaborate on a safety plan, and the caller and counselor determine the client will harm themselves, emergency services could be contacted and attempt to locate the caller and send first responders. Data from previous years shows that of the 2.4 million calls per year, about 2% of interactions resulted in emergency dispatch.

Mental health professionals can discuss with their clients whether calling 988 works for them. There are alternatives, such as “warm” lines staffed by “peers” who have experienced mental health challenges. Other options include Blackline, a hotline geared towards Black, Black LGBTQ+, brown, Native, and Muslim communities, the trans lifeline for trans and questioning individuals, and other local peer-led support groups.

Sources NPR, SAMHSA