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Scottsdale, Arizona, United States
Angela M. DeRosa DO, MBA, CPE graduated from the Chicago College of Osteopathic Medicine in 1995. She went on to do an Internal Medicine Residency with a fast track emphasis in Women’s Health at Lutheran General Hospital. After her residency, she became the Director of Women’s Health Services and Education at Lutheran General Hospital. After two years of practice she started a full time career as the West Coast Senior Medical Director with Procter and Gamble Pharmaceuticals. There she worked on women's health product development, research and marketing. Seven years after starting this position, Dr. DeRosa decided to pursue other clinical endeavors. Dr. DeRosa is a nationally recognized internist and women’s health expert. Her clinical focus is on revitalizing the physician-patient relationship; striving to provide the highest quality of care to her patients in a warm compassionate environment.

Saturday, January 15, 2011

Tuscon Tragedy: How medicine failed us.

As an Arizona healthcare professional, I have watched the Tucson tragedy unfold in absolute horror and disgust; knowing in my heart that the medical profession and government have largely failed in this situation. The terrible loss and injury of our fellow citizens saddens me beyond words. May our prayers comfort those in need at this time.

As the politically motivated continue to look to blame one another, I find their blame misplaced and only aimed at political gain. There is a much larger issue and one closer to the actual cause.

If we look at the underlying pathology that affected the perpetrator of this senseless event, it is evident that he had a significant mental disorder which became fueled by substance abuse. In addition, there were many opportunities by multiple folks and institutions to intervene. This didn’t need to happen……..

I have clinically witnessed numerous times, young males who engaged in substance abuse (especially depressants and hallucinogens such as marijuana and Salvia Divinorum) who lose their “natural” serotonin which can cause mood disorders or worsen one that is already present. These substances lower testosterone and ultimately cause gonadal failure resulting in lowered libido, infertility, weight gain, cardiovascular events and muscle atrophy. The less known affects of testosterone include mood stability and coping mechanism which are all augmented by serotonin receptors which require testosterone to properly fire. Both males and females, through normal aging, lose testosterone which causes a decrease in mood and coping. If one abuses marijuana or other illegal substances, the body slows it natural production of testosterone even further. And it the abuse is in a younger person, the mind never develops properly and these deficiencies can be further exaggerated.

No matter what side a person sits on the marijuana debate, I believe, we can all agree that these types of substances, are unhealthy for the developing mind.

Simple medical blood tests or intervention could have prevented such a decline. Unfortunately, there are so many stigmas associated with mental decline or suffering and a lack of funding to help support people with such difficulties. The avenues made affordable are when the crisis has reached an extreme, requiring involuntary lockdown, or tragic conclusions such as this.

Mood disorders are often exempt from insurance policies or the actual cause of denial of insurance in the first place. People are afraid to admit they need help or when they do find the resources, they are minimal or they are treated with disrespect at the best or as “crazy”.

So few clinicians are willing to look deeper or take the time to listen to patient. This takes time and effort. Also, most providers do not understand the role of hormones such as testosterone and other underlying treatable conditions exacerbating the mood disorders. To make matters worse, their attempts to “fix” the problem through anti-depressants may only make matters worse. Selective Serotonins Re-uptake Inhibitors (SSRI’s) are known to cause sexual dysfunction but most clinicians and patients are unaware of the underlying mechanism. This side effect comes from an increase in Serum Hormone Binding Globulin (SHBG) which causes a lowering in free testosterone. This decrease’s a patient libido and sexual function. But, as I stated above, there is more to testosterone than libido. It also causes a decline in serotonin which makes mood and coping worse.

These drugs may temporarily make the patient feel better, but over time, the decline in testosterone results in worsening of mood and an exacerbation of the underlying mental condition. It becomes a vicious cycle which often results in the providers increase the doses or adding other medication further making matters worse. If they were aware of this effect, they could work to avoid this and help their patients.

In this case, this young man had an underlying mental condition which presented with paranoia, depression, anger and psychotic breaks. Then he likely tried to self medicate these delusions with mind altering substances.

On many occasions, the people he encounter during his primary and secondary education, failed to make a proper assessment and only passed him onto others hoping that “it would just go away”. He was not only showing mood instability but also evoked fear in others. This should have been report to agencies or at the very least prompted a psychological evaluation. The college he attended wanted him to have an evaluation in order to be accepted back but what about other institutions unaware of this or the unsuspecting public. We have mechanisms in place to attempt to stop people from drinking and driving. You would think that threatening violence such as this in a public forum would require some consequences. We can find away to balance civil liberties while protecting the public from “high risk” individuals who appear to be crying out for help.

These miss-steps led to a deadly cocktail of delusions, with no place to seek help, lack of authority to intervene and opportunity. This ultimately caused this tragic event. I only can hope we can learn from this. “The immediate future is going to be tragic for all of us unless we find a way of making the vast educational resources of this country serve the true purpose of education, truth and justice. “
(Anne Sullivan Macy)

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