Women & Antidepressants

Pink, a magazine for business women, has an article in its April/May 2007 issue titled, “The Magic Pill.” (The only way to read this article is to get a hard-copy of the mag.) No, this isn’t about birth control. The subhead: “Antidepressants are now used for everything from migraines to menopause. But are women getting an overdose?”

Good question. The article, well-written by Mary Anne Dunkin, does a nice job of trying to present both sides of the coin. One subject, Pam Gilchrist, takes tricyclic antidepressants to relieve her fibromyalgia symptoms. “One of the [antidepressants] that allows her to keep going” is Effexor (venlafaxine). God forbid the woman should ever have to come off of that one. (It works well when you’re on it, but withdrawal is sheer hell.)

The other subject mentioned in the article, Billie Wickstrom, suffers from bipolar disorder, but had a therapist who diagnosed her with obsessive-compulsive disorder. The psychiatrist she was referred to promptly put her on Anafranil (clomipramine). We all know what antidepressants tend to do for those with bipolar disorder. Wickstrom blanked out at an interview that she says she normally would have aced. In another incident, she veered off-course after leaving town and spent the night on the side of the road with her daughter. “Search parties in three states” were out looking for them.

“Three years and three hospitalizations later, Wickstrom is finally free of clomipramine and has a job she loves as PR director for a $300 million family of companies. She says she’s happy, she’s focused and she feels great – consistently.”

Dunkin’s article uncovers a large, problematic use – by my standards, anyway – of off-label usage by doctors.

“Gilchrist… is one of the estimated one in 10 American women taking some type of antidepressant medication. And a considerable percentage of these prescriptions, particularly those for tricyclic antidepressants, are not used to treat depression at all.

A growing number of doctors today prescribe antidepressants for a wide range of problems, including anxiety, chronic pain, insomnia, migraines, high blood pressure, irritable bowel syndrome, premenstrual syndrome, menopausal hot flashes and smoking cessation.”

I’m sure the list goes on, but magazines have but oh so much space.

Melissa McNeilDr. Melissa McNeil at the University of Pittsburgh points out three things:

  1. Since depression is a prevalent (see common) condition, doctors are better detecting it.
  2. Since antidepressants have proven their safety and efficacy, primary care physicians have no reservations prescribing them.
  3. Clinical studies are finding that antidepressants can aid a number of medical issues apart from depression.

My take on McNeil’s points (I’ll try to keep them brief):

  • Depression is way too common to be abnormal. If a woman has a rough patch in life for 2 weeks or more, she’s got depression. As for doctors being better at detecting depression? Studies consistently show that doctors are great at overlooking depression in men.
  • Antidepressants haven’t proven jack squat. Placebos have proven more safety and efficacy than antidepressants. PCPs have no reservations prescribing them because they only know about the positive facts that pharma reps tell them instead of researching the potential side effects.
  • Clinical studies aren’t finding all those things out. Seroquel has FDA-approval to treat psychiatric symptoms (psychosis, for one). As far as I know, Seroquel is not FDA-approved to treat insomnia or crappy sleeping patterns. There are no specific clinical studies to see if Seroquel can treat insomnia. Seroquel is prescribed to treat insomnia/restless sleep because doctors have found that a major side effect of the drug is somnolence. If this is the case, Effexor should be prescribed for weight loss. It’d be the new Fen-Phen.

Dunkin cites two widely used antidepressants for nonpsychiatric uses: Wellbutrin (bupropion) and Prozac (fluoxetine). Zyban, used for smoking cessation is, well, bupropion. Sarafem, used to treat PMS symptoms is – you guessed it – fluoxetine.

Viktor BouquetteDr. Viktor Bouquette of Progressive Medical Group thankfully takes a more cautious approach:

“The widespread use – mostly misuse – by physicians of antidepressants to treat women for far-ranging symptoms from insomnia, chronic fatigue and irritability to PMS and menopause is merely another unfortunate example of the pharmaceutical industry’s tremendous influence on the practice of modern medicine. Take enough antidepressants and you may likely still have the symptoms, but you won’t care.”

Kudos to Dunkin for landing that quote. Since Bouquette is part of an alternative medicine group, he’s got a good motive for slamming pharma companies.

McNeil goes on to sound anti-d happy in the article. Not that it matters, but she is also a section editor for the Journal of Women’s Health, which has several corporate associates representing pharmaceutical companies. (She is also the only source in the article who sings anti-d’s praises.) Dunkin tracked down Dr. Scott Haltzman, a clinical professor at the Brown University Department of Psychiatry, who advocated patient responsibility.

“Just because antidepressants work for depression does not mean they should always be used. People need to learn skills to manage their depressive symptoms instead of depending on medication. When you take medicine for every complaint, you lose the opportunity to learn how to regulate your mood on your own.”

Oh, for more doctors like Haltzman and Bouquette.

UPDATE: Uh, alleged fraud suit pending against Progressive Medical Group. Bouquette is now part of Progressive Medical Centers of America.

Celebrities take undisclosed money to endorse pharma drugs

This is old news, but I found it interesting enough to put up here because of my obsession with celebrities (although I haven’t been keeping up with them recently).

Walk of FameBrandweekNRX posted about the FTC investigating pharmaceutical companies paying stars “undisclosed” amounts of money to endorse medication. BrandweekNRX has the entire list, but here are some of my favorites:

  • Alonzo Mourning of basketball team Miami Heart – Johnson & Johnson’s (J&J’s) Procrit for anemia
  • Sally Field, an outspoken activist for osteoporosis awareness – Roche Therapeutics’ Boniva
  • Holly Marie Combs of Charmed – Ortho contraceptives for J&J’s subsidiary, Ortho McNeil
  • Terry Bradshaw, my beloved football commentator – GlaxoSmithKline’s (GSK) Paxil
  • Lorraine Bracco of The Sopranos – Pfizer’s Zoloft

Attribution: CLPsych

Nothing you didn't already know

Lamictal is hot shit

“In its own way, the best patient group for Lamictal therapy is the bipolar II patient, a person with mild manias and severe depressions.” The side effects are also more tolerable than those of any bipolar drugs: little weight gain, lethargy, or nausea. “It’s the most interesting drug to come along since lithium,” says Ivan Goldberg. “Lamictal is hot shit.”

I found this on soulful sepulcher and have to admit – Lamictal has killed my manias. Since going up to 200 mg in January, I haven’t had a real manic episode – well, it’s really a mixed episode, but whatever. This makes me wonder if the Lamictal IS working; if I’ve tricked myself with a placebo; or if God is just being merciful to me. I try to convince myself with the last two. (Well, I find the latter to be absolutely true.)

Despite my pharma rantings, I have to agree: "Lamictal is hot shit."

Paxil's great for kids

An Associated Press article has reported on how antidepressants have a positive effect on children and adolescents. The upside? No suicides.

Antidepressants used: Paxil, Celexa, Zoloft, Lexapro, Prozac, Serzone, Remeron.

Dr. David Brent from the University Of Pittsburgh School Of Medicine is a flat-out idiot:

‘‘The medications are safe and effective and should be considered as an important part of treatment. The benefits seem favorable compared to the small risk of suicidal thoughts and behavior.’’

Screw you, Dr. Brent for not taking meds and taking money from drug companies (probably to fund research studies). All meds listed above – Paxil, namely – have side/withdrawal effects strong enough to fuck an adult up, let alone a developing child. Sure, I recommend alcohol for kids: It’s safe, effective, and the benefits are favorable compared to the small risk of alcoholism and drunk driving.

The prestigious Duke University has a smarter and cautious doctor, Dr. John March, chief of child and adolescent psychiatry at Duke University Medical Center.

“He said the suicidal behavior risk, although lower than found by the FDA, demands that doctors and families watch for warning signs.

‘You can’t treat kids with these drugs without taking this information into account,’ said March, who was not involved in the study, but does similar research. ‘You can’t say, ‘Take these and call me in six weeks.’ You have to monitor carefully the benefits and adverse events.’

An addendum: “The study was supported by grants from the National Institute of Mental Health and the Robert Wood Johnson Foundation.”

Talk amongst yourselves.

Wyeth looking for Pristiq's FDA approval in 2008

Depressed Americans will be spared of Pristiq for 1 year. According to an article from Reuters, "positive" data has raised investors’ hopes in Wyeth’s future star drug.

"The trial data showed low doses of Pristiq were effective against both depression and hot flashes and caused less nausea than was seen in prior studies of higher doses. Although the new data will take more time for regulators to analyze, it could bolster prospects for eventual approval and commercial success of the drug."

My best guess? Pharma reps will push Pristiq at higher dosages and doctors will prescribe it at higher dosages with a minimal warning of nausea. I’d like to know the highest dosage tolerated with the least amount of nausea. And really, what is considered a low dosage anyway? The difference between 37.5 mg of Effexor and 300 mg of Effexor is significant despite the fact people told me that the dosages didn’t compare to that of Lexapro’s. (It was supposedly less powerful than Lexapro.)

Anyway, I’ll stop my rants. I’ll follow Pristiq as the information continues to trickle out but don’t expect to hear much about it until next year when Wyeth becomes the proud papa of a brand new (and approved) product.

Tips for proper self-withdrawal from medication(s)

Gianna, a reader of this site, has a great and informative blog, Bipolar Blast. In a recent post, she gives some tips for proper psych drug withdrawal. This is particularly helpful for those dealing with severe antidepressant withdrawal effects. For me, Effexor comes to mind. I also think about "Honey’s" experience with Zoloft. Not only does Gianna emphasize diet and nutrition as an important part of the process, but she also delves into proper titration. (Many people think that the diet and nutrition thing is obvious, but many people overlook that important piece of recovery.)

I understand that many people – especially in the psych world – think Peter Breggin’s a wack job, but he can have some good points. Gianna refers to Breggin’s 10% rule:

"Breggin suggests what has come to be known the 10% rule. Any given drug should not be reduced anymore than 10% at a time. Once a taper is complete the next taper should not exceed 10% of the new dose. Therefore, the milligram, then fraction of milligram amount decreases with each new taper. I’ve found that I have to sometimes go in even smaller amounts. As low as 5% and sometimes people go as small as 2.5%–for people on benzodiazepines it is not unusual to go in even smaller amounts. Cutting pills is not always enough. Sometimes liquid titration is necessary. This may involve dissolving the smallest dose pill in water, club soda or even alcohol, which can then be diluted with water, then using a syringe to cut down milliliters at a time. Medications also sometimes come in liquid form and can be gotten by prescription. It should be noted that some medications should not be dissolved. Especially time released medications. This would be extremely dangerous."

Gianna clearly knows what she’s talking about. Head on over to her site to read the rest of the post.

Johnson & Johnson subpoenaed

RisperdalI was reading the business section of my Metro paper this morning and noticed that Johnson & Johnson was subpoenaed in Boston, San Francisco, and Philly. According to the Associated Press, it is in relation to “sales and marketing of three drugs.”  The drugs? Risperdal, Topamax and Natrecor. Risperdal is used for schizophrenia and bipolar mania, Topamax is an epilepsy drug (if not approved for bipolar use, probably used off-label for that purpose), and Natrecor is used for patients with heart disease.

The latest subpoenas seek information about the corporate supervision and oversight of J&J’s Janssen, Ortho-McNeil and Scios subsidiaries, which sell the drugs, J&J said.

J&J posted Risperdal sales of $4.18 billion last year, an 18 per cent increase from 2005. In November 2005, Janssen received a subpoena from the U.S. Attorney’s Office in Philadelphia seeking information about Risperdal marketing and adverse reactions to the drug.

Topamax sales were $2.03 billion last year, a 21 per cent increase from 2005. Ortho-McNeil received a subpoena from the U.S. Attorney’s Office in Boston in December 2003 seeking documents relating to the drug’s marketing, including alleged “off-label” marketing, J&J said in the SEC filing. Doctors often prescribe drugs for uses not described on U.S. Food and Drug Administration-approved labels, but pharmaceutical companies cannot market products for off-label usage.

Do we have another Zyprexa case on our hands?

Between the Risperdal investigations, the Zyprexa lawsuits, the Seroquel lawsuits, BMS’s recent mysterious settlement with the US Attorney in New Jersey (it’s not clear if that was related to Abilify, but I bet it was), plus the pending Congressional investigation of Zyprexa and Seroquel, it looks like the wonder drugs are in a world of trouble. In my adult life, I cannot recall a class of drugs that have ended up in such a pickle before. Nor have I seen such a class of drugs that were once touted as cures turn into such duds. The whole thing is just weird.

The wonder drugs are probably in trouble, but they won’t get pulled off the market and I doubt they’ll get more coverage than how the situation affects the company’s stocks. (This is one area where I’d like to be wrong.) But I agree with Dawdy’s assessment that a class of drugs have never been more criticized than atypicals. There have been individual instances of investigations within a class of drugs, but not a whole slew of them. What leads companies to shady practices in this area when it comes to mental health? Perhaps it’s because the drugs have not been conclusively proven to be the savior they are touted as. Or maybe it’s because the hypotheses – that’s really what the explanations of how these drugs work are – have enough of an effect from clinical trials to market and make a substantial profit. I’d venture to say that psych drugs are the only class of drugs that are marketed based on hypothesis only and not conclusive evidence.

Read more at Furious Seasons.

Drug Interactions

soulful sepulcher has a post up on drug interactions. You can find nearly all meds and find out the interactions as drugdigest.org. I did a search for lamotrigine (Lamictal) and venlafaxine (Effexor), which included interactions with food and alcohol and there were none. (That was a relief.) I’d encourage anyone on medication to do this search to make sure that multiple psych drugs are not interfering with each other.

Hirschfeld developed MDQ for GSK

“GlaxoSmithKline, one of the world’s leading research-based pharmaceutical healthcare companies, is committed to improving the quality of human life by enabling people to do more, feel better, and live longer.”

Quetiapine articleOK, I’ll be honest. I can’t keep up with my own posts and have no idea whether or not I’ve posted on this yet. Judging from the fact that I still have this bp booklet, I’m going to guess not. If I have, then there’s more.

When my psychiatrist diagnosed me with bipolar disorder in November, he handed me a bunch of material: a mood tracker (PDF), an article touting the benefits of Seroquel, and a booklet titled, “Bipolar Disorder,” which refers the reader to www.1on1.health.com.

The booklet seems pretty harmless to a patient newly diagnosed with bipolar disorder:

“Highs and lows can be part of life. But, with bipolar disorder, they can be severe. You may feel too depressed to get out of bed one day. Soon after, you may feel full of energy. You may have normal times between the highs and lows. When people have mood symptoms, it’s more likely to be depression.

Mood swings can be hard to predict. But you may have warning signs. You may even learn what can trigger your symptoms. You’ll read about this and more in this booklet.

Bipolar disorder is complex. Doctors docn’t know what causes it. They know that genes play a role. The illness may be linked to brain chemicals. These chemicals can get out of balance.

There are treatments to help control the symptoms. Learn about your condition. Get help for it. This booklet is a good first step.”

Thank you, GlaxoSmithKline.

GSK, the provider of such psych drugs as Lamictal, Paxil, and Wellbutrin, issues a series of booklets for patients referring them to 1on1health.com. The topics include depression, anxiety disorders, epilepsy, type 2 diabetes mellitus, high cholesterol, among others. The tips seems pretty simple and straightforward:

“Health and lifestyle chances may trigger your symptoms. Some common changes are:

Not having a sleep schedule
Misusing alcohol or drugs
Stopping your medicine, or starting medicine for depression or another illness
Having thyroid or other health problems”

Then it gets into the general stuff about the difference between mania, depression and further clarifies what hypomania and mixed moods are. Then, the kicker follows:

“If you think you may have bipolar disorder, fill out the checklist on the next two pages. Share it with your doctor. He or she can use it to help diagnose you.”

Bipolar questionnaireFurious Seasons posted a link about a fake drug named Havidol (which I totally got suckered into because I skimmed the post and missed the “OK, it’s a gag” part), but the hilarity stems from similarly stupid (and vague) questions. I’ve put a screenshot of the PDF GSK provides on their Web site to the right. My issue is not so much with the questions necessarily, but with the lead-in to them:

Has there been a time when...” [emphasis mine]

It doesn’t matter whether you were 3 years old or 46 years old, if you answered “yes” to more than one “there’s ever been a time when” question, guess what? You MAY qualify for bipolar disorder! A sampling:

Has there ever been a time when…

  • You were easily angered that you shouted at people or started fights?
  • You felt much more sure of yourself than usual?
  • You talked or spoke much faster than usual?
  • You were so easily distracted that you couldn’t focus?
  • You had much more energy than usual?
  • You were much more active or did many more things than usual?
  • You were much more social than usual?
  • You were much more interested in sex than usual?

Guaranteed everyone reading this said “yes” to at least TWO questions. If not, I question whether you’re breathing. (Sadly enough, this makes me realize how easy it was for me to get fooled by the phony Havidol quiz.)

The follow-up to the questions above asks, “If you checked YES to more than one of the questions above, have several of these things happened during the same period of time?” Then, “How much of a problem did any of these things cause you (like not being able to work, or having money or legal troubles)? Choose one[:]

  1. No problem
  2. Minor problem
  3. Moderate problem
  4. Serious problem”

The multiple choice question above may not matter. Answering some of the lead-in questions in the affirmative may qualify you for the disorder.

Here’s a nice little tidbit. The questionnaire was “adapted with permission from Robert M.A. Hirschfeld, M.D.” So as an uninformed patient reading this (which I was at the time), I’m thinking, “Oh, this must be legit since they got permission from a doctor to use this checklist.” There’s more than meets the eye here.

On the surface, Dr. Hirschfeld seems like an awesome doctor – and he very well may be. Dr Hirschfeld’s bio from the University of Texas Medical Branch at Galveston (UTMB) extols the “Professor and Chair” of its psychiatry deparment. He has history of working with various national organizations such as the National Depressive and Manic-Depressive Association,  National Institute of Mental Health (NIMH), and National Alliance for Research on Schizophrenia and Depression (NARSAD). He’s written all kinds of articles and blah blah blah. He’s considered a leader in his research of bipolar disorder.

In fact, because Dr. Hirschfeld is so great, he’s a member of pharmaceutical boards and has acted as a consultant for pharmaceutical companies, according to ISI Highly Cited.com. Some of our favorite guys appear here: Pfizer, Wyeth, Abbott Labs., Bristol-Myers Squibb, Eli Lilly, Forest Labs, Janssen, and – lookee here! – GSK.

The duration of Dr. Hirschfeld’s affiliations with these pharmaceutical companies are unspecified. All other “appointments/affiliations” have assigned years, i.e. 1972-1977, 2001-Present. His consulting affiliations follow his internship in 1968-1969. It looks a bit misleading to follow the consulting jobs after, oh say, 1969, and not provide dates of when he became a consultant for all of these pharma companies. Toward the end of the document that I found, his affiliations from 1986-Present are listed with various boards, associations, journals, and a slew of pharmaceutical companies.

Hello, hello, hello. He is a MEMBER of the Zyprexa U.S. Bipolar Academic Advisory Board, the Celexa/Excitalopram [sic] Executive Advisory Board, the Lamictal National Advisory Board, and the Zoloft Advisory Board.

Humor me here. His clinical trials include:

  • 1994 Paroxetine for Dysthymia (SmithKline Beecham)
  • 1995-97 Several (I found five) double-blind studies on sertraline and imipramine in patients qualifying for the DSM-III definition of major depressive disorder
  • 1996-98 Gabapentin therapy for bipolar patients

And the list, including mirtazapine, fluoxetine, venlafaxine, lamotrigine, goes on. You can also find the “grants” pharma companies gave to fund these clinical trials.

From 1997-2000, Hirschfeld received a $100K grant from Abbott Labs to develop “a new checklist for bipolar symptoms.” (I’m not sure what the old one was.) In 2001, he received a $142K grant for the “Bipolar Prevalence and Impact MDQ Project.”

I don’t even need to look MDQ up. It’s Mood Disorder Questionnaire. The grant came from GSK, who “adapted” the questionnaire with Hirschfeld’s “permission.” That sounds simply gravy.

To understand more about bipolar disorder, you can listen to the stories of Greg, Stuart and Leslie – all your classic bipolar cases and how medication and/or therapy has helped them so much. You can also watch the bipolar
disorder animation
that regurgitates all the things that we’ve become skeptical about.

In the meantime, remember the instructions included in Seroquel’s safety information that no one reads (excuse the crappy “Paint” job):

Seroquel warnings

The "Black Dog"

Newsweek had an article on men and depression last week and the full text is now up on their Web site. I have a few – well, more than a few – comments on the article.

"Six million American men will be diagnosed with depression this year. But millions more suffer silently, unaware that their problem has a name or unwilling to seek treatment. … the facts suggest that, well, men tend not to take care of themselves and are reluctant to own up to mental illness.

Instead of talking about their feelings, men may mask them with alcohol, drug abuse, gambling, anger or by becoming workaholics. And even when they do realize they have a problem, men often view asking for help as an admission of weakness, a betrayal of their male identities."

I don’t need to say it, but I will anyway: This is common. My husband is a prime example.

My husband refused to admit that he suffered from depression for a long time. He would chalk it up to a "bad day" or "feeling crappy," but depressed? Never. After my most recent swing of suicidal attempts, it triggered his depression into a full-blown episode. He currently suffers from depression and chronic anxiety. (The anxiety is basically excessive worry.) For years, he never allowed his parents to see him cry. He’d refrain from tears around me when I told him I had an overly sensitive ex who cried at the drop of a hat. When speaking to others, he acted like everything was OK. Considering that he’s an even-tempered man (no highs, no lows), no one could detect everything. He kept it all inside.

His point of weakness? Allowing his father to see him cry. It was bad enough that his mother saw him crying, but his dad? That was a huge blow to his ego. Not only was it "an admission of weakness," it was "a betrayal of" his male identity. He’d always prided himself on seeming like he had his life all together. Breaking down and hysterically crying was like tearing his manhood apart. Besides, isn’t it "girly" for a man to cry? They’re supposed to keep it all inside and act like nothing’s wrong.

"Instead of talking about their feelings, men may mask them with alcohol, drug abuse, gambling, anger or by becoming workaholics."

I’d rather have my husband cry and vent instead of doing any of the previously mentioned.

"The Gary Cooper model of manhood … is so deeply embedded in our social psyche that some men would rather kill themselves than confront the fact that they feel despondent, inadequate or helpless.

‘Our definition of a successful man in this culture does not include being depressed, down or sad,’ says Michael Addis, chair of psychology at Clark University in Massachusetts. ‘In many ways it’s the exact opposite. A successful man is always up, positive, in charge and in control of his emotions.’"

I’m sure in my husband’s mind, he wasn’t successful. In fact, he’s admitted to being a "failure" many times. He’ll use the fact that he suffers from anxiety, gets depressed, and cries a lot as the reason that he’s "failed" me. I tell him it’s not true, but at times, he’s intent on not believing me. If he’s not always "up, positive, in charge and in control of his emotions" then he’s a failure. This is a common misconception, one of which my husband has fallen prey to.

"For decades, psychologists believed that men experienced depression at only a fraction of the rate of women. But this overly rosy view, doctors now recognize, was due to the fact that men were better at hiding their feelings."

Men don’t talk about their feelings. They talk about sports; they talk about the weather; they talk about cars; they talk about girls; they talk about drinking; they’ll talk briefly about their families.

Men don’t talk about how they feel. Men with feelings are either sissies or gay. See where I’m going?

"Depression-screening tests are so effective at early detection and may prevent so many future problems (and expenses) that the U.S. Army is rolling out a new, enhanced screening program for soldiers returning from Iraq."

And when they’ve recovered or their illness is "in remission," the Army has no problem sending the same troops back into combat. Something in this article that concerned me, however:

"In clinical trials, scientists found that a single, IV-administered dose of ketamine, an animal tranquilizer, reduced the symptoms of depression in just two to three hours and had long-lasting effects. Because of its hallucinogenic side effects, ketamine can never be used out of controlled environments. But the success of the trial is giving scientists new ideas about drugs and methods of administering them."

OK, ketamine. Isn’t this the "Special K" drug that can be addictive? I have a friend who worked in a vet hospital and she would steal ketamine and get high off of that crap. While ketamine can reduce the symptoms of depression, it can also induce hallucinogenic effects. Therefore, while a person is depressed while receiving ketamine treatment, he can possibly hallucinate. If he’s hallucinating – oh no – now he’s got psychosis which leads to a new diagnosis. Now, the doc’s got to put him on an antipsychotic in addition to his ketamine treatment. Am I the only one who finds administering an animal tranquilizers to humans disturbing?

"The most effective remedy remains a combination of medication and therapy, but finding the right drug and dosage is still more art than science. The nation’s largest depression-treatment study, STAR*D, a three-year NIMH-funded project, found that 67 percent of patients who complete from one to four treatment steps, such as trying a different medication or seeking counseling, can reach remission."

I’m still trying to figure out what STAR*D is, but I know that therapy is the best route before considering medication. I go on rants about how America suffers from what I’ve deemed OOPS (Overdiagnosed and Overmedicated Patient Syndrome), but it’s unbelievable what doctors will do to a patient who’s normally depressed over a loved one’s death. "Here, take Zoloft," the doc says. "You can take it for a short period of time until your symptoms go away."

What happened to GRIEVING? Are people not allowed to have emotions anymore? Is it wrong to be sad over saddening events? If a woman is depressed during a messy divorce battle, why is she immediately thrown on meds? So she can feel better once the court proceedings are over? Maybe she could have dealt with the situation without antidepressants. We’re suffering from a widespread OOPS epidemic. Doctors dole out antidepressants for depression like antibiotics for colds. And doctors dole out stimulation medication (i.e. Ritalin) to kids like people hand out candy on Halloween. (Alas, another story for another day.) 

"Taking care of yourself physically, mentally and emotionally—maybe that’s the real definition of what it means to be a man."

I can only hope and pray that this country learns that lesson in the coming century.

For the next couple of days, I’ll have a series on my husband Bob’s depression. I do detour into my experience with psych drugs and suicide but then hop on track in the end. Remember, I’m also suffering from a version of OOPS – Narcissistic Personality Disorder.

*sigh* I can’t help but wonder whether depression, anxiety, and 75 % of other mental illnesses are just a fabrication  and patients are mere pawns in the wild game of  pharmaceutical chess.

Pristiq's under-the-radar clinical trials

News stories on Wyeth’s Pristiq, Effexor’s “knockoff”, have focused on the drug’s uses that are pending FDA-approval: vasomotor symptoms accompanying menopause (see hot flashes) and depression. (“Knockoff” term courtesy of CLPsych.) The major media has failed to pick up on Wyeth’s Phase III clinical trials to use Pristiq for fibromyalgia and neuropathic pain (injured tissue or damaged nerve fibers) in diabetics. A search for Pristiq on Wyeth’s Web site yields no results. Desvenlafaxine yields two very meager results.

In related matters, bifeprunox is pending FDA-approval for the use of schizophrenia and is still in Phase III for use of bipolar disorder. They are also in Phase III of testing Lybrex (levonorgestrel) for use for Premenstrual Dysmorphic Disorder in addition to the drug functioning as an oral contraceptive. (I’ll be honest; I had NO clue that diagnosis existed.) In any event, I’ve been misdiagnosed because according to the symptoms, I qualify. I think I also qualify for OOPS – Overdiagnosed and Overmedicated Patient Syndrome.

I’d like expound on Wyeth’s Learn and Confirm phase that’s supposed to replace Phase I and II of clinical trials. It sounds like a speedier way to just get drugs to Phase III of clin. trials, but it’s late and I’m working on something else, so I’ll save that for another day.

Also something to tackle in the future: All these interesting clinical trial results for Effexor XR involving depression and GAD. We’ll see…

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Mood: 6.5

Loose Screws Mental Health News

In one of the scariest articles I’ve read in a while, Ms . Jane Brody in the NYT explains the symptoms and results of an illness called serotonin syndrome. And yes, too much of it can be fatal. Key symptoms to watch out for:

  • Cognitive-behavioral symptoms like confusion, disorientation, agitation, irritability, unresponsiveness and anxiety.
  • Neuromuscular symptoms like muscle spasms, exaggerated reflexes, muscular rigidity, tremors, loss of coordination and shivering.
  • Autonomic nervous system symptoms like fever, profuse sweating, rapid heart rate, raised blood pressure and dilated pupils.

(link attribution: Furious Seasons)

doggieIn another story that I find appalling, the FDA has approved a drug for carsick dogs. Yes, that’s right. Carsick dogs. soulful sepulcher first wrote about it and linked to the original story. How long before kids start taking this stuff to get high or something? You know something’s wrong when dogs can die from serotonin syndrome and feel better off of FDA-approved drugs. *shakes head* He’s cute, but he’ll just have to throw up.

Decision Resources attempts to restore confidence in Big Pharma's atypicals

Zyprexa

Whee for self-promotion!

“Eli Lilly’s Zyprexa Will Remain the Clinical Gold Standard for the Treatment of Schizophrenia Through 2015″

“Clinical Gold Standard,” huh?

I can’t bring anything new to the table on this. Maybe I’m wrong, but here I go:

“For almost three decades, Decision Resources has provided in-depth research on the trends, emerging developments, and market potential in various healthcare industry sectors.  Our client base is diverse – including large pharmaceutical companies, emerging biotechnology concerns, financial services, managed care organizations, and medical device manufacturers who turn to Decision Resources to help shape their strategy and master their chosen markets.

The privately-owned company offers a rich array of research publications advisory services, and consulting that make it second to none for quality, analytical depth and insight. With access to almost 10,000 thought leaders, specialists, HMO formulary directors, and general practitioners, Decision Resources’ highly-credentialed analysts are able to reconcile real-world practice with hard numbers from the industry’s most respected data sources.  The resulting analysis and insights drive business decisions and commercial success within the biopharmaceutical, managed care, medical device, and financial markets.”

Here’s my assessment, take it with a grain of salt: In an attempt to fight the decline in sales from the NYT-induced Zyprexa backlash, Eli Lilly has gone on the offensive and hired Decision Resources to reinvent its star medication.

Decision Resources (DR), a privately owned company (no hyphen if a modifier ends in “-ly”), has a client base that includes large pharmaceutical companies. Ta-da! Don’t get it?

Decision Resources is not a public company; hence, in addition to not receiving federal money, it doesn’t need to report its financial dealings to the SEC. Therefore, no publicly accessible financial records of DR’s clients. They haven’t said they are an “independent” organization. Perhaps this is implied. Whatever the case may be, DR gets paid by its client base to research their products and “help shape their strategy and master their chosen markets.”

This isn’t brain science; this is on their “About Us” section of their Web site. Therefore, if Eli Lilly turns to DR and pays them to – I like DR’s wording here – “shape their strategy and master their chosen markets,” then DR is essentially a PR loudspeaker letting everyone know that Zyprexa is the “clinical gold standard” for schizophrenia.

What a bunch of hooey.

Not too long ago, it seems that AstraZeneca (AZ) may have had DR engineer its new marketing strategy to give Seroquel a boost. Why not? Mental health media watchdogs are hatin’ on the atypical antipsychotics.

“According to a new report entitled Schizophrenia: Turning Physician Insight into Projected Patient Share, Zyprexa is superior in efficacy to all other current therapies, particularly on measures that are most important to prescribers, such as impact on global symptoms and responder rate.”

Holla at me if you’ve got your hands on that report mentioned above.

“In spite of scoring* less favorable than the other drugs in terms of safety and lower than risperidone in terms of delivery features, Zyprexa is the gold standard.”

OK – so it’s not safe and it doesn’t deliver as well as Risperdal – whatever that means – but Zyprexa is still “the gold standard”?

“This overall advantage for a drug with significant safety concerns highlights the importance of efficacy to prescribers.”

I want you to reread that: ” This overall advantage for a drug with significant safety concerns highlights the importance of efficacy to prescribers.” Let’s attempt to paraphrase this: The benefit of this potentially harmful drug shows the importance of how effective it is to those who receive the drug. Although Zyprexa has “significant safety concerns,” the drug works well enough for doctors to prescribe it to patients. Uh, no. Positives don’t outweigh the negatives. It was nice jargon for a second there, though. (If this is effed up enough for adults, why subject children to this crap?)

“The report also finds that the most commercially important emerging antipsychotics (Janssen’s Invega, Organon BioSciences’ asenapine, and Wyeth/Solvay/Lundbeck’s bifeprunox) score* lower than Zyprexa, indicating that Zyprexa will remain unsurpassed during Decision Resources’ forecast period.”

I know I’m doing a play-by-play but this is important. I need to find out how DR decided that Zyprexa would be the “gold standard” until 2015. (What’s the significance of this year? Does EL’s patent on Zyprexa expire then? Nope, Eli Lilly’s patent on Zyprexa expires in 2011. Expect a similar molecularly structured olanzapine before then. Biolexapine?) So basically, in this report, DR’s conclusion is Zyprexa beats every other atypical antipsychotic for schizophrenia by far. Notice that AZ’s Seroquel (the soon-to-be “gold standard” of bipolar meds),  an atypical also used for schizophrenia, is not listed. Not coincidence.

The little asterisk (*) next to the word “score” prompts me to wonder: Just how did they come up with these scores? Well, the asterisk tells me that I need to contact DR for the methodology behind the product scores. I just might. Then send it off to CL Psych or Furious Seasons to decipher the crap out of it.

Another thing to note on this PR:

“”Invega is a metabolite of risperidone and is likely to have efficacy similar to that of risperidone, which scored* slightly lower than Zyprexa overall,” said Nitasha Manchanda, Ph.D., analyst at Decision Resources. “Asenapine also lacks the differentiation to replace Zyprexa as the gold standard because it does not make as significant an impact on global symptoms, and bifeprunox is significantly inferior to Zyprexa in all primary efficacy measures and is not capable of surpassing Zyprexa.””

Dr. Manchanda, analyst for DR, pulled bifeprunox – not yet on the drug market – into the Zyprexa comparison and somehow was able to call it “significantly inferior to Zyprexa” with an incapability to “surpass” it. How many people have used bifeprunox, Ms. Manchanda? OK, now tell me how many people have used Zyprexa? And you’re telling me that a drug that hasn’t yet hit the market is “significantly inferior” to a drug that has been on the market for the past couple of years and has 1,200 lawsuits still pending in addition to the millions that have already been paid?

As for AZ, DR has determined that Seroquel will become the “gold standard” for bipolar medication by 2010, knocking Lamictal out of its current “gold standard” status. Like Furious Seasons, I had NO idea Lamictal was held up so highly for bipolar meds. Considering that lithium has always been the king of bipolar meds and treats both acute mania and depression better than Lamictal, I’m surprised to read this.

“According to the new DecisionBase report entitled Bipolar Depression: Turning Physician Insight into Projected Market Share, Seroquel’s advantages over Lamictal include the more profound effect on depressive symptoms seen in short-term trials.”

My doctor precribed Lamictal to me for management of depressive symptoms in bipolar disorder. He conversely prescribed Seroquel for mania (and to help me get sleep).  Getting back to the short-term trials, Lamictal was tested for 18 months for long-term management of bipolar disorder. Seroquel, however, was tested for 8 weeks. Effective for the short-term? Perhaps. But most patients on atypicals take them long-term. And that’s precisely where Seroquel fails.

“The drug’s efficacy on this measure differentiates it from other therapies, according to thought-leading psychiatrists, and the importance assigned to this measure by prescribing psychiatrists drives Seroquel’s product score above Lamictal’s.*”

According to thought-leading psychiatrists who probably function as consultants and analysts for “large pharmaceutical companies.” Seroquel may have the potential to sell more than Lamictal by 2010 – if this is what DR’s gauging. However, it seems like DR is trying to push Seroquel, not just as a better market share, but as a better product. In this “report,” DR also fails to compare Seroquel’s efficacy to Zyprexa’s. What a convenient absence for a product used for psychosis in bipolar disorder.

(ignore any spelling errors in this post. it’s late and i bumped my forehead against the edge of a car door in the rain. ouch.)

Blogs: Tracking Effexor Withdrawal

I really should have posted on this a LONG time ago, but Graham’s Blog has done an unbelievable job of tracking his Effexor withdrawal symptoms. Something I learned today:

"| Night Sweats – I had this very bad, constantly wake up drenched in sweat,
literally soaked to the skin and to the mattress. But Have just realised I have
not had these severity of symptoms for some weeks, which is helping with the
consistency of sleep."

Ohh, so that’s why I wake up drenched in sweat in the middle of the night regardless of whether it’s warm or cold in my room. To quote Dawdy over at Furious Seasons, like Paxil, it truly is the "gift that keeps on giving." Hooray for long-lasting effects from psych meds! [sarcasm] Now, I’ve got this occasional twitch in my cheek. I took Paxil for about 3 months in 2003 and I still get eye twitches that I never had previous to the medication.

Check out Graham’s Blog and see the hell that Effexor can cause. Stephany at soulful sepulcher tracks some helpful tips for withdrawing from a psych med.

Pristiq's FDA Chances: Depression – Yea; Menopause – Nay

As more info on Pristiq continues to roll out, I'll do my best to track them quite closely.

While Wyeth scrambles to resolve issues in its Puerto Rico plant to meet FDA standards, Ms. Kathleen Kerr of Newsday recently reported on Pristiq's potential to be approved for use in depression and hot flashes resulting from menopause. I was so excited to see some decent reporting on a mental health issue in a paper other than the NYT. It was also nice to see that it didn't end with "Shares of Wyeth fell 38 cents Friday to close at $51.50 on the New York Stock Exchange."

"If Pristiq wins Food and Drug Administration approval, it will be the first antidepressant and only non-hormonal remedy marketed specifically for hot flashes. But Pristiq isn't without problems – it poses rare suicide risks in young people."

Read the rest of this entry »

Mind Over Matter, Pt. 2

Perhaps I've written about this previously. Perhaps I haven't. Regardless, I'll tackle it anyway.

Some people with a mental illness who hear what I'm about to say will tell me I'm crazy. Perhaps I'd get "partially correct."

Read the rest of this entry »

Catching up: Furious Seasons

I’ve been out of it. Really out of it.

In my backlog of reading, Furious Seasons has posted the results of what he’s entitled, "The Zyprexa Chronicles."

The judge ruled in favor of Lilly.

Holy crap. I knew this would happen, but hoped it wouldn’t.

This all occurred on Feb. 13, so I’m really behind the times here. (Did Punxsawtawney Phil see his shadow yet?) But it’s a reminder to, not just the blogosphere, but also to the media that, well, pharma companies are more powerful and have more sway in court.

After reading a bit more on the situation (ok – I’m getting all my info from ONE blog), it seems that the judge hasn’t really ruled against blogs using or disseminating these documents (MindFreedom.org being the exception apparently) but these leaked documents could cause Lilly "irreparable harm." What? Documents that need to be made public would harm Lilly? It’s David against Goliath. Mainstream media — CBS, ABC, NBC, AP — haven’t picked up on this story. The majority of Americans – I’d venture to say the majority of Zyprexa consumers – don’t know about the proven side effects of this drug. I highly doubt it would cause "irreparable harm."

Classic quote:

"The way reporters work is a good deal for the public. We get paid like school teachers, think like lawyers and detectives, fight like Marines when necessary and write like… oh, nevermind."

Man, ain’t it the truth. Especially the schoolteacher pay. Except in Brooklyn, NY where they’ll pay a starting teacher at $40K because they need teachers in the inner city. But I digress.

"So, Ms. [Marni] Lemons (Eli Lilly spokeswoman), what I reported on yesterday — that your company was talking about potentially downplaying glucose increases noted in studies used to approve Zyprexa for long-term use in bipolar disorder — was based on these documents and it sure looks to me like your employees were strategizing all over the Lilly email system. I contacted your press office on Monday and asked them to respond to several questions about that document. Your people never responded….

The same goes for you people at the FDA. Stop telling me to file FOIAs in order to get basic public information that affects millions of people that should already be freely available on your website."

For those who don’t know, FOIA stands for Freedom of Information Act, in which anyone can write to a governmental agency and appeal for documents that have been made public. The nice part about this? The agency can black out information that don’t want you to know. They can deny your request, block out some data, or block out so much that the document ends up being useless. Oh, and FOIAs take forever and freaking day to arrive because the gov’t sends them when it’s convenient for them.

Furious Seasons has also been following the NYT’s coverage about a child diagnosed with ADHD and bipolar, who was killed and supposedly overdosed on medication. Riiight. Unfortunately, from what I can see – perhaps I’ll find a bit more – the NYT is extensively covering mental health issues. Perhaps they’re getting a ton of hits on the Zyprexa series and have figured out that people actually care about mental health topics. Whatever the reasoning, I’m glad they’re doing it.

Astute observation from Furious Seasons:

"This whole diagnose-medicate-blame-the-"illness"-for-bad-outcomes nonsense has got to stop. It’s bad enough in adults and teens, but in kids it is a complete outrage. It is interesting to me, though, that when a child dies, the skeptical questions are asked. When an adult has awful results from taking Zyprexa, say, or Paxil, the media is largely silent."

More to come on other blogs…

A final update on my Effexor withdrawal

I failed to update on my Effexor withdrawal because, well, you know why.

After three to four weeks, my Effexor symptoms – well, most of them anyway – have dissipated. The brain shocks were gone by early February. The vertigo as of now has completely resolved. (Although I’ll probably still have occasional instances where it may linger.) The dizziness also has lightened up. I can confidently say that I’m pretty much back-to-normal. All cases will differ, but for me, it took about five weeks total to have a complete recovery.

But don’t do headstands after Effexor – whoo, boy, can that throw you for a loop.

Also – it took about four weeks to get the drowsy effect of fluoxetine (Prozac) out of my system. January was an extremely rough month for meds, let me tell you.

Abilify phone booth

Sorry I’ve been away so long again. Work slaughtered me; I had a birthday; and I was depressed for pretty much the entire weekend until today. I’ll probably backlog some posts for the week to catch up. I’ll probably still be slow in responding to comments and e-mails. I haven’t kept up on any blogs. I’ll try to catch up as best as I can. Keep in my mind my depression has side-swiped me (sp?) and I’ve jumped up on my Lamictal from 150 mg to 200 mg. The jump knocked me for a loop yesterday afternoon. *sigh*

In attempt to make up for the absence, I have pictures of the Abilify phone booth that I see on my way to work. They’re not of the greatest quality, but you’ll get the idea. Click on the jump for the pictures.

Read the rest of this entry »

Blog worth checking out

Holly Finch’s blog “Am I Still Me?” is worth taking a look at. She was a survivor in the London bombing that occurred on July 7, 2005 and as a result, blogs about her daily life while suffering from PTSD.

She recently blogged about coming off citalopram (U.S. trademark name: Celexa) and is experiencing some awful withdrawal effects. This makes me glad that I skipped Celexa in the hospital before I met my doctor. He recommended Effexor instead.

Not that it makes a difference really. I just had the privilege of not having two withdrawal symptoms in succession.

Loose Screws Mental Health News

As much as I hate to admit it, the Scientologists have a point.

A group linked to Scientology staged a protest near a school after a student on psychiatric drugs stabbed a classmate to death. The point of the protest was to highlight “the dangers of antidepressants.”

“Several Scientologists held signs that mentioned by name John Odgren, the teen accused in the fatal stabbing. Signs included slogans such as “What psychiatric drugs was John Odgren prescribed?” and “Stop combining drugs to make walking time bombs.”

Odgren, 16, has been diagnosed with Asperger’s syndrome, a mild form of autism, and according to his attorney was taking several prescription medications at the time of the stabbing. Odgren lived in Princeton but attended a special education program at L-S.”

I didn’t know that psychiatric drugs made people homicidal. I guess if they can make people suicidal then homicidal isn’t that far off.

“’There’s a lot of concern around the country when kids are becoming violent on psychiatric drugs,’ said Kevin Hall, the Scientology group’s New England director.”

Concern from who? This is probably something I should look into. See my favorite quote below:

“This is not a serious request by a serious group,” said School Committee Chairman Mark Collins on the demand that Odgren’s medical records be made public.”

Ouch. Scientology dismissed in one sentence.

UPDATE: Psychiatry drugs supposedly have no violent effect on children. But there are two sides to the debate.

Version 1 —

“Though the Food and Drug Administration currently includes a warning, called a ‘black box warning,’ on SSRIs stating studies have shown increased risk of suicide, particularly among teens and children, [John Fromson, chair of the psychiatry department at MetroWest Medical Center] said there are no studies which show the drugs cause violence toward others.

‘Violence is a social issue here,’ he said. ‘Illicit street drugs can do that…but to make a connection between medication that’s prescribed for legitimate reasons and at appropriate doses and violence – the scientific evidence just isn’t there.'” [emphasis mine]

Version 2 —

“Advocates like Lisa Van Syckel, however, insist the drugs can lead to violence, because they’ve seen it firsthand.

Van Syckel’s anti-depressant ordeal began seven years ago, when her then- 15-year-old daughter Michelle was prescribed the SSRI Paxil for depression and anorexia.

Over the next year, Van Syckel said, she attacked her brother, she viciously attacked three police officers, she went after another student with a baseball bat and she cut the word ‘die’ into her abdomen.

After nearly a year on the medication, doctors changed Michelle’s diagnosis to Lyme disease, and gradually weaned the teen off the drugs, and Van Syckel said Michelle has been herself ever since.”

Perhaps the scientific evidence isn’t there because clinical studies don’t track adolescents long enough to determine whether a propensity toward violence to others significantly increases.


A Mexican man who tried to commit suicide became a victim of police homicide. (Weird.) He threw himself on the train tracks in the Mexico City subway and was eventually rescued by station employees. After two policemen took him into custody, they allegedly beat him to death inside their patrol car. It’s so sad that this man had a second chance at life and two stupid policemen took it away.


I didn’t know this was possible:

“A 23-year-old man who sold a lethal cocktail of drugs as “suicide pills” on the Internet was sentenced by a court in Germany on Wednesday to three years and nine months in prison. The man pleaded guilty to 16 counts of the illegal sale of pharmaceuticals, a spokesman for the court in Wuppertal said.”

Wow. Who does a Google search for “suicide cocktail” or “lethal drug cocktails”? Isn’t it easier (and cheaper) to do it the old-fashioned ways: crash a car, hanging, jumping off a bridge…? Not advocating suicide, but I don’t understand why people need to pay for suicide. Maybe they’re wussies like me. But that’s what overdosing on pills is for.  The Captain Obvious quote of the day:

“Suicide and assisting suicide are not illegal in Germany.”

Maybe I should move to Germany. (KIDDING. Just kidding. Sort of.)


50 Cent’s producer Disco D (Dave Shayman) killed himself on January 23. Although not much is known about his death, there is speculation that Disco D had bipolar disorder.

“DJ Vlad, a good friend of D, was shocked upon hearing the news.

‘Disco D was a good friend of mine. I lived with him in Brazil for a couple weeks. He was a real artist,’ Vlad revealed. ‘I just talked to him a few days ago, and he told me things were hard. I tried to cheer him up. I didn’t realize how hard it really was. I’m devastated right now.’”

No one really knows how difficult it is for someone struggling with depression and suicidal thoughts unless you’ve been there.


An article from IHT details interesting research that Harvard’s McLean Hospital is conducting to find out more about genetic schizophrenia.

“Consider, said Deborah Levy, the lab’s director: ‘The incidence of schizophrenia is stable at about 1 percent, and schizophrenics have very low reproductive rates. So what is keeping those genes going? One hypothesis is that most of the people carrying the schizophrenia genes are not the patients. Rather, they are some of the well parents and well siblings, most of whom never show signs of the illness.’”

Hmm. Is that why I’m an only child?

“The effects of such genes may show up in a variety of subtle ways, they say – including faulty eye-tracking and asymmetry in facial features so hard to detect that it is best measured by highly specialized 3-D cameras.

At Levy’s lab, people with schizophrenia and their relatives undergo 10 to 12 hours of tests. … The faces are measured in minute detail by Curtis Deutsch, a genetics expert who focuses on facial variations and their links to various diseases. … So, subtle abnormalities in the shape and layout of a face may reflect specific abnormalities in brain structure, he said. Thus far, he said, he has found that some schizophrenics do have certain minor facial anomalies – none of them visible to the naked eye – as do some of their healthy relatives.”

So it’s possible that facial features and movements could provide a clue to schizophrenic genes or perhaps increased risk for schizophrenia. The article’s pretty interesting. Go read the rest of it.

Neuronetics TMS at the mercy of FDA's PMS

Today just wasn’t a good day for Neuronetics.

After the long-awaited hearing date for FDA approval, Neuronetics’ TMS (transcranial magnetic stimulation) device got shut down. Hard.

As I’d previously mentioned, CLPsych immediately reported the outcome of the FDA hearing. A juicy quote from a report he linked to:

"The majority of the panel—made up of an engineer, several psychiatrists and neurologists, and a statistician—had no problem with rTMS’s risks. There are almost none. The biggest worry with it is that it might accidentally spark a seizure, but that did not happen even once out of the 155 patients treated. The problem was that Neuronetics couldn’t prove any benefit. Treated patients got a little better, but so did those patients that underwent a sham treatment."

Cool. Placebos work just as well as the cure.

PharmaGossip tackles antipsychotics meds

Nice post by PharmaGossip on antipsychotics:

"Some newer antipsychotic medications approved to treat schizophrenia and bipolar disorder are being prescribed to millions of Americans for depression, dementia, and other psychiatric disorders without strong evidence that such off-label uses are effective, according to a new analysis by the Department of Health & Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ)." [emphasis kinda mine]

The rest of the post is quite informative. Head on over there to read more.

Pessimists get heart disease while Lexapro's "better" than Cymbalta

If view the glass as half-empty, you may be at increased risk for heart disease. An essay, published via the NYT, explains the findings of a study.

"A study by researchers in the Netherlands has found that people who are temperamentally pessimistic are more likely to die of heart disease and other causes than those who are by nature optimistic."

While people with depression are at a higher risk for poor health, pessimists apparently are too.

"Dr. [Eric J.] Giltay and his colleagues found that subjects with the highest level of optimism were 45 percent less likely than those with the highest level of pessimism to die of all causes during the study.

For people who already have well-documented heart disease, depression increases the risk of death about threefold."

Dr. Richard A. Friedman, author of the essay, get to the heart (npi) of the matter: screen pessimists for depression.


CL Psych wrote about how Lexapro’s data beat Cymbalta’s data but in a semi-shady manner. My mind can’t comprehend all the scientific math and data behind this so feel free to read his post and ask him your questions.

intueri hits the spot

Oh. My. Goodness.

Abilify phone booth (side view)Intueri originally wrote the post about seeing Abilify on the side of a phone booth. I thought it was pretty funny and pretty stupid.

I still find it stupid, but even more so now.

I was on the bus heading to work today (I don’t normally take it) . When it reached a red light near the subway, I saw a telephone booth – akin to the one that you see on the right – draped in an Abilify ad. The ad is exactly what you see here. (If you can’t see it, go to Abilify.com and click on the “see our print adverisement!”)

I work near two major colleges with students who all have cell phones. Adults in the area are too busy thinking about their own problems while heading into the subway. (They, too, are likely to own cell phones.) Public telephones are rarely used anymore. So who’s going to read an ad on Abilify, let alone on a public telephone booth?

Some marketing person at Bristol-Myers Squibb probably thought it would be awesome to have an ad for Abilify near two major colleges. “All the college kids that walk by will see it!”

The readable text – from the bus, anyway – was “Treating bipolar disorder takes understanding.”

Understanding of what? Who’ll actually stand there and go, “Yeah, I need understanding” and walk right up to it to read more.

    • “where you’ve been
    • where you want to go
    • how you want to get there”

I’m ready to understand my history, my future, and the plans I should make. Uh-huh, Abilify will help me do that.

“Ask your doctor or health care professional if ABILIFY is right for you.” [emphasis mine]

The bus didn’t stay there long enough for me to see if they included the safety information, but here’s the gist of what they provide:

    • “Acute manic and mixed episodes associated with Bipolar I Disorder
    • Maintaining efficacy in patients with Bipolar I Disorder with a recent manic or mixed episode who had been stabilized and then maintained for at least 6 weeks “

Someone can explain the last part to me a little better? I’m a mixed-episode case, do I qualify for Abilify?

I was under the impression that Abilify (aripiprazole) is an atypical antipsychotic. Antipsychotics should be prescribed for those who have psychosis. (I may be wrong here; I’m still trying to figure out the difference between typical and atypicals.) I don’t have psychosis. I don’t need Abilify. But the few bipolar people who will read that ad – they’re likely to be homeless – will be misled into thinking that they need Abilify to help them. They’ll go their doctors, saying, “I’ve heard Abilify helps people with bipolar disorder, could I perhaps try it?” PCPs will immediately churn out prescriptions and uneducated psychiatrists (yes, they are out there despite their degrees) will say, “Sure, Abilify works for bipolar disorder. Let’s see if it works for you.” The smart psych would say, “I’m not sure if it would be right for you. It’s an atypical antipsychotic that targets Bipolar I patients who have symptoms of psychosis. Let’s try something else instead.”

So I went on my soapbox. Again. But it angers me to see:

    • An Abilify ad on a phone booth. Period.
    • A misleading advertisement geared to all people with bipolar disorder (it doesn’t specify until you get to the fine print) that says, “Try this; it may work for you.”
    • An advertisement for medication. At all.

What’s next? A marketing blitz by Eli Lilly? “Zyprexa doesn’t cause diabetes! Check out zyprexafacts.com for more information!”

Big Pharma never fails to surprise me.

Awaiting FDA approval for TMS treatment

Neuronetics will find out today whether the FDA will approve its TMS (transcranial magnetic stimulation) device to treat depression. If I haven’t got the time, I’m sure CLPsych will get on this. I’d like to delve into this a bit more considering I live relatively close to the Malvern, Pa.-based company… (The journalist in me gets her hopes up for probably nothing.)

'Dr. Titrate's little helpers'

Even if it’s the last thing you do, please go read this. I can relate to this girl in many ways (unfortunately). It’s a long read, but well worth it. Choice quote:

"Stoked by Dr. Titrate’s little helpers [Adderall and Dextrostat], I hosted my own college radio show and called it “The ADD Hour.” Naturally, “The ADD Hour” lasted just nine minutes, and I played only the first eighteen seconds of every song."

Which brings me to another thought: no one calls ADHD ADD anymore. A Google search for "ADD" produced meager results. What gives?

2nd-generation Celexa, or TC-2216

Targacept is in the process of developing a “new class of [oral] drugs known as NNR (neuronal nicotinic receptor) Therapeutics.” They’re starting the first phase of a clinical trial called TC-2216 that targets depression and anxiety treatment.

“The trial is designed to evaluate the safety and tolerability of TC-2216 and to assess its pharmacokinetic profile. The trial is a double-blind, placebo-controlled crossover study, with sequential ascending single oral doses administered to healthy male volunteers.”

The next paragraph in the press release (basically) that I got this from goes on to explain that the new compound focuses in on the central nervous system and mood-regulating neurotransmitters, blah, blah, blah.

“In preclinical studies, TC-2216 showed greater potency than and anti-depressant effects comparable to selective serotonin reuptake inhibitors and tricyclics, which are commonly used treatments for depression, as well as anxiety-relieving effects.”

Because every new product in the clinical trial phase and has yet to receive FDA approval is better than everything currently out on the market. Of course.

“In November, the company announced positive top line results from a Phase II clinical trial of TRIDMAC, a treatment combination comprised of mecamylamine hydrochloride as an augmentation therapy to citalopram hydrobromide, in patients who did not respond adequately to citalopram alone. Mecamylamine hydrochloride binds non-selectively to various NNR subtypes, but there is a body of scientific evidence that suggests that its anti-depressant activity is derived through its antagonism at the alpha4beta2 NNR.”

What’s that mean? They’re basically working on Celexa II if people were treatment-resistant to the original Celexa. Like many other drug companies, they’re patenting a similar version of Celexa once Celexa’s eligible to become a generic brand.

“‘The results of our TRIDMAC trial not only substantiate the promise of the NNR mechanism in the treatment of depression and other mood disorders, but also further bolster our enthusiasm for the potential of TC-2216 said J. Donald deBethizy, Ph.D., Targacept’s President and Chief Executive Officer.’”

That’s a pretty bold statement for a company that’s just in Phase I of a clinical trial.

Loose Screws Mental Health News

A new Canadian study has found that most workers who struggled with depression had job performances were affected. (Nothing new here, right?)

“On average, the study says, depressed workers reported 32 days in the past year during which symptoms had resulted in ‘their being totally unable to work or carry out normal activities.’”

Seems like people really are taking ‘mental health’ days these days.


Bahrain is having a problem with Indians committing suicide in the country. In January, so far, three Indians have killed themselves. Triggers leading up to the suicides are theorized to be “mental or economic depression, stressful working conditions, low wages and poor housing.”


According to Dr. Brian Doyle, people with ADHD are at a higher risk for mood disorders such as major depressive disorder.

“In a recent study, 38.3% of individuals with a primary diagnosis of ADHD during the previous 12 months also had a mood disorder, compared with 5% of subjects who didn’t have ADHD.   The reverse is also true; individuals who have major depression are likelier to have ADHD than other persons.   In a Massachusetts General Hospital survey, 16% of adults with a primary diagnosis of major depressive disorder had a lifetime history of ADHD.”

Maybe I’m tired right now, but I couldn’t wrap my head around those statistics. Basically, if you’ve got a primary diagnosis of ADHD, you’re likely to have a mood disorder; if you’ve got MDD, you’re likely to also have ADHD; and if you’ve got a primary diagnosis of MDD, you probably have had ADHD for pretty much your whole life. That’s a lot to swallow.

“I am trying to screen more of my depressed patients for ADHD — especially if the patient’s depression is not responding well to treatment. The standard ADHD rating scales are a good place to start.”

I’ve heard it’s hard to screen adults for ADHD; on the flip side, I’ve also been told that it’s more difficult to find ADHD in women than in men. Dr. Doyle’s definitely on the right track here in keeping his eyes open for better ADHD screening. Perhaps I really do have ADHD.


While many celebrities are “outing” themselves on their depressive episodes, Dr. Deborah Serani’s got a list of other well-known people who have either admitted to or speculated to have experienced depression.


I’m late on the bandwagon with this but a study released in December shows that displaced women in Darfur suffer from severe depression. According to an article in Ms. Magazine:

“The International Medical Corps (IMC) posits that women’s multiple roles in society, along with constant stressors like low socioeconomic status, domestic violence, and the threat of rape when venturing outside, may account for the poor mental health of these displaced women. Women’s restricted access to education may also affect their ability to access proper care and make informed decisions about their own physical and mental health.”

And to think those of us in developed countries have problems.

“Almost one-third (31 percent) of women surveyed met the criteria for major depressive disorder while 63 percent reported suffering the emotional symptoms of depression. Five percent reported suicidal thoughts, 2 percent had attempted suicide, and another 2 percent of households had a member commit suicide in the past year. Nearly all of the respondents (98 percent) felt that counseling provided by humanitarian agencies would be the most helpful way of dealing with these feelings.”

It’s good to see that an overwhelming majority of women feel that counseling would help them. Sometimes, people in Western/developed countries take therapy for granted.

“Though depression rates are comparable to, or even lower than, those of other populations displaced by similar conflicts, the rates of suicide and suicidal ideation are ‘alarmingly high in contrast to general rates worldwide,’ according to the report.”

This, unfortunately, makes sense. Suicide is a reaction to ending constant pain. I admire women in Darfur who choose to live despite never-ending pain.  This article puts me to shame somewhat. I am incredibly blessed to have all the amenities of this country and encouragement and love from family and friends. However, I feel pretty stupid when I fall apart over minor things compared to the women in Darfur. It’s an awful cliché, but “I really do have a lot going for me; why am I depressed?”


ViagraFor men: Are you depressed and can’t get an erection? Don’t worry – Viagra can kill two birds with one stone!

A Canadian study (yes, another one) says that Viagra (sildenafil) can help improve mild depression and, of course, aid impotence in men.

“Dr. Sidney Kennedy and his team studied 184 men who had had erection problems for about four years and also met the criteria for minor, but not major, depression.

[After six weeks of treatment], the 98 men who received sildenafil had a 47 per cent reduction in their depression scores, indicating a change from mild to minimal depression. In comparison, men taking placebos had only a 26 per cent decrease in their scores, which remained in the range of mild depression.”

Pfizer’s getting their sales reps started on this one. Expect to see reps carrying Viagra brochures and info to psychiatrists eventually.

Pristiq gains ground with FDA

FDA approval for Pristiq (I'll refer to it as Pq occasionally) is contingent upon Wyeth's handling of "quality control problems… made to the satisfaction of federal inspectors." As I'd previously mentioned before, Wyeth has built an amazingly similar medication based on Effexor. Wyeth is trying to market Pristiq as an antidepressant and treatment for vasomotor symptoms (hot flashes during menopause). Wyeth is significantly banking on Pristiq since their $3.5 billion Effexor XR will lose its patent in a few years, allowing other companies to make venlafaxine generics.

Some of the "quality control" problems Wyeth is experiencing:

  • unclear whether Pq keeps depressive episodes at bay
  • efficacy at low doses and in young kids
  • severe nausea in 50 percent of patients in the clinical trials

Reuters' article notes this, though:

"But the studies do not need to be completed prior to approval of the new depression pill."

While Wyeth has admitted that Pq is "structurally related" to Effexor, it "has not yet disclosed if Pristiq has any advantages over Effexor XR, other than to say it would be an alternative to existing treatments."

But it has acknowledged the newer drug caused nausea in about one-half of patients in clinical trials.

Wyeth is banking on patients sticking out the nausea for one week (it supposedly subsides after that) or a 50 mg pill that would be more effective than the whopping 400 mg they used in earlier phases of the clinical trials.

"The company said it will not launch Pristiq until it obtains results from the low-dose trials. Moreover, Wyeth said the timing of the launch also will depend on progress of the FDA's ongoing review of Pristiq as a possible non-hormonal treatment for hot flashes. The FDA is scheduled to decide on the hot flashes indication in April."

Wyeth wants to be absolutely sure they can cover all of their bases in an effort not to lose a single portion on their market share — from those who can tolerate low doses at 50 mg to those who need to go 400 mg and up.

"A G Edwards analyst Joseph Tooley has predicted Pristiq will garner annual sales of $1.4 billion by 2011 — about $1 billion from use against depression and the remainder for menopausal symptoms."

Getting not only psychiatrists to prescribe the drug, but also OB/GYNs is a clever move on their part.

Loose Screws Mental Health News

Wow. I learned something new – “Women are over-represented in all cases of” depression, anxiety, dysthymia and panic attacks. Read more here.


An interesting observation from Gretchen Rubin, blogger of The Happiness Project.

“Studies showed that depressed people have as many nice experiences as non-depressed people, but they remember them less well.”


Graham’s Blog has linked to interesting fashion jewelry: Made with Molecules. For only $20, you can:

“Display your favorite neurotransmitters close to your brain!”

Erhm. The very thought of this disturbs me. Also feel free to purchase a serotonin-happiness card or a dopamine-heart card – just in time for Valentine’s Day.

dopamine heart card

Pfizer is cutting 10,000 from its workforce citing nothing other than loss of profits:

“The drug giant Pfizer said Monday that it would lay off 10,000 workers and close several manufacturing and research sites in an effort to bolster earnings hurt by the loss of patent protection on certain drugs and by setbacks in developing new products.”

I’ve mentioned patent protection before but it seems that Pfizer isn’t generating enough “structurally related” drugs to prevent the loss of its profits to generics. The two biggest losses: Zoloft and Zithromax.

“Pfizer said the moves would save $1.5 billion to $2 billion a year in pretax expenses.

Pharmaceutical industry analysts have generally been welcoming cutbacks by Pfizer but have said that while cost-cutting is beneficial, the company needs to resume growth by bringing new products to market.”

Pfizer’s a big company; I’m sure they’ll have no problems rebounding. However, I have no doubt that the failed torcetrapib factored into Pfizer’s decision to cut staffers.


A Philly plaintiff in the Vioxx suit against Merck has willingly withdrawn her suit. She cannot refile against Merck.

“Merck has consistently said it will fight each case on a one by one basis rather than submit to a large settlement.

In trials that have reached a jury verdict so far, Merck has won nine and lost four, including one Merck victory that since has been thrown out.”

The legal fees surrounding the Merck case must be astounding, but is it really worth it for Merck to drag these cases out against 27,000 other plaintiffs? I would assume on Merck’s part that it would be cheaper to settle. But then again, maybe it’s the whole “we need to clear our name” thing. That’s a fast way to lose profits for a pharma company.

Eli Lilly: Zyprexa causes diabetes; Byetta can help

I found this Bloomberg chart in the Metro Philly newspaper and thought it showed an interesting paradox. I tried to find a link for it on the Internet but as of yesterday, there was none.

Eli Lilly's Byetta

Loose Screws Mental Health News

Since I was born on Groundhog Day (Google it if you don’t know when it is), I found this story about a groundhog so endearing. (And I make sure to turn around on my birthday to see my shadow.)

Cate BlanchettIf you’re over 50 and on antidepressants, look out – you might be doubling your risk for osteoporosis. Fracture risks seem to be unrelated to falls caused by dizziness and low blood pressure. CLPsych’s analysis is also worth a read. (Many thanks to Bob Thompson for the link.)

People has an article on Cate Blanchett talking about marriage:

“Getting married is insanity; I mean, it’s a risk – who knows if you’re going to be together forever? But you both say, ‘’We’re going to take this chance, in the same spirit.’”

Read the rest of this entry »

Loose Screws Mental Health News

According to a press release (I’m well aware what I’m saying), a recent study possibly shows that schizophrenia’s physical effects are more widespread in the body; researchers previously theorized that schizophrenia was limited to the central nervous system.

“The findings could lead to better diagnostic testing for the disease and could help explain why those afflicted with it are more prone to type II diabetes, cardiovascular diseases, and other chronic health problems.”

Apparently, those who suffer from schizophrenia have abnormal proteins in the liver and red blood cells. While schizophrenia’s most visible effects are psychological, researchers have noted that schizophrenics are at a higher risk for “chronic diseases.” The genetic and physical implications of such a study could prove interesting, especially for those suffering from and at risk for schizophrenia. Also in schizophrenia news, researchers have noticed an “excessive startle response.” The startle response, known as prepulse inhibition (PPI), is being considered as a biomarker for the illness.

Something Furious Seasons might like to argue if he hasn’t taken the following on:

“Lastly, but quite importantly, atypical antipsychotic were found to be more effective than typical antipsychotics in improving PPI, thus ‘normalizing’ the startle response. This led the authors to note:

‘Because an overwhelming number of patients with schizophrenia are currently treated with atypical APs, it is possible that PPI deficits in this population are a vanishing biomarker.”

What’s the advantage with atypicals vs. typicals? How do they work differently? *sigh* I need a pharmaceutical-specific wikipedia.

Schizophrenia News previously wrote about how proof is lacking in schizophrenia developing in those who have suffered from child abuse. (Excuse me for the awful construction of that sentence.) However, a new study shows that those at a high risk for schizophrenia benefit from having a good relationship with their parents during childhood. Read more.

Editor and Publisher has noted that suicides among Army soldiers doubled in 2005 compared to 2004.

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UPDATE: Venlafaxine withdrawal symptoms

I previously wrote about how fluoxetine helped smooth out my withdrawal from venlafaxine. I’m doing much better and am able to function.

What’s the update then?

I’ve got lingering side effects from either the fluoxetine or the venlafaxine – I’m not sure which.

somnolenceThe lingering somnolence/grogginess for about a week or so can definitely be attributed to fluoxetine. I’d never struggled with somnolence on any med except when I first started Effexor in the hospital. Grogginess has never been a problem except for my antihistamine medication hydroxyzine.

The brain shocks still linger. They’re not as bad nor are they frequent. I can walk around, turn, spin – no problem. But if I’m in the middle of walking  down the street and turn my neck slightly to see if a car is coming before I cross – *zap!* – brain shock. That’s all I get for the rest of my 15-minute walk. I’d say that’s pretty good (considering what I’d previously endured).

Dizziness, vertigo, and light-headedness: those are much more frequent. As I sit here and type, my entire field of vision can swirl clockwise and return to normal via counter-clockwise. It happens for about 3 seconds or less, but it’s long enough for me to notice and go, “Whoa.” (Who needs recreational drugs when you’ve got withdrawals from psych meds?) These side effects are not as frequent as they used to be with the direct venlafaxine withdrawal, but they can occur about 30 times or less throughout a 17-hour day (7 a.m.-12 a.m.) for me.

I’ve read that people can use fluoxetine to offset venlafaxine withdrawal symptoms with relatively uneventful side effects. Somnolence was not a fun side effect. Just a warning.

Keep an eye out for schizo/psychosis drug bifeprunox

Someone get this on Furious Seasons’ radar:

Wyeth is also in development for an atypical antipsychotic, bifeprunox, for schizophrenia. Bifeprunox has no trade name yet.

“Bifeprunox, a dopamine partial agonist, is an investigational atypical antipsychotic for the treatment of schizophrenia. Clinical data were presented from safety and efficacy studies that evaluated bifeprunox for the treatment of schizophrenia in both acutely psychotic patients and patients who have stabilized disease.

While bifeprunox has been shown to have a smaller mean effect in acute psychosis when compared with older atypical antipsychotics that have some well-known side effects, it may be particularly well-suited for patients who are experiencing side effects with their current therapy. The safety data for bifeprunox have consistently shown a favorable weight and metabolic profile in both short- and long-term studies, which is a common and serious side effect that can cause patients to stop taking their medication.”

A few questions on Wyeth’s schizo drug:

  • How long before this is marketed to bipolar I’s with psychosis?
  • Older atypical antipsychotics or older typical antipsychotics?
  • I’d like to see the data on weight and metabolic profiles on this. Most APs don’t have a good track record with weight, i.e. Seroquel, Abilify, Zyprexa.

Bifeprunox will developing over the coming months and years. I’ll probably check out clinicaltrials.gov in the future to check on updates.

Pristiq posing as pristine

The Trouble With Spikol has linked to an article in the San Diego Union-Tribune (via Reuters) that covers Wyeth's new Effexor XR knock-off, Pristiq (desvenlafaxine succinate). Why are they launching Pristiq? Their patent on Effexor will expire in July 2010 when making generic versions of the drug will be up for grabs.

"Wyeth said in July, however, that it will not introduce Pristiq until it completes tests of a low 50-milligram dose of the drug, following trials of higher dosages in which about half the patients experienced nausea."

Too bad clinical trials don't test for withdrawal symptoms. Will Pristiq avoid the withdrawal hell issues that Effexor XR has?

“'We will wait for the results of the low-dose trials, which we've said we expect in early 2007, before making a decision' on when to launch Pristiq, company spokeswoman Gwen Fisher told Reuters on Friday.

She said nausea seen in the earlier trials was mild to moderate and generally went away within a week after treatment began.”

How long were these clinical trials and if the nausea was seen in the "earlier trials," what about the most recent trials?

Pending FDA approval, Wyeth would also like to use Pristiq for vasomotor symptoms in menopausal women.  Wyeth's unannounced strategy will be to introduce Pristiq long before Effexor's patent expires so they don't lose any of their $1 billion market share to an Effexor generic.

A Wyeth PR that went under my radar:

“Pristiq, a serotonin/norepinephrine reuptake inhibitor (SNRI) now is being studied with a specific focus on women. It initially was developed for two indications that currently are pending approval from the U.S. Food and Drug Administration (FDA) – the treatment of major depressive disorder (MDD) and vasomotor symptoms (VMS) associated with menopause. 

In the area of depression, Pristiq is expected to improve the balance of serotonin and norepinephrine as compared with serotonin reuptake inhibitors (SSRI) because of its pharmacologic profile as a dual reuptake inhibitor.”

Isn’t that what SNRIs are supposed to do?

“Clinical studies confirm that Pristiq is effective in both men and women. However, women over age 40 represent about 50 percent of the depression market and could benefit from an antidepressant that addresses their symptoms and physiology.”

No kidding – 50 percent of the depression market and the implication of all women over 40 years old? Sure, I believe that. Looks like Wall Street doesn't have much hope for the new drug either.

“Pristiq also may be a treatment option for patients who are on multiple medications. The compound has a low risk of drug-drug interactions. This is important when considering that depression often is a co-morbid condition in medically ill patients and that these patients frequently are taking multiple medications. The Company expects FDA action for the MDD indication in January 2007.”

The multiple medications thing. Um, I’m not a fan of that unless it’s absolutely necessary. It isn’t necessary in a lot of cases.

“FDA action for the second application for Pristiq for vasomotor symptoms associated with menopause is anticipated in April 2007. Pristiq is expected to provide significant relief of hot flushes (decrease in number and severity) associated with menopause.

If approved, Pristiq will be the first non-hormonal treatment indicated for relief of VMS.

The Company also plans to pursue indications for Pristiq that would include fibromyalgia syndrome and diabetic neuropathic pain.”

Wyeth certainly is attempting to milk this new drug for all it’s worth. I hope Furious Seasons or CLPsych take up on investigating this one since I simply don’t have the time, resources, or ability.

Seroquel abuse and medication weight gain

SeroquelFurious Seasons has blogged about Seroquel (quetiapine) in the past and he recently posted on Seroquel abuse in an Ohio prison. Apparently, inmates have been snorting the atypical antipsychotic, also known in slang terms as “quell” or “Susie-Q.” Excerpt from Furious Seasons:

“Second, we all know that Seroquel is regularly handed out to bipolars and depressives and people with anxiety in order to address insomnia, as opposed to the kind of underlying psychosis/mania issues you’d expect it to be used for. PCPs hand it out this way and so do psychiatrists. What I have noticed among friends who’ve been given Seroquel for sleep issues is that they end up, over a few months time, needing more and more of the drug in order to get an effect. Or, put another way, people keep complaining of problems with sleep despite taking, say, 300 mgs. of Seroquel and their doctor will keep upping the dose to get the desired effect. As a result, I have seen people with very mild bipolar disorder wind up taking 800 mgs. of Seroquel a day–that’s roughly the same that a schizophrenic in a state hospital would get–and still they get no results, aside from putting on tons of weight. I have heard this from other readers of this blog as well.”

My aunt, who works in the psych wing of a hospital, warned me that she’s seen patients on Seroquel gain weight. A man I met at my Bipolar and Depression Alliance Group last night gained 60 lbs since taking Seroquel. I can’t image that everyone who takes Seroquel overeats to a point of obesity and leads a sedentary lifestyle. I have a random theory that Seroquel signficantly slows a person’s metabolism down to the point where it is difficult for a person to lose weight.

Read the rest of this entry »

Neurontin: Pfizer and Eli Lilly share a common history

My mother-in-law was telling me yesterday about how her hairdresser’s daughter has been diagnosed bipolar with OCD characteristics. She says her daughter’s on “Neo-something” – she couldn’t quite remember the name.

I racked my brain for a bipolar med name that began with “n.” Nothing really came to mind except for neurontin. I told myself, “No, that can’t be right. Isn’t that associated with VNS?”

Nope; Neurontin really is a medication associated with bipolar disorder. Neurontin’s generic name is gabapentin.

Neurontin (gabapentin)

Read the rest of this entry »

Pharmaceutical roundup

AbilifyNearly every mental health blog I know is talking about this post from intueri.org. It’s definitely worth the read. I don’t know much about Abilify, but I don’t think most uneducated bipolars know that it is prescribed specifically for those with psychosis. On the flip side, I don’t think uneducated PCPs know that tidbit either. A person with bipolar without symptoms of psychosis who asks for Abilify may be in for a rude awakening. [UPDATE: Who paid this chick? I only skimmed the post but I don’t see any negative side effects listed.]

I’m not deep into the pharmaceutical industry like all of these heavyweights: CL Psych, PharmaGossip, and Furious Seasons, among many others whom I may have failed to mention. However, there’s a wealth of information to be found. My newest discovery:

“The approach is called ‘ethical pharmaceuticals,’ and it was unveiled on January 2 by Sunil Shaunak, professor of infectious diseases at Imperial College, and Steve Brocchini of the London School of Pharmacy, the Guardian reports. Their team of scientists in India and the UK, financed by the prestigious Wellcome with technical assistance from the UK government, have developed a method of making small but significant changes to the molecular structure of existing drugs, thereby transforming them into new products, circumventing the long-term patents used by the corporate giants of Big Pharma to keep prices – and profits – high. [emphasis mine] This will give the world’s poorest and most vulnerable people access to life-saving medicines – now priced out of reach – for mere pennies.”

I read the above on CLPsych’s blog (originally from Chris Floyd at truthout) and couldn’t believe what I was reading. It somewhat ties into what I’ve been researching about Neurontin (which will probably be posted later in the day):

“Pfizer has developed a successor to gabapentin [Neurontin’s generic name], called pregabalin (being marketed as Lyrica®). Structurally related to gabapentin [emphasis mine], pregabalin is effective for neuropathic pain associated with diabetes and shingles, and for the treatment of epilepsy and seizures.”

Pfizer, in an attempt to distance itself from the trouble surrounding Neurontin, developed another medicine – pregabalin, which is similarly structured to gabapentin. Pfizer can now claim, “Don’t like Neurontin? You can have Lyrica instead!” Pfizer also tried to pass off the (illegal) off-label marketing practices with Neurontin off to their acquired division Parke-Davis. So now we’ve got two options: Pfizer either has learned from Parke-Davis’ issues with Neurontin or is pretty stupid and pushing Lyrica for off-label usage similar to that of Neurontin’s. No evidence to support either option… yet. But CLPsych delves into an interesting practice that Pharma companies use to circumvent a drug patent running out:

“News Flash — PhRMA does NOT believe in the free market: While PhRMA likes when the market works in their favor, they also believe in circumventing that same market when it comes to competition. When drugs are slated to come off-patent, which would allow generic version of the drug to be made, PhRMA members have increasingly turned to buying off the competition. That’s right; they simply pay the generic manufacturer to not make a generic version of the patented drug, so that the consumer can continue to pay a hefty price for the drug which is still under patent. [emphasis sorta mine]

Wow. That bit of information has left me speechless. Screw the consumer that can’t afford psych meds without health insurance; we as Big Pharma need our DAMN money!!! [end rant]

This practice, called “reverse payments,” is not something new and, at the current moment, is relatively legal. Supposedly, the FTC and the Department of Justice are keeping their eyes on reverse payments and patients can only imagine what might occur in the future. PharmaGossip has more, but slips this bit of info before linking to the Star-Ledger:

“And with the patents on 70 blockbuster drugs — with a total of $48 billion in annual sales — set to expire by 2011, the industry expects reverse-payment deals to proliferate further.”

The FTC and Justice Department better hurry up and step in so we can finally have a generic version of Lipitor!

In all honesty, my mind can’t simply fathom the depths to which Pharma will stoop to make money. (Perhaps because I don’t work directly within the medical industry.) It has me wondering if Pharma is worse than gas companies. Is OPEC more trustworthy than Eli Lilly? I’ll leave it up to you to decide.

Loose Screws Mental Health News

According to the NIH, mothers can ward off postpartum depression by taking a prenatal vitamin to boost low iron levels. Mothers with iron deficiency were twice as likely to be at risk for PPD. Also, in case you didn’t know, counseling can help or stave off PPD as well.

Another NIH study has suggested that people who don’t respond to antidepressants could be aided by an injection of ketamine. Ketamine is primarily used for anesthesia. According to researchers, a dose of ketamine helped improve more than half of the participants’ mood in 2 hours (all 7 of them) while 71 percent felt better after 24 hours (all 13 of them). Supposedly, the effects lasted for a week for a third of the participants (all 4 of them). That’s very nice and all, but I’m looking forward to the follow-up study that analyzes ketamine’s long-term effects and safety.

A departure from news — are you bipolar? Take this quiz to figure it out! (P.S. Don’t take the quiz seriously.)

Dawdy over at Furious Seasons writes about a recent study that ties smoking with a “heightened risk of suicide in patients with bipolar disorder.” And an excerpt of his conversation with a DEA agent at the end of his post is awesome.

I’m also behind on reading many of the blogs on my blogroll so I’m doing my best to catch up – sorry for the delay…

Loose Screws Mental Health News

Starting off with some crazy (npi) mental health news, psychotherapists are now beginning to diagnose depression and anxiety in infants. Yes, infants. Before you know it, newborns will begin suffering from post-traumatic stress disorder after enduring complications during delivery. Fetuses will suffer from depression due to lack of exposure to light.

I’m all for diagnosing mental illness in children, but infant depression? Unless it’s mistreated, the concept is ridiculous.

“He says he doesn’t put babies on the couch. Instead, he observed Jayda through a one way mirror. He was looking for clues on why she wouldn’t bond with her mother, Kari Garza.”

What?

“Psychologist Douglas Goldsmith says ‘even by the first birthday, some of the research is saying we should be able to start to see signs of more serious social disorders.’

There are some warning signs to look out for, such as a lack interest in sights and sounds. Others include of lack of desire to interact; listlessness; or excessive crying.”

I can’t help but think it’s rooted in a physical rather than a mental problem. I excessively cried for six months as an infant; no knew that I’d developed eczema and the itching was unbearable because I wasn’t able scratch.

“Figuring out what’s depression versus normal behavior is hard, according Pediatrician Linda Nelson of the Franciscan Children’s Hospital, because ‘the crankiness and all of that, teasing that out from true depression, it’s very difficult.'”

Josh of “We Worrywrites:

“I may be way off the mark on this one, but if I’m not mistaken, an infant’s cognitive abilities are incredibly limited and, for the most part, are dictated entirely by instinctual behaviors. It seems that it would be impossible to determine if an infant had depression or anxiety because it’s impossible to ask them.”

Nope, not off the mark at all.


Want to know what dealing with a bipolar is like? The following is dead on:

“Bipolar is a hell of a disease, and I wonder if patients [at my community health center job] knew how devastating it is, whether they’d choose to label themselves that way.

Bipolar used to be called manic-depression. People with bipolar disorder are constantly on a roller coast ride between severe depression and mania. On the depressed end, this can include feelings of worthlessness, excessive guilt, changes in eating (over- or under-), changes in sleep patterns (can’t go to sleep or can’t wake up), and recurrent thoughts of death.

On the manic end, bipolar people experience feelings of grandiosity, believing they’re capable of things nobody can do. At this end of the spectrum they often sleep very little, their thoughts race, and they can’t stop talking. They tend to get involved in risky activities, such as unrestrained buying sprees, sexual indiscretions, or foolish business investments. Some feel more angry than expansive in their manic phase, or when they’re on their way up or down.”

Congrats. You get the gold star. You’ve just learned something today (if you’re not bipolar).


I recently read Graham’s Blog and among a list of meds, I saw “Zispin.”

Whaa?

It’s trademarked as Remeron in the U.S. and Zispin in Great Britain. The generic name is mirtazapine. Sounds like a name for a German lady €“ Fraulein Mirtazapine.

According to the wonderful wikipedia, mirta treats “mild to severe” depression.” That’s a wide spectrum of patients to cover. Mirta is as effective for people with mild depression as it is for those who are dang near suicidal everyday? I’m not convinced.

Of course, since it’s a med, it’s used off-label for panic disorder, GAC, OCD, and PTSD among other health problems.

If you’re you suffer from bipolar and get a prescription for this stuff, get another doctor quick: mania is a side effect.

I won’t get into the fine details of how mirta works, but it appears that it enhances neurotransmitter actions rather than affect serotonin levels directly.

There’s my new medication lesson of the day.


I’m late on the bandwagon, here. I’m sure Furious Seasons, CL Psych, and other blogs have railed on the injustice of Judge Weinstein’s stupid yes, it is stupid decision to uphold his gag order (he imposed it so why would he change it?) that keeps blogs from “dissemination” Eli Lilly’s leaked documents. Basically, the judge wants to block wiki Zyprexa Kills from showing this info. Any other blog that has the documents, links to it, or publishes it is — well — subject to a gag order as well. *gag*

I have a personal opinion on the matter and since you’re reading this blog, you’ll be subjected to it.

Read the rest of this entry »

"Quetiapine comes from the root word 'quiet'"

[UPDATE: I had some funky issues with my table. It should be fixed now. Sorry about that.]

The first time I visited my psychiatrist for my initial evaluation, he gave me the option of choosing one of three medications: Seroquel, Lithium, or Lamictal. He handed me information about Seroquel and Lamictal. I did some research on both meds (lithium was out of the question because I don’t have time to get my blood checked constantly) and Lamictal sounded like a way better deal than Seroquel. I found mental health blog Furious Seasons (probably via The Trouble With Spikol) and read numerous posts on Seroquel’s adverse effects and all the good stuff AstraZeneca doesn’t tell anyone. From Philip Dawdy’s “Seroquel, The Bipolar Pill?” post, here’s what stood out to me:

“He told her that he didn’t think Seroquel worked benignly for patients and that the increased blood-sugar levels and cholesterol levels associated with its use were unacceptable to him. She broke out a recent paper which claimed that there were no metabolic syndrome problems with Seroquel.”

The post got me thinking. One of the materials I received from my psychiatrist was an article on how Seroquel seems to help the depressive part of bipolar disorder. He had a stack of these articles. My guess is not that he’s an overzealous reader of various newspapers but received the glowing article from – you got it! – a pharma rep. The article was taken from the August 2005 issue of Clinical Psychiatry News. (NOTE: I received the article in November 2006.)

Clinical Psychiatry News’ publication goals:

“Clinical Psychiatry News is an independent newspaper that provides the practicing psychiatrist with timely and relevant news and commentary about clinical developments in the field and about the impact of health care policy on the specialty and the physician’s practice.”

Good thing they didn’t say objectively.

I don’t know much about ClinPsych’s reputation and whether they are generally a good paper that reports things objectively. However, the article, “Atypical Quetiapine Appears Effective for Bipolar Depression,” reads like a press release. I’m not happy about receiving (practically) PR material from my doctor when trying to make an unbiased decision.

The article’s lede:

“The atypical antipsychotic quetiapine led to significantly greater reductions in bipolar depression than did placebo within the first week of treatment and throughout an 8-week randomized, controlled study of 511 patients, Andrew J. Cutler, M.D., said.”

Dr. Andrew CutlerDr. Cutler? Who IS Dr. Cutler? No research necessary; look no further than the article itself:

“The differences between the placebo group and each quetiapine group were significant at each weekly assessment, said Dr. Cutler of the University of South Florida, Tampa. He is a speaker and consultant for, and has received research grants from, the company that makes quetiapine: AstraZeneca.”

At least they disclosed his financial affiliations.

It is also worth noting that Dr. Cutler also founded a clinical research company, CORE Research, which runs many of the clinical trials that he’s involved in. CORE Research’s background details:

“CORE Research, Inc. is a private research company with three offices in the Central Florida area. CORE specializes in pharmaceutical research and psychopharmacology for mental illnesses such as Bipolar Disorder, Depression, Anxiety, Schizophrenia, Attention Deficit Disorder, and Insomnia.”

Private + Pharmaceutical research + Psychopharmacology = Funding from Big Pharma Companies

I sound like I’m touting some grand conspiracy theory. (OK, maybe I am.) CORE’s background bio makes the company sound objective and unaffiliated, which isn’t the case. If Dr. Cutler has “received research grants from” not only AstraZeneca, but other companies, it’s in his best interest to make sure that their pharmaceutical products turn out OK. Namely in the interest of AZ – remember: he’s a consultant for them.

How can I expect to make a decision about which medication to take (remember it’s between Lamictal and Seroquel now) based on promotional materials from pharm companies and – oh – an article touting the benefits of Seroquel with quotes only from the study’s lead author who is paid to say good things about the company’s products?

I didn’t.

Then how did I decide on Lamictal over Seroquel? Wikipedia‘s outline of each medication’s side effects, of course, in addition to other materials. (Don’t EVER overlook the Patient Safety Information of any medication. Unless you’re reading about the molecular structure – ignore that.)

Lamictal (lamotrigine) side effects Seroquel (quetiapine) side effects
Headaches Sedation
Insomnia Agitation
Insomnia Constipation
Major weight loss Memory problems (i.e. anterograde amnesia)
Blurred/double vision Headaches
Muscle aches Abnormal liver tests
Lack of coordination Dizziness
Sleepiness Upset stomach
Nausea Substantial weight gain
Vomiting Stuffy nose feeling
Rash (Stevens-Johnson syndrome) [uncommon in adults] Neuroleptic malignant syndrome [rare]
Binds to melanin-containing tissues (i.e. iris of the eye) Tardive dyskinesia [rare]
Diabetes [unclear]
Cataracts [possible]

Not that Lamictal’s side effects looked like a walk in the park, but considering that I’d already had awful trouble with weight gain on Paxil and Lexapro – nearly 50 lbs. – Seroquel was a serious no-go on my part. That and I don’t mind major weight loss from Lamictal. (Although I have been told Lamictal has no effect on weight.) Below is a copy of the article I received from my psychiatrist or you can just go and read the archived full text at Clinical Psychiatry News.

Quetiapine article

Loose Screws Mental Health News

Yeah – the copy editor in me wants to try “Loose Screws News.” For now.

Clinical Psychology and Psychiatry is among many of my favorite blogs to read. In this particular post, he rips on Eli Lilly’s zyprexafacts.com, which was set up in response to NYT articles that alleged Lilly drug reps pushed Zyprexa to physicians for off-label uses. I hope to just have a stupid ol’ time and rip on each Eli Lilly press release in response to each NYT article, but we’ll see what happens. I’ve already got one lined up with notes scribbled on the printout; I just need to transfer it into electronic form. (Oh, the joys of being a transit commuter.)

Liz Spikol linked to an article originally published in bp magazine about how difficult marriages are when one spouse suffers from bipolar disorder. The saddest statistic I’ve ever read:

“In the United States and Canada, at least 40 percent of all marriages fail. But the statistics for marriages involving a person who has bipolar disorder are especially sobering—an estimated 90 percent of these end in divorce, according to a November 2003 article, ‘Managing Bipolar Disorder,’ in Psychology Today.”

Um, joy considering that I’m I suffer from bipolar and have been married for just over a year now. This strikes incredible fear in my heart. It’s not that we don’t love and care for each other, but I can only imagine how much a spouse who doesn’t suffer from bipd can take. I hate to say it, but I keep waiting for my husband to walk out on me. Not because I’m pessimistic (OK, I am, but that’s beside the point), but because I fear that he’ll reach a point where he’ll say, “I can’t take anymore of this! I’ve dealt with this for 10 years and nothing’s changed, nothing’s getting better. I’m sorry, but I can’t be married to you and deal with this anymore.” Just waiting.

Kelly Osborne Retarded celebrity story of the day: Kelly Osborne suffers from depression because she’s so privileged. But hey! — she’ll pose for Playboy and get photoshopped so she can feel better. *gags*

If you’re mentally ill and fired for it, don’t bother suing. It looks like the mentally ill don’t have a case unless there’s a physical illness to somehow “prove” it:

“Sixteen years after Congress enacted the Americans with Disabilities Act (ADA), people with psychiatric disabilities are faring worse in court cases against employers for discrimination than are people with physical disabilities, researchers have found in a national study.

‘People with psychiatric disabilities were less likely to receive a monetary award or job-related benefit, more likely to feel as though they were not treated fairly during the legal proceedings and more likely to believe they received less respect in court,’ said Jeffrey Swanson, Ph.D., a study investigator and an associate professor of psychiatry at Duke University Medical Center.”

I’m not sure how to solve this problem. Psychiatric disabilities are less tangible and harder to prove than a physical disability. It’s easier to wage war against a company if you suffer from a bad back vs. if you suffer from depression. (Whether or not the bad back is a fictional illness is up to you.)

Another oy moment. (The Long Islander in me is coming back full force.) Got a pet that’s misbehaving? Put him or her on an antidepressant. Double oy.

New Zealand is being introduced to lamotrigine (trade name Lamictal in the U.S.). Good luck, bipolar New Zealanders. Best wishes.

And finally, a study has discovered that about half of patients who suffer from some kind of severe burn suffer from clinical depression. (Shouldn’t someone diagnose this as PTSD? That’s pretty traumatic, if you ask me.) While the finding isn’t surprising, the study highlights the need not only to treat the physical ailment, but also to address the mental healing necessary to overcome stress from the injury.

My semi-daily fluoxetine update

Okay, the brain shivers are gone. Completely. I still get some vertigo and light-headedness but it happens maybe three times a day max. So fluoxetine has eliminated some of the effects.

I wasn’t prepared for fluoxetine’s side effects, however. And boy, it’s got some kickers.

Since I was on an incredibly low dosage (10-20 mg), there weren’t many side effects.
But boy, is somnolence kicking my butt.

After becoming used to waking up before I’m supposed to, now I’m having the opposite problem: I can’t get up at all. I need my husband to drag me out of bed. And since he’s so nice, he doesn’t do that either.

Argh. As of Friday night, I’ve stopped taking fluoxetine so I’m praying to God that these side effects will go away. I hate somnolence. I’ve had that issue with hydroxyzine (Atarax) and it’s the same reason that I refuse to take quetiapine (Seroquel). I’m getting sleepy right now. If I can get up before noon, I’ll be so freakin’ lucky.

The metabolism aspect of fluoxetine doesn’t make me jump for joy.  According to my favorite “reputable” site, wikipedia:

“Fluoxetine is metabolised to norfluoxetine, and it may take up to 1 to 2 months for the active drug substance to disappear from the body.”

I don’t know if I can tolerate somnolence for 1-2 months. I hope the side effects from this is out of my system by the end of the week.

Come to think of it: somnolence vs. brain shivers?

I’ll take somnolence ANY DAY.

Loose Screws Mental Health News

Liz Spikol linked to this and I can’t believe I missed it: Poorer mental health for black Caribbeans.

“The longer Caribbean immigrants who are black stay in the United States, the poorer their mental health, according to a study.

Prior research has shown that black Caribbean immigrants differ from African-Americans in various measures of physical health, but little research has been done on differences in mental health.

‘What we found was that ethnicity matters a lot in the black population in the United States for mental health risk,’ [lead author David R.] Williams said.”

This is certainly a study that should yield interesting results. As a first-generation African-American with West Indian parents, I can definitely see the higher risks of mental health problems in my own family. Not only is it an ethnic problem, but it also is rooted in genetic causes. My maternal line has no history of mental illness (the DSM threw out homosexuality a while ago), but my paternal line has many cases of mental illness – almost all of them developed after immigrating to the U.S. From what I understand, my grandmother suffered from some kind of mental illness and out of her eight children, three of them developed mental illness, including my father.

I’m mainly interested to see what kind of effect this could have on first-, second-, and third-generation blacks of Caribbean ancestry and what correlations result from immigrant relatives who developed mental illnesses in the U.S.

Before leaving office, Gov. George Pataki signed a bill into law that requires commercial insurance policies to pay for mental health care just like care for physical illnesses. (Pataki has been slightly redeemed in the sight of a former New Yorker who suffered under his reign.)  Since this is news from Dec. 23, you might have to pay $4.99 to read the article, but as of Jan. 9, the article is still available for free. Read a few excerpts below:

“Most commercial policies already cover mental health treatment, which the governor said had helped allay his concerns about cost, and so do government programs like Medicare and Medicaid.

Business organizations – whose members pay for most health insurance – and insurance companies generally oppose these kinds of mandates. But they did not work against the mental health bill this year, after small employers were exempted and after coverage that would have mandated treatment for alcohol and drug addiction was taken out of the bill.

An employer with fewer than 50 workers could opt out, but the insurer would be required to offer a policy that covered mental illness. The law pledges that the state will develop a method to help small businesses pay for that coverage if they choose to buy it.

There were at least 17 other states that mandated some kind of mental health coverage, but not full parity with other health benefits.”

I'm glad that the state has offered to help small businesses pay for mental health coverage if employers choose to provide it. It would be difficult for a small business to pay for health insurance – let alone mental health! – for 50 employees or less. However, it's an important investment in employees that small businesses and large corporations can't afford to overlook.

As for treatment for substance abuse, the state is doing a major disservice to employees who struggle with these issues. More employees are likely to suffer from some kind of substance abuse problem and the lack of coverage for treatment is a step backwards. During my mental health treatment, I've noticed that mental health problems sometimes accompany substance abuse. If a patient can't obtain substance abuse coverage, then the entire problem isn't solved. I can only hope that an amendment mandating substance abuse coverage is added to the bill in the future.

The American Foundation for Suicide Prevention provides their take on the bill:

"The law requires insurance companies to cover 30 inpatient and 20 outpatient days of treatment for mental illness. Companies must fully cover "biologically-based mental illnesses" including major depression, obsessive compulsive disorder, anorexia and binge eating. Timothy's Law would also require coverage for children with attention deficit disorder, disruptive behavior disorders or disorders that include suicidal symptoms. The measure is expected to increase premiums about 3 percent and no more than 10 percent, while providing a much wider array of mental health services.

Timothy's Law took effect on New Year's Day and will last for three years. The Legislature will make a decision about continuing the law in 2009. New York is the 38th state to enact mental health parity."

Fluoxetine helps offset Effexor withdrawal

ProzacGreat news: I upped my dosage took 20 mg of fluoxetine last night and the Effexor brain shivers have completely worn off. My cognitive functioning has completely returned and I’m no longer afraid of passing out when walking or turning to talk to someone. I’ll probably take another 20 mg tonight and call it a day for fluoxetine. (Thank you Dr. Ivan!)

So it’s true: If you’re experiencing Effexor withdrawal, ask your doctor or psychiatrist (whomever you’re seeing for mental illness) for 20 mg of fluoxetine and take it for about 2-3 days.  This may not work for everyone (especially those who may be treatment-resistant) but I’m confident it can work for the vast majority of sufferers. I’ll tell you later if I have a suicidal relapse; I’ll be on the alert for the next two weeks. That’s how long it took me to have a relapse when I quit Lexapro cold turkey.

Many thanks to Furious Seasons for the shout-out.

UPDATE: An old post from a blog detailing an Effexor withdrawal experience. I was on Effexor for about 3 months and the withdrawal effects were essentially the same.

Patient Responsibility

“An article on brain shocks from about.com linked to a statement at socialaudit.org.uk on venlafaxine withdrawal. It seems that when coming off of venlafaxine, it is best to use fluoxetine (Prozac) in conjunction with it. Somehow, Prozac’s effects can minimize or negate the side effects of Effexor allowing for an uneventful withdrawal. I’m seeing my psychiatrist later today and I might bring up the idea with him. He might think one of two things: a) I’m crazy (pun not intended) or b) I don’t know what I’m talking about. My guess is he’ll choose the latter of the two.

Unlike most patients, I know more about meds than ‘the average bear.’”

UPDATE: I asked my doctor about going on fluoxetine to offset the effect of venlafaxine withdrawal. He looked up, somewhat shocked, and said, “Yeah.” So then I pushed and said, “Well, I’d like 10 mg then.” lol. He wrote out a prescription for 10 mg of Prozac in addition to bumping me up from 150 mg to 200 mg of Lamictal. I took the fluoxetine (Prozac is now a generic drug) last night and it has offset the intensity of the brain shocks. I experience them but they are much more mild compared to yesterday when they were moderate to severe. Yesterday, I was barely able to drive; today, I drove nearly an hour to work on a somewhat urban road with good reflexes and almost normal cognitive functioning. I can only hope that the Prozac continues to aid my withdrawal issues. And I was happy to wake up this morning without wondering why I dreamt that I was in a department store with parrots singing Gwen Stefani’s “Wind It Up” and swinging like moneys instead of flying.

You get the idea: Effexor causes some strange dreams.

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Venlafaxine withdrawal symptoms

Work has got me busy, folks, so posts may drop significantly in the next coming days/months. Possibly through April or May. (I’ll probably have one of those work days when I end up doing more blogging than working. It happens every now and then.) But don’t be surprised if Saturday quotes, Wednesday puppies, and Sunday stats are what pops up each week. I’ve got many of those backlogged through April. I’ll try to backlog some other posts on bipolar disorder and depression for the coming weeks and quickly blog on anything that’s timely.

electric shockIn the meantime, I had to take a sick day today. It’s my third day off of the Effexor and I’m having some weird side effects (see Case 1: Standard Dose under the link). Whenever I turn or move too quickly (consider your “natural” body turn), I “kind of” see stars and the whole world slightly spins beyond my field of vision for about 3 seconds before coming back into focus. After doing some light research on the side effects of venlafaxine (Effexor’s generic name), I’ve found out that side effects can incude vertigo, dizziness, light-headedness (associated with dizziness), and something called “brain shivers,” which are a form of electric shock sensations. You know that feeling when you get an electric shock from somebody? Yeah, imagine feeling that throughout your whole body. Precisely; not a good feeling. Nancy Schimelpfening, blogger for depression.about.com, found a newsgroup posting on the brain shiver effect, mainly associated with venlafaxine:

It happens to me if I turn my head quickly, or if I stop suddenly, or in general with sudden motion. They’re worse if I’m nervous.

i’ve seen them described as feeling as though your brain keeps going when you turn your head. that doesn’t seem quite adequate to me. it’s more like this:

you turn your head (or your whole body — this happens to me if i whirl around too quickly as i’m taking the stairs. what. doesn’t everyone whirl on the stairs…?), but your brain *stays put* for a micro second, then tries to catch up but only in a stuttering, stopstart motion, accompanied by a staccato ‘zzt zzt zzt’ with each stop. the ‘zzt’ you can feel in your head, an electric sort of vertigo, and it often reverberates in your hands and fingers. some folks feel it in their toes; i haven’t yet.

sometimes your brain overshoots and comes strobing back, then overshoots again.. this all unfolds in just a second or two.

these days i endeavor to go around corners all smooth slow and steadylike. helps to reduce the number of brain shivers per day

Yeah, that’s me. It’s hard to explain to someone who’s never felt it. I got this feeling after not taking Paxil for three days too. The effects eventually wore off, but it was such a weird feeling.

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