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Show A6 Monday, April 7, 2008 DAILY HERALD the drugs. , Circumstances in a person's life, such as relationship or work problems, can play a role in how they react to medications, Peterson said For example, Ragsdale and his wife, Kristy, were estranged and she had filed for divorce. And a patient's condition before he starts taking medication can also affect how he reacts to the drugs. "With relationship problems, people can quickly change from one emotional state to another When peppleare going through a divorce it's extremely hard for people to handle emotionally," Paulson said, t "There are a lot of different variables in these types of situ-- ; ations and negative outcomes often cannot be simplified to a complication with medication Ragsdale Continued from Al Two of those drugs, Paxil and Ritalin, are fairly well known, while the others arent quite household names. But - ' how much do people know about any of the medications Ragsdale was taking? What they're for I Paxil and Doxepine: Both are antidepressants that are primarily prescribed to treat depression and anxiety disor- ders, though they have other uses as welL According to Dr. Bernard Grosser, a psychiatry professor at the University of Utah and former chairman of the department, Doxepine can also be used to treat stomach disorders. Dr. Joseph Yau, the medical director of Valley Mental Health in Salt Lake City, said Paxil is sometimes . prescribed to treat obsessive-compulsidisorders. Scott Peterson, a nurse at the office of , Dr. Philip Washburn, a Salem psychiatrist, said Doxepine is an older generation antidepressant, which is more commonly prescribed as a sleep aid today. Ritalin and Provigil: Of all the drugs named in the Ragsn dale case, the most was probably Ritalin, which is commonly prescribed to treat attention deficit disorder and attention deficit hyperactivity disorder in children and sometimes in adults. Provigil is often used to treat narcolepsy, a condition in which patients are excessively sleepy and may suddenly fall asleep during the day. Both Ritalin and Provigil can act as stimulants. Grosser said some studies have shown that Provigil can help people stay awake in general, though it hasn't been approved for that by the Food and Drug Administration. Grosser described it use." as an "off-labI Testosterone: This is not a psychiatric medication in the same sense that the other four enhance their effects el antidepressants to ' , alone." ve well-know- MARIO RUIZDaily Herald , Alerting agents, such as Ritalin or Provigil, are sometimes prescribed with ; drugs are, but it canbeused in the context of disorders such as depression. Patients with depression sometimes have levels of testosterone in their bodies, Grosser said, and they may take medications to replenish those testosterone levels. Testosterone has been known in some cases to cause aggressive behavior. The drug is a steroid, Peterson said, and people who are on high doses, such as some athletes, sometimes display a lot of aggression or anger. The doses prescribed by doctors, however, are much lower than those used by athletes. "If he had testosterone levels done, blood levels, and it was shown to be low, then that could've been used as a means of getting his testosterone level up," Grosser said. "It certainly has been reported that people who are depressed can have ; lower testosterone levels. But the question is which came first?" ; Many of these drugs can be prescribed individually for specific disorders, but in combination they are sometimes used to augment each other, Grosser said. One antidepressant, for example, can be used to enhance the effect of an- - ing antidepressants. Ragsdale's other if the first medication is i sister said some side effects not having the desired effect. , of the drugs he was taking include manic reaction, suicide, Grosser said alerting agents, such as Ritalin or Provigil, are homicidal tendencies, hallucisometimes prescribed with an-- ; nations, delusions, psychosis, tidepressants for that reasoa .. ;: amnesia, panic and seizures. The FDA's warnings about "One drug in a certain dose can actually make another antidepressants are disputed. Grosser and Dr. David Pauldrug act like you've taken 10 times the amount that you reson, an Orem psychiatrist, ally did," Peterson said. "There pointed out that suicide rates in the United States had been are some psychiatrists that ... double up on the same kinds steadily decreasing before that of drugs to get an optimal rewarning came out. Both said suicide rates may have actually sponse, and that's acceptable increased since then, medical practice." According to Yau, side efSimilarly, some drugs may fects can vary, depending on have the opposite effect, depending on the person and the the patient. Much like with combination of medications. food, a person's metabolism Peterson said certain antibiotmay affect how a medication affects them, and one patient ics, for example, can nullify the effects of some antidepresmay metabolize a drug faster or slower than someone else. sants. There are common side effects, there's occasional side efWhat they do fects, there's rare side effects," Yau said. All of these drugs have a Other factors must also be variety of side effects, which opponents of psychiatric medi- taken into account, such as cations cite as a source of con- whether a patient follows the directions on his medicatioa cern. In 2004, the FDA issued If a patient is supposed to take a warning about a possible increase of suicidal thoughts and one pill every four hours but behavior in patients, especially takes three instead, it can seriously alter the effectiveness of younger people, who are tak-- . . . , Credit location and employee name; in most cases it does not indicate the specific item purchased. Requests by the AP for lists of the additional data in a timely manner were repeatedly declined on privacy and proprietary grounds. The VA list shows that some credit-car- d holders took a modest route. VA employees in locations such as Portland, Ore., Gainesville, Fla., and Sheridan, Wyo., had charges for Motel 6 and Travelodge inns. One VA headquarters employee appears to have passed up casino hotels by booking at a Holiday Inn i Express in Las Vegas for $787.75. "For government travel and other spending, you have to be mindful of the appearances you're creating," said Steve Ellis, vice president of the watchdog group Taxpayers for Common Sense. "If you're staying at a hotel at a strip in Vegas, you better have a pretty good reason for why a taxpayer should be funding the stay." "It's not like the VA hasn't gotten into trouble for credit card abuses in the past," he added. "I find it hard to justify any government purchase from Sharper unless you get something reImage ally goofy, it's going to be cheaper are calling home." The Department of Veterans Affairs, like many public and private groups, Continued from A 1 hosts conferences and meetings in Las , quarters in Washington and at medical Vegas due to the ease of participant centers around the nation, also spent travel, the capacity of the facilities, and tens of thousands of dollars at Wyndham the overall cost associated with hosting a hotels in places such as San Diego, Orconference," he said. lando, Fla., and on the riverfront in Little According to VA policy, purchase Rock, Ark. One-tim-e charges ranged up cards may be used at hotels to rent to $8,000. conference rooms or obtain audiovisual On at least six occasions, employees equipment or other items for VA meet- , based at VA headquarters made credit ings. They should not be used to reserve card charges at Las Vegas casino hotels lodging. Auditors long have urged the VA to adopt policies to encourage use of totaling $26,198. VA spokesman Matt Smith the depart- free conference rooms. Auditors previment was reviewing these and other pur- ously faulted the agency for booking chases as part of its routine oversight of rooms at expensive casino hotels without employee spending. He noted that many evidence it first had sought free space. of the purchases at Sharper Image and In the coming weeks, auditors at the n other stores included clocks for Government Accountability Office and the VA inspector general's office are to issue ' yeterans, humidifiers, air purifiers, alarm devices and basic planner prodreports on purchase card use and spenducts. ing controls at the VA and other agencies. Smith said all the casino hotel expendiThe reports are expected to show lingertures in 2007 were for conferences and ing problems at the VA, which auditors related expenses. He said the spending cited in 2004 for lax spending controls that was justified because Las Vegas is a place wasted up to $1.1 millioa where "VA is building a new medical cenThe list of charges provided to the AP ter and an increasing number of veterans gives the vendor, amount purchased, .',. low-visio- . Grosser said it is important to monitor the side effects of medications, which isyvhy psychiatrists start out by'prescrib-in- g low doses and take kind of a approach. At Ragsdale's last hearing in , March, his sister criticized the nurse practitioner who prescribed his medications, saying that the side effects were not monitored closely enough. "You go low and you go slow. This is good medical practice to start the medication at a low dose, then gradually moving up on it. But the point is that you've got to keep tabs on your patient," Grosser said. "There are a group of side effects that are common, and there are a group of side effects with al these drugs that are less common. There's only so far that you can go. Are you going to get the side effects that occur in one case in a thousand?" When speaking to reporters after her brother's last hearing, Tamara Ragsdale asked reporters to look up the Web site www.drugawareness.org. The site lists myriad incidents of suicidal, homicidal or other violent behavior it says has been linked to antidepressant use. wait-and-s- , . Conference Grosser said that some opponents of psychiatric medications will take an unusual case and trumpet it as a demonstra-- ; tion of how dangerous the drugs are. Yau emphasized j that psychological disorders have biological bases. If a di- - f agnoses is sound, then psychiatric medications are often the proper course of treatment. "Psychiatric disorders are very real disorder Yau said." "There is a scientific base for treating psychiatric disorders with medications. Problems have come from people who do not believe psychiatrkfdisor-- , ders are real, or it's just a matter of someone not choosing . the right lifestyle." V Despite the bad press that his profession sometimes receives, Paulson pointed out that great strides have been made in the field of psychiatry over the past 0 years. Patients who would have been confined to mental institutions several decades ago are now leading productive lives (hanks' to psychiatric medications. ... There's a number of people with severe mental illness like schizophrenia that are actually able to hold down jobs and function in family life, which was inconceivable before," he 15-2- , '. said. Many people may have already formed opinions on whether it was Ragsdale or his medications that were responsible for the death of his wife. Without analyzing him personally, Grosser, Peterson, Paul- - . son and Yau were unwilling to venture a guess on whether his family's claims were true, or even whether they are plausible. "I don't think anyone would put themselves in such a posi- tion to make such a response on just knowing about it from the news," Yau said. "Human beings are so complex, whether you're on medication or not on medication." I Jeremy Duda can be reached at 344-256- ' orjduda 1 heraldextra.com. ley theme, Monson asked y Saints to show kindness and respect to those who hold different religious beliefs and to strengthen their families by making the home' a loving sanctuary. He also said that as the moral fabric of society unravels v around them, church members ;sfiould strive to be steadfast in .their values!"1 ? r ; r Weitte waging a war with sin," Monson said. "But we) need not despair. It is a war we ' ; can and will win." Monsori's love for people of the church was obvious by the look in his eyes as he spoke, said Pierce Thiot, a student at the church-owne- d Brighani I'oung University in Latter-da- Continued from Al ambassador of truth to the entire world and beloved by all" Hinckley died Jan. 27 at age 97 after nearly 13 years leading ' the church. Mormons follow a pattern of apostolic succession to select f. a new president, with the job . passing to next most-senichurch leader upon the death , of the previous leader. Mon-so-n has been a senior church leader since 1963 and was one of Hinckley's closest advisers. Monson said Sunday he possesses a deep understanding of the responsibilities of his office and an appreciation for the work of the 15 men previously Provo. "It's a conference I'll never inthejob. "My earnest prayer is that I forget," he said. 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