Saturday Stats

"In 2001, firearms were used in 54% of youth suicides." – National Center for Injury Prevention and Control

Suicide: Understanding and Intervening – Part III

A “situational crisis” may lead a person to have “intense psychological pain.” As a result of this psychological pain, a person can begin to experience “distorted thinking” and/or may “abuse medication.”

1. Situational crises

These include financial problems, illness, bereavement, relational conflict, or public humiliation. Black notes that situational crises tend to act as a “catalyst to suicide,” driving the person to believe he or she has no other solutions to solve his or her problem(s).

2. Severe psychological pain
Black gets to the heart of suicide attempts:

“The goal of suicide is often simply to end that pain: ‘I just want the pain to go away.’ … ‘I just want to die’ most often means, ‘I want to stop feeling bad.’”

This, above all things, is the biggest reason behind a suicide attempt. If people felt like they had other options to their problems apart from suicide, most would take the alternate routes. In a suicidal moment – whether planned or not – the suicidal person is thinking about ending the “pain.” Death itself is not the goal; it’s an end to emotional pain. Death seems to serve as a means to that end.

3. Distorted Thoughts
Distorted thinking is a characteristic of suicides. Black writes:

“Problems may seems catastrophic when they are not. Predictions about the future can become arbitrary and unrealistic.

While problems get unbearable and circumstances may seems bleak, instead of looking for assistance, those who are suicidal convince themselves that only death or loss of consciousness can release them from emotional pain.

4. Abuse of medication
A person who attempts to overdose on medication seeks one of two things: death or loss of consciousness. Abuse of medication that requires hospitalization provides a legitimate reason to “escape” the problems of life. Abusing medication is a person’s way of saying that he needs, as Black puts it, “an emotional vacation.” The person feels overwhelmed by the stressors of life and temporarily need to block out all distractions. At this point, it is safe to say a person is mentally ill. The need for escape from problems is the mind’s way of saying that it needs time to recover and become mentally healthy again. Abusing medication is the desperate way of doing this.

Suicide: Understanding and Intervening – Part II

In 10 years of struggling with suicidal thoughts, I’m practically a “suicidal” expert. (I said "practically," not actually.) I know quite a bit about suicidal ideations and many of the thought processes behind them. Jeffrey Black lists more common features in suicidal thinking:

  • Extreme psychological pain related to unmet psychological needs.
  • A view of self that says she cannot tolerate such intense pain.
  • An overwhelming feeling of hopelessness, and the belief that she is helpless to solve problems.
  • A sense of isolation or desertion accompanied by the belief that others cannot, should not, or do not want to offer support, nurture, or care.

Not all suicides are planned. I, for one, can attest to the fact that they can be impulsive. The combination of elements that Black identifies can seem to lead someone to a suicide attempt. Black’s pattern of identifying someone who possibly could have suicidal tendencies is as follows:

  • Sense of hopelessness
  • Pattern of poor coping skills
  • Limited tolerance for pain
  • Need to flee from help

All four are likely to be present to classify someone as suicidal. Two out of four does not a suicidal person make. Desperate, yes, but not undeniably suicidal.

“Hopelessness can be both a source of psychological pain and a result. A person’s belief in her inability to change things is probably bound up with her experience that the pain is intolerable.

Here’s the equation for a suicidal mind, here is the equation:

problems + inability to change problems = intolerable pain.

If the equation becomes problem + inability to change problems + intolerable pain, then the only solution – as perceived – is suicide. Black breaks down the facets of suicide:

  • The result of a continuous transaction between a person’s heart
  • The symptoms of depression
  • The kinds of stressors in the person’s environment
  • The strategies a person uses to cope with depression and other life events

A person turns to suicide if he is suffering from severe depression; has poor coping strategies; feels that his stressors are too much to handle; and in his heart, has decided that as a result of these circumstances and feelings, he must end his life.

Puppy of the Week

Pitbull (courtesy The Daily Puppy)
Pitbull

Suicide: Understanding and Intervening – Part I

Black’s Common Features of Suicidal Thinking

  1. Bitterness
  2. Anger
  3. An unwillingness to forgive
  4. The “last word” in argument
  5. A way to punish someone

“Romans 1 suggests that a person – believer or unbeliever – who contemplates suicide must actively suppress the Spirit’s testimony that he is a creature made in the image of God, living in dependence on him.”

“Actively suppress” is a strong statement. If it means a person is aware of this suppression, then I’d disagree. Some people may be aware of this but that isn’t always the case. Black emphasizes suicidal believers are made in the image of God and insinuates that suicidal attempts are willful acts of disobedience:

“We want to demolish the idea that someone who takes his life is a sad, wounded, and weakened victim, and that suicide is a noble expression of his fragility and God’s failure to rescue him.”

While suicide is not a noble expression of fragility, suicide shows a suicidal person and those around him how weak he is. This is not “weak” that describes someone with a character flaw; those referred to as weak are those who need emotional help. Those who are emotionally stronger are able to encourage someone who is emotionally weak. A man who takes his life may have been sad, may have been wounded, and may have been weak – but God’s grace was not beyond him and what is perceived as God’s “failure” to rescue him was still within God’s control. (I won’t get into the fine details of why He allows some people to live and some to die in this post.)

Suicide: Understanding and Intervening – Outline

While the book had me put off, I did glean a couple of things from it, mainly things that pertain to Christians who struggle with suicidal ideation.

“The paradox is brought into full focus when a suicidal Christian wants to know if she will lose her salvation if she kills herself. The contradiction in her thinking – that the same God who has the power to condemn her eternally doesn’t have the power to help her now – seems lost on her.”

The key here for Christians is to focus on “the Way, the Truth, and the Life.” This is especially difficult to do when a person doesn’t know the next path to take, what to believe, or desperately wants die. The Biblical view of Christianity holds that a person who has trusted in Jesus Christ as his Lord and Savior and commits suicide is not condemned to hell. However, the booklet deals with issues leading up to this point and does not focus on suicide per se.

While suicide is viewed as a psychological act born out of a depressive state, the author correctly states it is “the act of a sinful heart.” All Christians must come to terms that many mental illnesses are a result of a sinful, fallen condition. Christianity rejects the teaching that “all people are inherently good.” From a Biblical standpoint, that’s a fallacy. Psalm 53:3 reminds readers, “There is none who does good, not even one.” Those who believe in God must accept that they are fallen, sinful creatures incapable of consistently doing good in and of themselves. Depressive and suicidal tendencies stem from this sinful nature.

Black quotes G.C. Berkouwer:

“One cannot find sense in the senseless and meaning in the meaningless.”

Life as a non-Christian can be senseless and meaningless because there seems to be nothing to live for other than the self. A belief in Jesus Christ as Savior gives life a brand new sense of meaning. But even a Christian can lose track of that. Again, the inability to remain focused on God stems from a sin nature.

Black uses the apostle Paul as an example of someone who overcame trials, hardships, and suffering. In II Corinthians 4:17, Paul refers to his suffering as a “light affliction, which is but for a moment.” Black outlines how Paul is able to regard trials as light, momentary afflictions:

  1. Paul lives his entire life with purpose. He endures the suffering because of the good he knows will come out of it.
  2. His life is lived for the future, for a “far more exceeding and eternal weight of glory.” (II Cor. 4:17)
  3. Paul is “strengthened” to face the challenges that God has given him through the Holy Spirit.

While Black explains how Paul overcame his difficult trials with courageous faith, his application flies over the head of any depressed believer. The above may be encouraging to a believer who is disappointed by trials, but it is an application out of the grasp of someone who is suicidal. A more appropriate application would be King David in the Psalms, “Why are you cast down, O my soul, and why are you in turmoil within me?” (Psalm 43:5) or rather Elijah, who after a great spiritual victory, prays to God, “It is enough; now, O Lord, take away my life.” (I Kings 19:4) Perhaps even a suicidal person can relate to Job, “"Why is light given to him who is in misery, and life to the bitter in soul, who long for death, but it comes not.” (Job 3:20-21) Black overlooks believers with applicable moments of despair and opts to use the apostle Paul as example for hope. Here, the cliché is applicable: a person must go through the darkest part of the tunnel before he can see the light.

Not only did I feel as though Black throw Paul’s example in for a “See? This is how a true believer should act,” he immediately delves into how “suicide is a sinful act.” Pitting depressed people against a great apostle like Paul is just an awful reminder that they just don't “stack” up. Contrasting a suicidal person with a spiritual giant is yet another reminder as to why he needs to die, not to live. As I mentioned before, using Elijah, David, or Job would have been a more empathetic approach.

An underlying base of suicide is selfishness. Black capitalizes on this thought:

“My goal is not simply to get the person to repent over a specific act of lawbreaking (suicide), but to undermine his pattern of sinfully self-centered rationalization.”

He adds that suicide is an “expression of self-centeredness contrary to our position as creatures responsible to a Creator.” Suicidal thoughts remove God from being the primary focus of life and make people gods in their lives. Suicide seems like a noble way of dying (a form of narcissism) while it is essentially a slap in the face to God. Suicide says to God, “I don’t trust that you can help me through life so I’m taking matters into my own hands,” whether the individual is aware of God or not.

"Thinking Blogger Award"

Thinking Blogger Award

Silver Neurotic at The Post-College Years has awarded the “Thinking Blogger Award” to me. I’m not a fan of memes anymore (e.g., I posted this and the five specified people should post it too), but I thought it’d be a good way to recognize other blogs that I try to read (when I can these days). I inevitably will leave off tons of others that I read just as often so please don’t be offended!

1. Furious Seasons – Mental health journalism at its best. ‘Nuff said.

2. Clinical Psychology & Psychiatry: A Closer Look – Detailed analysis of drugs and drug company news. Between CLPsych and Furious Seasons, I’ve got my daily dose of psych drugs covered.

3. Bipolar Blast – Gianna views mental illness and treatment with a new (and fresh) perspective. Her detailed and thorough analyses leave readers with new information and many answers.

4. soulful sepulcher – Stephany chronicles her journey of mental illness while also taking care of her daughter who has been put through the mental hospital wringer. Many of her stories are shocking and saddening, but she also provides glimpses of hope and joy. soulful sepulchre also doesn’t fail to keep up on pharma tricks and trends.

5. Honey’s Journey – “Honey’s” mom chronicles her daughter’s journey of recovery after taking Zoloft. This is a great blog to read if you want to learn more about the withdrawal effects of antidepressants. (I’d also recommend Graham’s Blog for the same reason too.)

Oops, I threw in a sixth. Oh well. See below.

The participation rules are simple:
1. If, and only if, you get tagged, write a post with links to 5 blogs that make you think.
2. Link to this post so that people can easily find the exact origin of the meme.
3. Optional: Proudly display the ‘Thinking Blogger Award’ with a link to the post that you wrote.


You can let the blogs above know about this post, I need to get to bed, like, 2 hours ago. I only did this because it didn’t require much brain power. (I’m all thought-out from my long work days!) I’ll be taking a break from pharma posts for a bit until my job’s busy season is over. (Can’t wait for May…) Delayed response to e-mails for the same reason… 😦

Also, I’m working on another series about codependency (aka “people-pleasing”) and how it contributes to depression for many people. (This is what I do with my free time during my train commutes.) Stay tuned…

Suicide: Understanding and Intervening – Introduction

“Won’t you share a common disaster? Share with me a common disaster. Oh, a common disaster.” – Cowboy Junkies, “A Common Disaster”

SuicideI receive weekly counseling at CCEF (Christian Counseling and Education Foundation) in Glenside, Pennsylvania, The foundation has an outreach program called Resources for Changing Lives that publishes educational material on different topics. One of the small booklets I purchased was “Suicide: Understanding and Intervening (SUI)” by Jeffrey S. Black. The booklet is a tad bigger than a 3 x 5 index card and consists of 31 pages. Of all the things I read in the book, the last paragraph stood out in my mind:

“In the years I have been involved in biblical counseling, I have not completely fathomed the hopelessness and despair in a believer that makes death more attractive than life. I pray that my inability is not merely a lack of empathy for someone who struggles. I hope that it is a vision for Christ and his kingdom that keeps the true ‘meaning’ of suicide out of my reach.”

While I understand Mr. Black has years of counseling those who struggle with suicidal ideations, I can’t help but wonder: What made him qualified to write this book?

In reading SUI, I felt as though the author took an objective stance in writing this. It came across as matter-of-factual rather than empathetic or sympathetic. I read the book – in all honesty – looking for answers and some kind of sympathy. I only received a slew of answers. The book should aptly be renamed “Suicide: A Factual Guide to Intervention.” No understanding required.

The book wasn’t bad; it just felt like the author wanted to keep his distance. “Don’t get too close to the reader lest you understand what a suicidal person is experiencing!” But the lack of emotion to relate to the reader detracted from many of the positive aspects of the book.

Out of five stars, I give the book three stars. Despite the absence of emotion, the book gives great bits of information I hope to share. As a person who struggles with suicidal thoughts on a recurring basis, the book was a bit of a disappointment. I know of other counselors at the foundation who could have written a more sympathetic book than Mr. Black. But he wrote it, so it’s time to delve into it.

Quote of the Week

"Everything is always okay in the end.  If it’s not okay, then it’s not the end." — Unknown   

Saturday Stats

"Suicide is the eighth leading cause of death for all U.S. men." – National Center for Injury Prevention and Control

The Worst Things To Say To Someone Who Is Depressed: 91-97

This list is divided to have 10 of "The Worst Things To Say To Someone
Who Is Depressed" published each week. To see the entire list: go here. The ones that apply to me are bolded.

91. "Well, we all have our cross to bear."

92. "You should join band or chorus or something. That way you won’t be thinking about yourself so much."

93. "YOU change YOUR mind."

94. "You’re useless."

95. "Nobody is responsible for your depression."

96. "You don’t like feeling that way? So, change it!"

97. "You’re not depressed, you’re just crazy."

This concludes the weekly list of "The Worst Things To Say To Someone Who Is Depressed."

Suicide: Understanding and Intervening Series

Beginning next week, I’ll be unveiling a series on a booklet that I read called, "Suicide: Understanding and Intervening," by Jeffrey S. Black. According to the booklet, Mr. Black pastors Calvary Chapel in Philadelphia and is an adjunct faculty member for the Christian Counseling and Education Foundation’s School of Biblical Counseling. (Since the booklet was written in 1998, I don’t know if the previous sentence still holds true.)

The book is directed at readers who want to know how to help a suicidal person. I quote much of the book and offer some comments, but I also try to add some important pieces that I think Mr. Black overlooked. The booklet relies on the Bible to support many of its points so it is heavily Christian-themed. However, there are other interesting tips that anyone – Christian or non-Christian – can use to help those who are suicidal.

I’ll be honest: I read the book myself, and as a person who struggles with suicidal thoughts, I found it to be disappointing. This probably stems from the fact that suicidal people are not the target audience. Those who care about suicidal people are. Regardless, reading the book allowed me to gain some insight into my thought processes when I become suicidal. These thoughts aren’t evident to me when I am suicidal, but they do occur. Perhaps the coming book analysis can be a helpful tool for readers of this blog, not only for those who want to help suicidal people, but also for those who have attempted suicide and are looking for a way to thwart the process.

Revisited: Twisted Christian Viewpoint on Mental Illness

Many thanks to Gianna for reminding me about this post. It sunk into the recesses of my blog and I’d forgotten about it, I reread it recently and found it incredibly relevant and uplifting. Go ahead and read it for yourself.

Puppy of the Week

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.

Commenter quote of the week

"Marissa, I wonder right along with your wondering -that much of mental illness is a fabrication… and a pharmaceutical gold mine fabrication at that. We (those taking psychotropic drugs/those loving people who are taking them) are pawns in the biggest drug study ever." – "Honey’s" Mom

Indeed. And in this market, Big Pharma are the Kings and Queens of this chess game of life.

Quote of the Week

"The search for happiness is one of the chief sources of unhappiness." — Eric Hoffer

Saturday Stats

"In 2001, 5,393 Americans over age 65 committed suicide. Of those, 85% were men and 15% were women." – National Center for Injury Prevention and Control

Comment on "The Black Dog" Series

In one of my rare (unbacklogged) posts this week, I’m posting a comment from my mother-in-law and father-in-law mostly about Bob’s depression. Read below:

We love, support and encourage Bob and Marissa in every way that we can think of or are asked of. We wish that we had known more of what Bob was going through in his childhood and in his school and college years but he kept it very well hidden. We as parents maybe should have seen through some of what was going on but Bob tells us now that he became a master at keeping it hidden and we are not to blame for not realizing. That doesn’t make it any easier as parents to accept that we were oblivious to our own child’s needs but it is something that we are working on changing and accepting so that we can NOW be there for them, to do all that we can NOW to give them all the backup, encouragement, support and love that we can. There is nothing in this world that we wouldn’t do for our children (including our loving daughter-in-laws). We want the best for them and for their lives, we wish them contentment, stability, happiness, love, an understanding of each other and a willingness to forgive and forget – that they would turn to each other and us but most of all God in times of need. We pray that they will let us “in” and find a need for us as much as we need them. We hope that they can remember to pick their battles – to not sweat the petty stuff, to give and forgive freely and openly to each other and others. Bob and Marrissa mean the world to Dad and I, there is nothing that they can’t tell us, show us, do, think, or act on that would make us turn away from them – we just love them!

Family support is not just a bonus; it’s a real necessity.

The Worst Things To Say To Someone Who Is Depressed: 81-90

This list is divided to have 10 of "The Worst Things To Say To Someone
Who Is Depressed" published each week. To see the entire list: go here. The ones that apply to me are bolded.

81. "What you need is some real tragedy in your life to give you perspective."

82. "You’re a writer, aren’t you? Just think of all the good material you’re getting out of this." (This one makes no DAMN sense. But it’s kinda true.)

83. "Have you tried chamomile tea?"

84. "You will be ok, just hang in there, it will pass." or "This too shall pass."-Ann Landers

85. "Oh, perk up!"

86. "Try not being so depressed."

87. "Quit whining. Go out and help people and you won’t have time to brood…"

88. "Go out and get some fresh air… that always makes me feel better."

89. "You have to take up your bed and carry on."

90. "Why don’t you give up going to those quacks (i.e. doctors) and throw out those pills, then you’ll feel better."

Puppy of the Week

Bipolar I

"You’re manic, manic / There is a chemical in your brain / It’s pouring sunshine and rage / You can never know what to expect / You’re manic, manic" ~ Plumb: Manic

I spoke to someone online in November who asked me if I was bipolar I or II. I was reading the mood-tracking chart that my doctor gave me  (courtesy of GSK via Lamictal) and noticed it mentioned bipolar I.

But I am still left with many questions regarding bipolar disorder:

  • How will it affect me personally?
  • When I have an "episode," what is my husband supposed to do?

The bp diagnosis has explained a lot of things, but prompts so many more questions, which need answers…

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.

Lack of updates this week

Busy week at work means little to no updates perhaps. (I might be able to during lunch.) I’m already trying to catch up on e-mail since I haven’t been able to access my personal account since sometime last week. (Last Sunday maybe?)

Look for more occasional updates next week.

Quote of the Week

"Read not to contradict nor to believe, but to weigh and consider." — Francis Bacon

Saturday Stats

"American Indian and Alaskan Natives have the highest rate of suicide in the 15 to 24 age group." – National Center for Injury Prevention and Control

The Worst Things To Say To Someone Who Is Depressed: 71-80

This list is divided to have 10 of "The Worst Things To Say To Someone
Who Is Depressed" published each week. To see the entire list: go here. The ones that apply to me are bolded.

71. "The world out there is not that bad…"

72. "Just try a little harder!"

73. "Believe me, I know how you feel. I was depressed once for several days."

74. "You need a boy/girlfriend."

75. "You need a hobby."

76. "Just pull yourself together."

77. "You’d feel better if you went to church."

78. "I think your depression is a way of punishing us."

79. "Sh*t or get off the pot."

80. "So, you’re depressed. Aren’t you always?"

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

Puppy of the Week

The "Black Dog," Part III

By the end of March, we decided to get engaged and work out our differences. (I’d move to Kentucky and he’d be open to not having biological kids.) In early July, I quit Lexapro cold turkey. (This, folks, is a NO-NO.) Two weeks later, I had a relapse and attempted to commit suicide. Bob freaked out and called the cops and I nearly lost my job at a prestigious magazine. It wasn’t Bob’s fault; it was mine for quitting a med cold turkey and it was Dr. X’s for not warning me about the potential for suicide attempts on the drug. Perhaps she didn’t know. After all, she kept doling out Lexapro samples to me via the drug rep. When I told her in August that Lexapro wasn’t working, she became skeptical, assumed that I was still being noncompliant and wrote out a prescription for Zoloft. By that point, I was tired of meds. I’d gained 40-50 lbs between Paxil and Lexapro (after being skinny all my life) and still had a difficult time functioning normally. I never filled my prescription.

I moved to Kentucky in September and started a new job in October. After things became a little hectic and overwhelming at work in December, I became suicidal once again. I never saw Bob during the day (I worked second shift into third shift sometimes) so he was able to be depressed during the night and hide it apart from me since I rarely saw him. Bob, fearful of a failing marriage and I’d make good on my promise to kill myself, made the decision for us to move back to his hometown in Pennsylvania in April 2006.

As of January 2006, I knew I needed to be hospitalized and talked about it frequently. However, I felt like I couldn’t: "My job needs me," I said. "We’re understaffed. My job needs me." Even the anxiety of handing in my resignation at a job I hadn’t been employed at for a year gripped me.

We began our job search in the metro Philly area in April and both landed jobs in May. He in the suburbs; I in Philadelphia. My suicidal attempts and thoughts remained with me, but began to increase in August. My sick days became frequent. After a honeymoon at the end of August, I came back in September to a hostile co-worker and a micromanaging, picky boss. Those factors – in addition to whatever I was already dealing with – contributed to taking a disability leave from my job and admitting myself to a psych hospital. I’d been unwilling to do it because I was so busy, but if not, my husband would have been forced to do it for me.

I stayed in the hospital for 7-8 days. The doctor who initially admitted me asked me what meds I’d been on. I said Lexapro and Paxil. I mentioned I didn’t like them. He suggested that I try Celexa in the meantime and that it wasn’t the same as those two. Before I began this blog, I had no idea that Lexapro (escitalopram) and Celexa (citalopram) are virtually the same thing. I passed on Celexa at med times, knowing that my case doctor would be switching me to something different. My case doctor, Dr. S, recommended Effexor XR after I told him that I’d had trouble with Lexapro and Paxil. He said, "Well, it’s an SNRI and functions differently than an SSRI. Let’s try you on that. We’ll start you off at 37.5 mg and get you up to 150 mg by the time you leave."

On the first day of Effexor, I developed severe somnolence that lasted an hour. Later that day and the next three days, I developed severe dry mouth. I’d never known what dry mouth was until then. So I chugged several Snapple Iced Teas a day since water wasn’t available through their vending machines. (Weird, I know.) When I began at my intensive outpatient treatment afterward, a nurse told me that drinking too much sugar can cause the liver to overproduce sugar – if I remember correctly – which can lead to diabetes. *sigh*

Because of a (somewhat) sexual assault incident at the hospital, my release was hastened and I left at 75 mg of Effexor. My psychiatrist at the outpatient clinic titrated me up to 150 mg, which according to him, "is standard. Some patients do better at 300 mg." (!) By the time my outpatient treatment was over, I was steady at 150 mg of Effexor.

In the meantime, my husband was overtaken by all the events that had been occuring since August. (You’d be freaked out too if you woke up to see your spouse trying to hang him/herself.)

In November, he finally admitted to me that he struggle with depression. He began crying all the time over nearly everything. As a computer programmer for seven years, he felt inadequate and insecure at his new job. He cried over my depression. He cried about worsening my depression with his depression. He became anxious over everything. He couldn’t sleep in the event that he’d wake up to see another suicide attempt. He became wracked with anxiety. After much provoking and nagging, he finally agreed to seek treatment in the evening at the outpatient clinic I’d been to. He found it somewhat helpful but admitted that it was difficult to act on what he’d learned.

November threw another curveball at us when my outpatient psychiatrist diagnosed me with bipolar disorder. That finally explained my hostile, irritable, and angry episodes (which normally occurred at night) in addition to my depression. Now, Bob became anxious over the next manic episode that might occur.

Just as he had involved my mother of my situation, I sat down with his parents and spoke with them about Bob’s. His parents seemed taken aback. The quiet, shy kid had all these problems that they’d never known about? His parents and I thought that Bob was freaking out over me and the recent events. Little did we all know that it was simply a trigger. Since I was around Bob all the time now, he wasn’t able to hide it from me any longer.

Despite weekly counseling that we began in August, he still suffers from extreme anxiety. He still suffers from depression with passing suicidal thoughts. He still cries and gets angry over, well, insignificant things. But he’s been brave to admit that he struggles with depression. He’s taken a leap of faith to talk to his parents, his brother, and me about what he deals with and some of what he’s been thinking. Bob has a long way to go, but he’s finally taken the steps forward to recovery.

The "Black Dog," Part II

In February 2004, I tried to kill myself. I don’t remember how now. But he pleaded with me to go see a doctor and get some help. Since I was 21, I no longer qualified under my mother’s health insurance so I tried to avoid docs as much as I could. My pediatric (PCP) doctor continued to treat me despite my age. Dr. X diagnosed me with depression and said, "Since you don’t have medical insurance, I’ll give you some samples of Paxil that a drug rep gave me."

Welcome to the beginning of my first experience with psych drugs.

(Just an aside: Before this, I had never taken medication for depression. My parents wouldn’t let me growing up. In the psych hospital, I said no even though the psychiatrist there gave me a tough time about it.)

I remained on Paxil through July. I wasn’t accustomed to taking medication each day so I’d take it for a day or two on and off. But no more than that. If I didn’t take it for three days, I knew it was time to get back on it. I’d suffer from dizziness and "brain shivers." It was also the first time that I developed eyelid twitching.

I went back to Dr. X and told her that Paxil wasn’t working. She told me that she knew I wasn’t consistent in taking my meds. But she still switched me to another med.

Enter Lexapro in September.

A crucial year in college. I was attempting to graduate that semester, juggle responsibilities as a reporter and copy editor for the college paper, manage a long-distance relationship, and complete a 50+ page honors paper. After accidentally reporting incorrect data on an investigative piece that I thought I’d thoroughly researched, university directors came down HARD on me. The managing editor made it a bigger deal that it really was (according to my teacher and newspaper advisor), freaking me out and sending me into a tailspin. I adhered to my Lexapro regimen much more carefully, but my depression worsened. By the end of October, I’d quit my job at the paper and found myself unable to get out of bed except for late afternoon and night classes. In November, I had to cut back from 16-18 credits down to 12 – just enough to keep me a full-time student. Of course, I didn’t graduate that semester.

I’d went to a psychologist (recommended by my PCP) who gave me "tough love" advice for $75 per half-hour. The "tough love" approach wasn’t for me and actually made me feel worse about myself. I continued to worsen under his care. In February, I switched to a Christian-based counselor and dramatically improved. She listened to me for $75 an hour and at the end of the session, gave me helpful advice. The support of my counselor and boyfriend helped me to get through the trying time. Bob helped pull me through graduation the next semester despite occasional moments of relapsing (into bed).

Bob, not accustomed to the severe depression at first, immediately became frustrated and used the "pull yourself up by your bootstraps" mentality. After all, despite his depression, he was still going to work, still living. When he noticed that strategy wasn’t working, he did some research on depression and became a little more sympathetic.

However, our relationship began taking a turn for the worse: we began arguing about pretty important things – where we’d live and whether we’d have biological children. We took "breaks" on and off and after several attempts at discussing breaking up, we tried to do so. Of course, it didn’t last. His depression kept him from feeling confident in our relationship and his ability to handle my depression. He conveniently left out how he was worried that his depression would conflict with mine.

The "Black Dog," Part I

Men and depression. What a loaded topic. This may be a long entry so brace yourselves.

My husband suffers from depression. He reads this blog and may be embarrassed to some extent since his mother reads it too. But his story (intermingled with mine eventually) is worth sharing because it may help others understand some of the stigma men face. I don’t have the full picture, but I’ll tell you his experience from what I’ve gathered.

My husband, he comments as Bob, slowly began to suffer from depression early in his teen years. As a large boy – as in large, I do mean morbidly obese, unfortunately – he was picked on, teased to no end, and practically tortured. Getting beat up by his brother and cousin didn’t do much to help, either.

Bob, a quiet, shy kid, was able to hide his developing depression well. If he was happy, he had the same sullen face that remained when he was upset or sad. By his senior year of high school, he was the tallest guy in the class, which by that point, people stopped provoking him.

But the hurt and social ridicule remained with him. He went off to college, continuing to be insecure about his weight. He assumed that he wouldn’t make any friends since he didn’t have any after high school. At the end of his sophomore year, he finally opened himself up to friendships with roommates, suitemates, and those who lived within his hall. He’d tried two dates that never worked out. He remained quiet, shy, and girlfriendless. His face remained sullen, garnering the name, “Mr. Happy Face.”

Read the rest of this entry »

Quote of the Week

"Get your facts first, and then you can distort them as much as you please." — Mark Twain

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.

Madonna's Mentally Ill: A Closer Look at Narcissists

MadonnaOK – I admit: I’m a huge Madonna fan. I was crazy enough to plunk down $300 (That I’d saved up for) to attend her most recent concert tour. And while I do like reading about her occasionally about her site madonna.com, her publicist, Liz Rosenberg, took really cheap shots at Britney Spears’ meltdown:

While other gawk-worthy celebs suffer meltdowns or embarrass themselves with ugly epithets, Madonna forever floats above the fray. She has triumphed by keeping her toes planted on the treadmill and her mind firmly on the bottom line.

It’s ironic that a woman who initially rose to popularity on the strength of controversy should sustain that career by clean living.

It makes for a particularly brutal contrast to the woman who looked, just a year and a half ago, like her obvious successor.

When Madonna planted that big wet one on Britney Spears’ kisser at the MTV Awards, everyone viewed it as the ultimate passing of the torch: the grand dame graciously handing off her crown to a new generation’s pop tart.

Now, it looks like the opposite was happening. Madonna was apparently laying down a gauntlet and offering up a challenge. “You’ve had a nice run, kid,” she seems to have been saying. “Now try to keep that up for two more decades.”

That Britney couldn’t even keep it up for one tenth that time – while Madonna blithely re-adjusted her crown and moved on – says everything about the difference between the two stars’ approach to their careers and lives.”

All that was really unnecessary. Perhaps it was a joke? I take everything too seriously these days. Rosenberg is also Madonna’s best friend so this was probably done with Madge’s approval. Essentially Madge/Rosenberg kicked someone while she was already down. As much as I enjoy Madonna’s music, it just shows how insensitive and ruthless she is to this day. (I don’t care who she has adopted.)

“Madonna’s method gave her yet another rousing career resurrection in the last two years. Her just-in-time return-to-the-club album, “Confessions on a Dance Floor,” brought her back to
multiplatinum sales after suffering her one (and only) poor-selling stinker of a CD, “American Life.” Madonna’s subsequent tour, last summer, was the most lucrative of the season.

While Cher has sustained an impossibly lengthy career as well, hers slogged through long desert stretches before finding fresh water. Madonna has danced from oasis to oasis with barely a dry patch in sight. Now 48, she gives every sign of being able to carry her pop torch for as long as she so desires.”

How unbelievably conceited and narcissistic. (At least she was willing to admit that American Life sucked – mainly because critics panned the album and its “supposed” antiwar message.) According to the world of Madonna, she is queen and she rules. I, a subservient peasant, will formally declare that Madonna’s got a mental illness: Narcissistic Personality Disorder.

Mental Health Blogger Hits Airwaves

Philip Dawdy at Furious Seasons has been going crazy – for lack of a better term – investigating the Zyprexa story. One step away from Alex Berenson, he’s considered the leader of the pack in this story. His detailed and unwavering criticism of Eli Lilly’s marketing of Zyprexa landed him airtime on the Australian Broadcasting Corporation (ABC). Listen to the podcast of "The Zyprexa Story" at All In The Mind now.

NOTE: I still have another 23 minutes to finish this. I tried to listen to it last night and the player reset itself at 8 mins. 12 seconds. I can’t wait to hear the Lilly rep’s rebuttal.

Saturday Stats

"Women report attempting suicide during their lifetime about three times as often as men." – National Center for Injury Prevention and Control

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.

When You Care to Send the Very Best

Hallmark has really outdone itself now. The Trouble With Spikol linked to an ABC News article that revealed Hallmark’s new line of cards: Journeys. The new “sensitive” line of cards covers just about everything in the merged “Get Well Soon”/”Sympathy” category.

      • Congratulations
      • Divorce
      • Eating Disorder
      • Friendship
      • Grief, traumatic loss
      • Inspirational
      • Leaving a bad situation
      • Losing hair from treatments
      • Miscarriage Post-partum depression
      • Quitting a bad habit
      • Significant anniversary
      • Thank you for being there
      • Thank hospice worker
      • Thinking of you
      • Tough times
      • Waiting for results
      • You can do it!

Anything you can think of, Hallmark’s just about got it all. “Thank hospice worker???” Even a card for gays coming out. It’s just weird. I feel like this is a gag akin to that I read (and fell for) at Furious Seasons.

I have to get on my soapbox for a minute here. Really, how did Hallmark’s Editorial Department think this up? How do you express your feelings to someone with an eating disorder? “You’ll get better soon! Just look at Katharine McPhee from American Idol!” Umm…

“Theresa Steffens, an assistant product manager at Hallmark, said a majority of online and focus group respondents said they couldn’t find what they were looking for when needing an encouragement card.

‘Either the consumer said they were walking away from the display or they were just unhappy with the card that they purchased, so we saw this as a huge opportunity,’ Steffens said.

Customers said they wanted cards dealing with more real-life situations.

‘They said, ‘I don’t know what to say during a difficult time, so I don’t say anything at all,’ Steffens said. So again there’s an opportunity there to help them talk through these tough situations that they’re dealing with and to foster that communication.'”

  • Leaving a bad situation: “I know you’ll succeed and walk away from this stronger than you ever imagined.” Oh wait, that’s plausible.
  • Losing hair from treatments: Don’t get me wrong; I’ve had a friend with cancer, but I’m not quite sure what you’d say to this. “Remember: beauty comes from within.” Dangit, that’s plausible too.
  • Miscarriage postpartum depression: Uhh… I’d need to see a card for this. I really can’t come up with a good one. “Don’t worry! There’s always the next round!” It’d suck to get something like that if doctors said that the (almost) mom could no longer conceive.
  • Quitting a bad habit: “Good for you! We all support you and stand behind you as you kick your bad habit of biting your fingernails!” Good grief if that card exists.

ABC News found an example for a card for depression:

“When the world gets heavy, remember, I’m here to help carry it with you.”

It’s a nice gesture, but it would mean nothing if there person who gave it never really called or visited afterward. At least writer Sarah Muller of Hallmark realized the sensitive potential of these cards:

“Writing the cards proved a challenge because the messages were designed to take a more personal approach than the standard sympathy card, said card writer Sarah Mueller.

“You can’t send somebody who is seriously depressed a ‘cheer-up’ card because it’s insulting and it doesn’t help,” Mueller said. “That’s what depression does, is it makes you feel like you’re all alone. So just being able to write something, the attempt was just to say, ‘I’m here.'”

It’ll be interesting to see how well Journeys does and whether it’ll still be around a year or two from now. Below is a card that I kind of found displeasing:

Hallmark Card

Maybe I need a better sense of humor with this.

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.)

The Worst Things To Say To Someone Who Is Depressed: 61-70

This list is divided to have 10 of "The Worst Things To Say To Someone
Who Is Depressed" published each week. To see the entire list: go here. The ones that apply to me are bolded.

61. "You’re always worried about *your* problems."

62. "Your problems aren’t that big."

63. "What are you worried about? You should be fine."

64. "Just don’t think about it."

65. "Go away."

66. "You don’t have the ability to do it."

67. "Just wait a few weeks, it’ll be over soon."

68. "Go out and have some fun!"

69. "You’re making me depressed as well…"

70. "I just want to help you."

10 Most Grammatically Incorrect Words Used in Blogs

English degreeOooh, my English-degree side loves this. (English degree modifying side, of course.) OK – so I really need to make sure every thing is spelled correctly when posting this. LOL – watch a misteak occur. 😉

Another Storm posted a link to “10 Most Misspelled Words in Blogs” at The Probabilist. My fave (also my biggest pet peeve):

“10. Lose – Loose
But if you’re too
loose on your writing discipline, you will end up losing those readers after a while. You’d have a bolt loose if you don’t apply these 10 writing rules from now on with greater care. You win some and you don’t lose anyone.”

Many of us type relatively fast so a misspelled word here or there could probably be overlooked. Accidentally typing an extra ‘o’ when you meant, “I’m losing my hair” won’t kill anyone, but if you continue to write how you’re scared of “loosing” your hair and not “loosing” it is important to you, that doesn’t bode well for you or your blog.  😛

Clinical Trial Phases: Handy to Know

Some of my readers may not have any clue about the difference between Phase I, II, or III of clinical trials, except that they’re, uh, different. Here’s info courtesy ClinicalTrials.gov:

"Study Phase
Most clinical trials are designated as phase I, II, or III, based on the type of questions that study is seeking to answer:

    * In Phase I clinical trials, researchers test a new drug or treatment in a small group of people (20-80) for the first time to evaluate its safety, determine a safe dosage range, and identify side effects.
    * In Phase II clinical trials, the study drug or treatment is given to a larger group of people (100-300) to see if it is effective and to further evaluate its safety.
    * In Phase III
studies, the study drug or treatment is given to large groups of people (1,000-3,000) to confirm its effectiveness, monitor side effects, compare it to commonly used treatments, and collect information that will allow the drug or treatment to be used safely.
    * In Phase IV studies, the post marketing studies delineate additional information including the drug’s risks, benefits, and optimal use.

These phases are defined by the Food and Drug Administration in the Code of Federal Regulations."

I’m sure a pharma blog will pick up on Pristiq soon enough.

Celebrity sensitivity: Anne Hathaway and Mark Curry

Anne Hathaway

Anne Hathaway recently admitted to her depression:

“Anne Hathaway says she suffered from anxiety and depression in her teens, but that she rejected medication and instead worked through her troubles.

“I said to Mom the other day, ‘Do you remember that girl? She has now gone, gone to sleep. She has said her piece and she is gone,’ ” Hathaway, 24, tells Britain’s Tatler magazine. “But then I thought, ‘I so remember her, only she is no longer part of me.’ ”

She continues, ‘I am sorry she was hurting for so long. It’s all so negatively narcissistic to be so consumed with self.'”

I suffered from depression when I was a teen. And sure, puberty – especially in women – causes all sorts of funky things to go awry. (No thanks to estrogen.) I do believe that teenage girls can suffer from severe depression caused by a “chemical imbalance.” However, I tried to “work through” my troubles and ended up in psych hospitals — twice. I’m so glad that Ms. Hathaway got over herself.

As for her last quote, “It’s all so negatively narcissistic to be so consumed with self,” I agree with it to some extent. Anxiety and depression are a form of self-absorption. If not, then why are MDD and GAD patients (especially) sent off to therapy to “work through” their troubles? While I wouldn’t go as far to say it’s “negatively narcissistic” (bad connotation), there are psychological troubles that can be influenced by chemical fluctuations in the body. To generalize and say that people can just “work through” their troubles on their own conveys the idea that mentally ill people do not need to seek treatment. I’d like to someone in the psych community come down so hard on her that she’d need to make a statement to justify this one. But it won’t happen. It’s okay to slam mentally ill people, but don’t slam race, gays, or those with addictions. What a double-standard. (attribution to The Trouble With Spikol)

Mark CurryFor those who are old enough to remember the show, “Hanging With Mr. Cooper,” comedian Mark Curry ended up suffering from depression after an accident in April which burned just over a fitfth of his body. Curry’s background in comedy helped push him to recovery, although it wasn’t easy.

“I was depressed,” he said. ”I thought about committing suicide, but where in a hospital room is a man who’s 6’6” going to hang himself?”

Curry says that fellow comedians such as Chris Tucker, Martin Lawrence, and Bill Cosby helped him push through his depression and focus on his receovery.

“’That’s how I got through it, my friends calling me.’

All jokes aside, Curry said the accident is serving as a catalyst to make some changes in his life. He’s found two new causes— raising money for burn victims and bringing attention to depression, which is still a huge taboo in the African American community.”

It’s good to see an black man raising awareness on depression and the circumstances that can lead a person to depression and suicide. I’m not happy that this happened to him, but I’m glad something good can come from it.

As for Ms. Hathaway, she is just part of a long list of celebrities continuing the “fashionable” trend of suffering from depression:

“The actress is the latest celebrity to discuss depression recently, joining Mandy Moore and Zach Braff.”

Maybe I’m being too negative. Perhaps it’s good to see attention being drawn to depression, but at the same time, it lessens the grave importance of how severe depression can be. It’s one thing to be depressed for a certain period of time, but it’s another thing to suffer from depression. I wish the media would get their terminology right. It diffentiates between Beyoncé and Brooke Shields.

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.

Nothing to do with anything

I was browsing Rich Kilpatrick’s Web site the other day and found this cool YouTube video below. I don’t know if anyone’s seen it, but I think the flute playing with the beatbox is pretty amazing. Having played flute previously, I can only imagine that he must need to douse his flute in ammonia afterward. All that spittle inside the flute mouth can get really stinky if left unwashed.

Now, I present to you, the Beatboxing Flutist:

Encouragement from one blogger to another

As you know, I’ve been flipping out because work has gotten busy, I’ve fallen behind on my blogging, haven’t really been able to blog because I haven’t found time, and have been too tired, and family issues, yada, yada, yadda… I received an e-mail from Stephany at soulful sepulcher that I needed to share because it encouraged me so much:

"Marissa,

Please know that I understand everything you are going through, from personal experience. I would like to pass on some wisdom now.

It is okay if you miss a blog post, or ‘miss a beat’ here and there in your blogging.

I can see your ambition, your motivation, your energy, and your spirit, already on your blog.
Do not feel obligated to ‘your blog’. This may sound strange; but absence on a blog, is okay.

Because, when you come back, it will be with clarity, wisdom, and grace.

Take care of you first. I know you have heard that before. I’m 47 and I hate it when the peeps tell me to ‘take care of yourself first’. But, they ended up being correct.

Take care,

You have a long and successful road ahead of you.

Sincerely,

Stephany"

That was such an encouragement and exactly what I needed. (I also think it’s funny how she nailed my personality on the head. I didn’t know I was that transparent.) I started this blog with hope to help others and others have helped me. Talk about a community of bloggers.