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.

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Small fish in a big pond

"I will admit to having developed an irrational dislike of it that’s out of all proportion to its actual impact or relevance. After all, it’s merely a small turd in the big pharma blog swimming pool. And sure, you don’t have to look at it or even go near it, but just knowing it’s there taints the whole experience." ~ PharmaGiles

Why is everyone deciding to give up now? Is this a bug going around akin to the flu?

Saturday Stats

"Two-thirds of people ‘with psychiatric disorders’ often wait two to five years or more before seeking treatment." — Breggin & Cohen, "Your Drug May Be Your Problem"

Controversial post is actually "Identifiable Post"

Polly at polarcoaster posted the following on her blog:

“Marissa at depression introspection posts about the Virginia Tech shootings, bullying, compassion, and prevention. It’s titled The Most Controversial Post You’ll Ever Read Today, but it’s hard for me to see it as controversial, when I agree with much of what she says, especially the parts about Columbine. When I was in junior high, I never considered killing the people who bullied me, but I certainly understood where Harris and Klebold were coming from. What I’ve never understood is why school shooters also tend to kill absolutely anyone that’s around — why wouldn’t they just target the bullies? Why do they also kill people who’ve never done anything to them?”

You know, I never realized how many people would end up identifying with how I felt. It wasn’t as controversial as I thought. I thought I’d get blasted for having these thoughts. It amazed me to see that people agreed with me. In retrospect, the post should have been titled, “The Most Identifiable Post You’ll Ever Read Today.”

The overreaction begins

A few days ago, I wrote about whether violent writing could predict who could become a murderer. Well, 18-year-old Allen Lee of Cary-Grove High School in Chicago, has been charged with disorderly conduct because his essay in his creative writing class was "violently disturbing."

"I understand what happened recently at Virginia Tech," said the teen's father, Albert Lee, referring to last week's massacre of 32 students by gunman Seung-Hui Cho. "I understand the situation."

But he added: "I don't see how somebody can get charged by writing in their homework. The teacher asked them to express themselves, and he followed instructions."

Experts say the charge against Lee is troubling because it was over an essay that even police say contained no direct threats against anyone at the school. However, Virginia Tech's actions toward Cho came under heavy scrutiny after the killings because of the "disturbing" plays and essays teachers say he had written for classes.

This is a roll-your-eyes kind of story, but it angers me beyond belief. A student who appeared to be a straight-A student and apparently didn't freak anyone out like Cho did may spend 30 days in jail and pay a $1,500 fine.

Today, Cary-Grove students rallied behind the arrested teen by organizing a petition drive to let him back in their school. They posted on walls quotes from the English teacher in which she had encouraged students to express their emotions through writing.

"I'm not going to lie. I signed the petition," said senior James Gitzinger. "But I can understand where the administration is coming from. I think I would react the same way if I was a teacher."

Normally, according to the article, disorderly conduct charges apply to pranks gone awry like pulling a fire alarm or dialing 911, but also "when someone's writings can disturb an individual."

There will probably be mixed reactions to this incident. I am a complete proponent of free speech. (I'll probably get a little political here, but you'll deal with it.) I'm black, but I totally support the Ku Klux Klan's right to say whatever racist things they want. Imus can call a basketball team "nappy-headed hos," but not get arrested. That's OK. Of course, the public tends to self-censor themselves on the issue of free speech so he was forced out of a job. People are free to use the "N" word if they'd like, even if I hate it. The only limit on free speech should be if it clearly endangers the welfare of others or incite violence. For example, "Saying I'm going to kill so-and-so" is NOT free speech and can get a person arrested.

I  mentioned in another post that writing can be a safe outlet for people to get their frustrations out. I also said that I tried being creative when writing an essay for Health class that highlighted the positive aspects of suicide instead of the negative ones. (In fairness, I was told to write three negative aspects of suicide and decided to try and be different.) I was sent to a school district counselor for evalution. You can read the entire post for the rest of the story.

I should probably also mention that I took a theater class in which we all had to write a one-act play. Mine clearly disturbed my classmates the most: It was a parallel world in which everyone was gay and anyone who was straight was ostracized. This wasn't revealed until the very end of the one-act. My classmates were horrified and my teacher was cool enough to see it for what it was – creative writing.

Now, for devil's advocate, Lee should have used better judgment in light of the VTech incident and written something else. My main issue is that he didn't specify a person, date, or location in what he wrote. The teacher felt "alarmed and distubed by the content" so she reported it to the correct authorities.

The difference between Lee and Cho is that Cho's behavior gave credence to people worrying about his mental state. If Lee has students rallying around him to return to school, I don't think he's scaring anyone. I'll stand corrected if I hear any stories about him stalking women.

P.S. If the Chicago Tribune tries to get you to register to read the story, here's some log-in info to use (not mine):

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

Thoughts on "A Lot of Thought"

I was going to post this as a comment on Furious Seasons, but I wrote so much, I figured I’d make it a blog post. It’s a heckuva read for a comment.

I know you [Philip Dawdy] know more about what I’m going to say than I do, but I thought I’d offer my perspective anyway.

I started off my career in journalism. It’s a field I love to work in – copy editor, reporter, I love it all. Starting pay in New York for an entry-level reporter generally begins around $22-$24K. At around 5 years, it jumps up to $33K, perhaps. It’s possible to reach a ceiling of $40K, depending on where a reporter works. (I don’t know if this is the case at the New York Times.) The only way to make a anything close to $50K or above is to go into management, (managing editor, editor-in-chief). This is NEW YORK. I have debts and more than $20K in student loans. A job that pays $33K in 5 years wouldn’t be enough to keep up with the cost of living (it can’t even afford a solo apartment in New York unless a person has zero debt and live in a studio the size of a closet). I only know about New York salary because I considered working in the newspaper industry there.

Sex and the City and Dirt make journalism look exceptionally glamorous. While it can be interesting, it can be dirty and quite boring (especially at community papers). Some newly graduated journalist may be willing to financially suffer from a cause he belives in – serving the public’s "right to know." After being unable to consistently make bill payments, having creditors call me a few times, and having my husband (then-boyfriend) come through for me multiple times, I’ve become less idealistic. Journalism, as a career, doesn’t provide any stability. Similar to what you said, experienced 40-something reporters are forced out for a cheaper and inexperienced 20-something. Even as young reporter, I find this disconcerting. This trend leaves papers with a lack of knowledgeable reporters; older reporters find themselves battling age discrimination and unable to attain a similar position elsewhere because their salary ranges are too high.

I currently work as a medical editorial assistant in Philadelphia. It’s far from the job I want – and the journalism degree I have – but it provides a good starting salary (this is actually my second job out of college), great health care, and other good benefits. As for property and housing rates rising, that’s the case everywhere near major cities. I fear attempting to buy a house 10 years from now in the area I currently live. More so in Seattle because of the tech giants moving in. I’d recommend Montana or Nebraska for affordable living.

TV news is crap. It’s fast-food news: easy to get on the go, but doesn’t serve any real informational value. PR is considered the backup job for reporters. I’ve done that and it’s awful. It’s boring, superficial, and full of regurgitation. I did a stint in PR and despite my zeal for the cause I worked for, it didn’t provide the challenge that reporting brings. I make good money doing what I do now even though I’m basically a glorified lackey. I hate not reporting, editing, and doing everything that I love to do. In the end, it all comes down to money. I can only hope to freelance or become a famous novelist someday. (Ha. Ha.)

The print journalism industry is dying. Companies are merging, trimming staff, and folding some papers altogether due to lack of readership and revenue. Traveling mainstream giants like The New York Times, USA Today, or the Wall Street Journal won’t die as easily, unless wireless internet access becomes available during flights, but I’m convinced other daily papers will. The majority of Americans don’t read daily papers; as the next few generations die, newspapers may become an item treasured in an archive museum.

There’s a need for more blogs that focus on mental illness and pharmaceutical companies. As more Americans are placed on psychotropic medications, there will be a need to hold pharma companies accountable. It may not seem like much now, but in the end, hopefully, it will add up. Change doesn’t occur overnight.

Mental illness is the big elephant in the room no one wants to discuss. That’s why my blog has a focus on mental illness from a Christian perspective. Many Christians have a perception that mental illness means a person doesn’t have enough faith in God, needs to pray more, or isn’t a Christian at all. Christians who suffers from mental illness are as taboo as Christians who admits they’re gay – both are considered unacceptable.

I’m not saying anything you don’t already know, but I’m figured I’d throw in my 2 cents for what it’s worth.

The fight against Big Pharma seems futile. But if you were battling aggressive cancer, would you be willing to give up this easily? I’d hate to see Furious Seasons go, but if it must, I understand, especially given your circumstances. Do what you gotta do.

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."

Giving Thanks

Gianna posted Peter Breggin’s post on Giving Thanks on her blog, "Bipolar Blast," and I really enjoyed reading it. I don’t agree with all of it, but overall, it’s something we should all try to incorporate in our daily lives. Here are some highlights:

1. Love is joyful awareness. Love life–people, animals, nature, gardening, art and music, sports and exercise, literature, God–anything and anyone that brings you a joyful awareness of the wonder of being a living creature.

3. Gratitude is the antidote to self-pity. Feeling sorry for oneself is ruinous. Especially don’t fall into believing that we live in the worst of times. It takes little imagination to know how much worse it has been for other people in previous ages and in other places. Be grateful for this life.

8. Approach every single challenge in life with determination to master it. Otherwise you won’t handle it. Feeling helpless in the face of adversity is a prescription for failure. Deciding to take on the challenges is a prescription for self-satisfaction and makes success more likely.

9. Don’t hide from or stifle your painful emotions. Feeling pain signals that there is something wrong in your life that needs immediate attention. Invite your painful emotions to tell you everything they can about what you really want out of life. All psychoactive substances, from illegal drugs to psychiatric medications, suppress our real emotions and should be avoided, especially in time of suffering and fear when we especially need to know what we are feeling.

10. Reject being labeled with a psychiatric diagnosis like depression, bipolar disorder or anxiety. There are no "psychiatric disorders;" only life disorders. All of us have to struggle, to go through hard times, and to find a way of becoming more in control of our emotions and more successful in our actions.

11. Don’t think of yourself as a survivor. Intending to survive guarantees little more than getting by. Think of yourself as some who intends to triumph.

12. Forgiving other people liberates us from hate. You won’t get even by hating, you’ll get miserable, bitter and spiritless. Take care of yourself by forgiving, and if necessary by avoiding hurtful people, but don’t waste a minute hating.

Can violent and disturbed writing predict a would-be murderer?

Deranged (and beloved) novelist Stephen King lends his thoughts on whether Cho’s disturbing and violent writing could have predicted a mentally ill psychopathic serial killer. (I guess I was being redundant, huh?)

"For most creative people, the imagination serves as an excretory channel for violence: We visualize what we will never actually do (James Patterson, for instance, a nice man who has all too often worked the street that my old friend George used to work). Cho doesn’t strike me as in the least creative, however. Dude was crazy. Dude was, in the memorable phrasing of Nikki Giovanni, ”just mean.” Essentially there’s no story here, except for a paranoid a–hole who went DEFCON-1. He may have been inspired by Columbine, but only because he was too dim to think up such a scenario on his own.

On the whole, I don’t think you can pick these guys out based on their work, unless you look for violence unenlivened by any real talent."

This links up with what I’d written a couple of days ago. Creative writing that seems disturbing may not be disturbing at all, but a release for those who have imaginations run wild. Most of us keep our fantasies as just that – fantasies. Stephen King hasn’t harmed anyone and he’s got some pretty effed up books out there. Don’t judge a book – haha – by its contents.

Thanks to Bob T. for the story.

Crazy and scary

“After all, we are crazy and scary.” – Philip Dawdy, Furious Seasons

Dawdy’s comment was sarcastic, but it’s been reality in my life.

During my recent stay at a mental hospital, I went to bed alone in my room one night because my roommate had been discharged earlier that day. I usually stayed up past the designated bedtime, reading a plethora of books and writing my thoughts for this blog on a notepad. At around 2 a.m., I covered my head and got ready to fall sleep on my right side as I normally do. Unfortunately for me, I slept facing the wall instead of the other bed. Shortly after, I heard someone creep into my room shortly. Hospital staff were still conducting bed checks so I convinced myself that the hospital had allowed an emergency patient in at 11 p.m., and she was settling in. However, that didn’t sit well with me. I hadn’t seen that happen during the week I’d been there.

But my heart was racing and the rustling around on the other bed – audible without sheets – didn’t sound right.

The patient – who turned out to be man rumored to have a history of sexual assault (his real diagnosis couldn’t be disclosed to patients) – slowly rose from the bed and stood to the left of my bed, behind me, in between the two beds separated only by a dresser. When I began to hear steady, heavy breathing, I became paralyzed with fear. (Now I know why those characters in the movies don’t run when you tell them to.) My heart raced – what was I to do? I knew this was a male patient and I didn’t know if he would rape me or not. I wasn’t strong; he’d overpower me.

My right hand slipped under my pillow and clenched the taboo flashlight I’d sneaked into my room past the hospital staff’s unsuspecting eyes. (I’d been so cooperative when I arrived, they trusted me to rummage through my confiscated things without being watched.) For the first time in my life, I was glad I’d broken a rule designed for my safety.

I clutched the flashlight, deciding what to do. Should I scream and risk an attack? Would he kill me? Could he kill me? Worse: What if no one heard me?

He gently pulled the covers off my feet. He began touching my exposed left foot, feeling it, caressing it, tickling it. It was the weirdest thing. I am normally ticklish, but this was too creepy; nothing was funny about having some creep touch my foot. He did this for perhaps 3 minutes. Then he pulled the covers back over my feet and walked over the other side of my bed where I was facing the wall. I was still under the covers, pretending to be asleep, yet I was quietly panting. My heart raced even more.

Then I heard rubbing. Rubbing. Like rubbing of the skin. You know where I’m going with this. This, uh, rubbing picked up speed. I remained even more paralyzed. I really didn’t know what to do now. His genitals were exposed and I was vulnerable.

I began to clear my head. I consciously slowed my breathing down and thought of all my possibilities. I’m generally a worst-case scenario girl: I know what I’d do if I got a knife held to my throat, if a bus or train overturned, or if a plane were to crash. But nothing prepared me for a possible assault at a mental hospital.

I gathered all my courage together, pretended to begin waking up and shone the flashlight toward the door like I was going to use the restroom in the middle of the night. And there he was. Boxers down, genitals exposed with his hand on his penis in the middle of masturbating.

I yelled like bloody hell. He said, “Shhh!” I ran past him to the door and out into the hallway. None of the residents heard me except the lone hospital attendant left for the night shift. The attendant went after him and essentially sent him back to his room. I was given a cup of water and I asked to call my family. I talked to my husband, explaining what happened. He was more than pissed. But it was after 2 in the morning and there was nobody there, save one hospital attendant and a nurse for each floor. After the call, I was given 1 mg of Ativan to help me relax and fall asleep. I’d taken Ativan before with positive effects so I more than happily took it. Otherwise, I really would have been too anxious and scared to sleep. The hospital attendant said I could lock the door if I wanted to. I did. About a half-hour later, I fell asleep with the overhead lights still on.

When I awoke, the hospital staff had been notified of the incident. No one seemed to take it seriously except a nice staffer who was willing to listen to me in my total freakout. But she couldn’t do anything since she was guarding a girl who was on 24-hour suicidal watch. The floor nurse asked me if I wanted him moved downstairs. I said yes. She warned me that they’d be trading him for someone else with a similar history. Did I want to be moved downstairs? I asked, “On the floor with the guy with the same history?” She said, “Yes.” I said, “No. I want out. Today.”

I debated calling the police. Other residents – bipolar and depressed like me – said I should. I thought it was futile. My family called and encouraged me to do it anyway, so I did.

The police came. One lone officer. It was me, the police officer, the director of the hospital, and some other staffer. I explained my situation and the officer said, “Well, we can’t do anything about it since he’s in here.” I argued, “He nearly assaulted me. You can’t take him to jail or press charges?” The outcome was obvious. The hospital and policeman thought I was crazy; in turn, I was scared of my predator.

I went to morning group and saw him lurking around. I was nervous and scared. What we he do? I essentially tattled on him. Thankfully, I’d told a couple of the “sane” guys on my floor who I was somewhat friendly with. They promised to be my bodyguards and essentially antagonized him. Everyone wanted to talk about what happened to me in group and address security in the hospital. The person running group wouldn’t allow it, said it was a tired topic, and we should talk about something else.

After a long, hard battle fought against the hospital by my husband and mother, I was released that day.

So yeah, Dawdy, you’re absolutely right. We are crazy and scary. Welcome to the life of a patient in a mental hospital.

Empathetic therapists

Read a good op-ed in New York Times on whether therapists need to have shared experiences with their patients to be a good therapist.

Credit where it's due

OK – you all update way too much for me to keep up with you blogs. Slow down! jk.

I’ve been catching up on reading many of your blogs and just wanted to say I’ve been amazed at the incredible job every one is doing on writing about mental health, their struggles, the latest incident at VTech, and many other things.

I try to give credit where credit is due. Keep on keepin’ on, folks.

Best,
Marissa

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.

Saturday Stats

"Using a low-end rate of 1 percent, Maxmend and War (1995, p. 33) estimate that 1,000-4,000 deaths occur in America each year as a result of MNS, neuroleptic maglinant syndrome, a reaction caused by neuroleptic drugs." — Breggin & Cohen, "Your Drug May Be Your Problem"

Dead people are mentally ill

Cho Seung-HuiThe New York Times published an article on a mental illness Cho Seung-Hui may or may not have had. The article cites experts who say Cho could have suffered from psychotic depression, avoidant personality disorder, or schizophrenia-paranoid type. The videos show, according to Dr. Michael Stone, “a paranoid person with sadistic traits, possibly psychotic.”

What’s the use of dissecting the mental illness of a dead man? Sure, it’d be great to understand what drove Cho to do what he did, but in the end, what does it matter? How will it prevent such future attacks? The better we understand the characteristics of a person behind this, the better we can medicate them?

News articles are going nuts (ha ha) expounding on Cho’s mental state. Do killers/murderers all have a mental illness to commit such heinous acts? Perhaps some of these people were just plain stupid? Was Kurt Cobain mentally ill because he took his own life?

Cho’s issues have shed light on mental illness, although in the most negative way imaginable. While Koreans (and likely many Asians) fear backlash from this incident, I have a funny feeling those diagnosed with a mental illness will too.

“You’re depressed? Bipolar? Ohmigod, are you going to go on a killing spree?”

Don’t be surprised if you ever hear that.

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.

The Most Controversial Post You'll Ever Read Today

I’m going to take a risk here and hope that I don’t end up having the cops investigate me for something that I only imagined.


"Professors and classmates were alarmed by [Cho Seung-Hui ‘s] class writings — pages filled with twisted, violence-drenched writing.

"It was not bad poetry. It was intimidating," poet Nikki Giovanni, one of his professors, told CNN Wednesday. "At first I thought, OK, he’s trying to see what the parameters are. Kids curse and talk about a lot of different things. He stayed in that spot. I said, ‘You can’t do that.’ He said, ‘Yes, I can.’ I said, ‘No, not in my class.’""Associated Press

The summer before my junior year of high school, I took a Health class. (The reason why eludes me.) One of my assignments – I will never forget this – was to write three reasons why suicide was bad.

Ha, ha, ha. I tried to be "creative" and wrote three reasons why suicide was good. First reason: It’s a very noble way to die as exemplified by the Japanese Kamikazes and the Romans during Julius Caesar’s time. I think my second reason had something to do with maintaining a legacy and protecting a family from shame.  I can’t remember my third reason, but by that point, I was reaching.

We read our responses aloud in class. My health teacher was NOT amused and my classmates found me a little more than disturbing at that point. She pulled me out of class to determine if I was suicidal. Apparently, I wasn’t convincing so my parents were contacted and I was referred to a school district counselor. The whole situation amused me. I was 75% joking, 25% serious. I was trying to convince myself why suicide was a good thing and in the end, realized I could barely provide three reasons why. My counselor interrogated me to gauge how suicidal I was.

"Yeah, I have a history of suicide attempts," I said. "But I was only trying to be creative. I wasn’t really serious."

"Do you have any suicidal thoughts?" she asked repeatedly.

"Nope," I countered.

"You sure?" she asks.

"Yup. I’m fine. Life is great." (Of all the times in my life, I was in a good place at that moment.)

When I was a junior in high school, the Columbine school shooting took place. While my classmates found themselves scared and horrified, I sat smirking in my seat. I thought to myself, "It’s about time us weirdos defended ourselves! All you stupid assholes who pick on us are totally getting your just desserts!" Eric Harris and Dylan Klebold were nonconformists, and thusly, picked on, bullied around, and teased. As a junior going through what I considered hell in high school, I could totally relate.  I found myself in the same position that year – without access to guns, where to find them, and the like – wanting to commit homicide on a mass scale at that school.

I had a hit list. I listed every teacher I hated and every classmate who tormented me. And I wanted to be the one to take their lives away.

I made a map of the school. The places I could enter, do enough damage, and where I could get out and escape with the highest possibility of escaping surrounding police. (In retrospect, there wasn’t anywhere really.) The hit list and maps are all gone. A lot of my anger has died too. I still carry some of it around with me because it’s been there so long, but the farther I get from my senior year of high school, the more I begin to heal and forgive. (I’ve also become a born-again Christian since then.)

Adults are oblivious to the angst, anger, and rage that builds up inside adolescents. If a someone grows up getting teased, parents often say, "Don’t listen to them. They don’t know what they’re saying. Just ignore them."

Do you know HOW many times I heard the words "Just ignore them"??? When I went to school and heard the same things day after day after day after day, it’s impossible to just "ignore them." Try being schizophrenic and ignoring the voices in your head. Go ahead – I dare you; it’s nigh unto impossible.

Everybody damn well knows now that Harris and Klebold didn’t ignore "them." And despite the murder-suicide, at the time, I badly envied Harris and Klebold. I wanted to show my classmates and teachers who was boss. That I wasn’t some stupid pussy they could shove around and make fun of.

So I sat in the back corner of classrooms, trying to be the girl that everyone thought would do a school shooting. I had my poetry journal that I scribbled in all day. My poetry was angry spewing nothing but hate for some of my classmates and teachers. I made Alanis Morissette’s first mainstream U.S. album look like butterflies and sunshine. I hid in dark classrooms and in the bathroom pouring my rage out on paper. My words were bullets that could harm whoever I wanted without the result leading to my arrest.

Virginia Tech shooter Cho Seung-Hui’s motives for the shooting spree are still unclear. It is widely speculated that he was spurred on by a recent breakup. The preparation that went into the shooting, however, seems like it may have taken a while. I don’t know how long ago his relationship may have ended. After my second relationship went sour, I was pretty angry, but not enough to kill my ex or other innocent people.

It also seems as though he may have been on medication for depression. His "increasingly violent and erratic behavior" also seemed to coincide with taking the medication. Hah – I wonder he’ll be counted as suicide and homicide data for whatever medication he was taking.

What’s the difference between Columbine and VTech for me? I’m past my rage and angst. In 1998, I found my weapons and ammunition through my poetry. I held myself hostage and eventually was able to free myself. Now, in 2007, I can find compassion and sympathy for victims and their families. I’m saddened to see the faces of the bright flames that were snuffed out in an instant. But I can also find compassion for the shooter as well – quotes from the media have streamed in about how bizarre and odd Cho was. His roommate even noticed strange and unusual behavior. The only person who seemed to have taken preventive action was his former creative writing teacher, famed poet Nikki Giovanni. No one else tried to get Cho help. No one attempted to reach out to him – no Caucasian, African America, Muslim, South Korean, Christian, what have you. Everyone allowed Cho to build a cocoon and live inside himself until he burst out taking 33 people down with him.

Those who knew Cho and did not attempt to find him help are responsible for the shooting that day just as much as Cho himself. Society can’t continue to pin an individual or gun-control laws down as the reason for these events. We all gossip about the person who could go nuts and shoot a place up. Instead, we could try to reach out to that person to prevent that from happening.

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Hypochondriacitis?

“You’re not a hypochondriac if you’re trying to convince yourself that you’re a hypochondriac.”

For the past month, I’ve been feeling fatigued, shaky, dizzy and have had bouts of vertigo. I’ve been going home after work, then crashing into bed for the rest of the night. I went to the doctor and she said nothing’s wrong except that my physical symptoms are being caused by depression. I’m not depressed at the moment and I’ve never had vertigo when I was in my severest depression so I think that’s a load of crap. However, I had a blood test that also checked my Lamictal levels and everything came back A-OK with an unusually high cholesterol level for a 25-year-old. (High cholesterol runs in my family so I’m at higher risk for heart disease, blah blah blah.) Despite the fact that science says I’m currently healthy, the way I feel says I’m not.

Anyway, I saw the Q&A below from the May 2007 issue of Shape magazine and related to it somewhat. I’m still not quite sure that my physical symptoms are manifesting through my depression when I haven’t been depressed for the past month.

“I’ve been tired and spacey lately and also started experiencing chronic headaches. My doctor says nothing’s wrong. Is it all in my head?”

No, there may be more going on than you or your doctor realizes. Headaches aren’t just caused by physical problems; they may also be a sign of depression. A new study at the University of Toledo found that women with chronic headaches, especially migraines, are 25 times more likely than other women to report symptoms of clinical depression. (emphasis not mine) Some other common signs include being unable to concentrate, gaining or losing weight suddenly, difficulty sleeping, or feeling fatigued, or losing interest in the things you usually love to do. But these symptoms may be overlooked during a medical 4evaluation, especially since many women don’t realize they should bring them up with their doctors. Twice as many women as men suffer from depression, yet nearly half of all cases go undiagnosed. If this sounds like you, make a doctor’s appointment to discuss any stressors in your life and their effects on your health.

Gina CuylerGina Cuyler, M.D., FACP, is a board-certified internist, instructor of clinical medicine at the University of Rochester Medical Center, and a fellow of the American College of Physicians.

Saturday Stats

65 percent of American adults who need behavioral health care services yet do not receive the services they require, according to the U.S. Surgeon General. Eighty percent of children also do not get the needed services. — Metro (newspaper)/NC

Saturday Stats

"Of the 24,672 suicide deaths reported among men in 2001, 60% involved the use of a firearm." – National Center for Injury Prevention and Control

Suicide: Understanding and Intervening – Conclusion

"The basic rule of suicide intervention is this: if the level of suffering can be reduced a little, the individual might choose to live." – Jeffrey S. Black

The quote above is the entire point of this post and the preceding posts on this subject. Suicide’s a difficult and divisive topic. People never seem to run out of opinions on the matter.  Jeffrey Black’s booklet was directed to an audience that wanted to know how to help a suicidal individual. I added a couple of things that I thought were relevant, but for the most part, Black is on target. I stopped harping on this through my posts, but I remained dismayed at the straightforward approach and lack of empathy in the book. While a person struggling with suicidal thoughts shouldn’t be "babied," he should be treated with compassion and care. Tough love works on some people, but its potential for backfire is great. Many people who consider suicide are extremely fragile and the slightest criticism could further convince them that they need to kill themselves. (FYI – I am one of these.) If you’ve known the person for a long time, assess his normal-tempered personality. From there, decide whether he is capable of accepting a bit of a heavy-handed push. A general rule: Avoid tough love if the suicidal person normally wouldn’t consider you "a loved one."

So this post concludes my longest-running series on suicide. This series has been in the works since October, when I entered the hospital, but I never had any time to really devote to it. The semi-meticulous person I am, I went through my posts and tried to edit them as much as possible. (OK, with the exception of this one.) A few mistakes might slip through, but for the most part, they should be relatively readable.

The point of this series wasn’t to bang non-Christians over the head with a Bible. (Uh, so to speak.) The booklet I dissected came from a Christian point of view, but I think there was a lot of helpful information, not just for Christians, but for anyone who wants to help a suicidal person. It’s not foolproof and it certainly isn’t the "be-all and end-all." It’s a guideline and a good start. Purchase the book at Amazon, if you’re interested.

Suicide: Understanding and Intervening – Part VI, Hopelessness

“If a Christian is without hope and sees himself as helpless, it underscores that his thinking is out of alignment with God’s.” – Jeffrey S. Black

A hopeless Christian is a paradox considering that Christians should have reason to hope. But when faced with trials of life, “keeping hope alive” proves difficult.

Black defines hopelessness in three ways:

  1. A failure to recognize God’s wisdom.
  2. A failure to desire what God desires.
  3. An unwillingness to view time the way God does.

Important questions for a hopeless Christian to ask himself:

  • Are my hopes in the situation getting better or in Christ?
  • Are my hopes in me or in Christ?
  • Are my hopes in other people or Christ?

A quote from Psalm 73:21-22:

“When my heart was embittered and I was pierced within, then I was senseless and ignorant.”

When a Christian’s focus isn’t on Christ, everything is hopeless. I struggle with answers how to get a Christian from a point of hopelessness to hopeful ness.

Suicide: Understanding and Intervening – Part V, Felt Need

According to Black, those drawn to suicide are being denied a “felt need.”

“Depressed people who report feeling suicidal normally associate their pain with some thwarted felt need. Second, they have come to believe that they cannot endure the pain associated with that ‘unmet need.’”

He continues:

“Where does all this anguish come from? It is created and sustained by thwarted desires that a person experiences as felt needs: ‘I need what I have lost and have no hope of getting.’”

I like the principle of felt need. It can be used in any suicidal situation. The principle of “felt need” correctly identifies why a person considers suicide. The main statement follows Black’s model:

“I need ___[fill in the blank]___ and feel hopeless about ___[fill in the blank]___.”

In my case, sometimes I don’t have specific reasons for being suicidal – I just am. Therefore, the previous statement for me is as follows, “I need TO BE FREE FROM EMOTIONAL PAIN and feel hopeless about FREEDOM FROM EMOTIONAL PAIN.”

This lack of hopelessness is what drives me directly to suicide.

Miss Philadelphia campaigns for teen depression awareness

Housekeeping items:

  1. My computer was on the fritz so I’m really backed up on reading/responding to e-mails and catching up on blogs. Work is busy so I haven’t been able to update regularly. (Although I have a minute right now.) My series on suicide was scheduled in advance.
  2. I’m postponing my puppy of the week series as of this week. I haven’t had time to schedule those posts either. Quote of the week and Saturday Stats may also be put on hold eventually. We’ll see.
  3. I really appreciate many of your thoughtful and insightful comments and hope to respond to them soon. Being married while working and having multiple things to do after work consumes much of my time. I don’t plan to have kids soon, but I may discontinue this blog if I have children. Perhaps not, I hope to be a stay-at-home mom.

Miss PhillyNow for the latest news I can give you:

Thank God the delivery boy has restarted delivering Metro newspaper in my hometown. I picked up today’s paper to find that Miss Philly’s mission is to raise awareness about depression in teens. Kimberly Rodgers of Richboro, Bucks County, Pennsylvania is a pharmaceutical marketing consultant at TargetRX in Horsham, Pa.

Miss Philly’s goals seem quite noble. From the Metro interview, she’s not pushing adolescents taking meds – she simply wants teens to “talk” about their problems. As a pharma rep, I’m sure she sees a lot of issues with depression, but I’m just curious as to why she’s targeted teens instead of the general public. Perhaps she sees adolescents as a demographic that gets overlooked? I’m not saying her motives are impure and funded by evil pharmaceutical interests, but I thought her campaign platform was interesting.

Just thought I’d share.

Suicide: Understanding and Intervening – Part IV, Helping A Suicidal Person

Helping a suicidal person is a touchy subject.  Black’s booklet is addressed to people who want to help a person who is suicidal.  Black’s provides some tips to help a suicidal person:

  1. “Acknowledge the reality of [the person’s] pain.”
  2. “Help him see the connection between his pain and his felt need.” Get them to say, “Life without ___ [fill in the blank]___ will be unbearable because ___[fill in the blank]___.
  3. “Challenge constricted options and irrational thoughts.”
  4. “Explore [the person’s] perceptions of hopelessness.” How hopeless is the person feeling? Can the situation be rectified or is it hopeless?
  5. “Help the person to separate pain and need.”

Assessing risk
Black’s following guideline is a good way to assess whether a person is considering suicide:

1. Presenting problem – Assessment begins by evaluating the problem that triggered the downward spiral.  This is difficult to do if the person can’t identify any triggers.

2. Background information – Analyze the person’s life and personality to gain a better understanding of how and why he is driven to a point where he considers taking his own life.  A good warning sign: If someone says, "I can’t deal" repeatedly. "I can’t deal" really means, "I don’t have the appropriate coping skills to handle my situation."

3. Substance abuse – While a person who abuses drugs or alcohol may not be suicidal, the likelihood that a depressed person who abuses drugs or alcohol is.

4. Resources – Encourage the (potentially) suicidal individual to seek out a support network: family, friends, church, therapists, or social groups.  If a person feels needed, he is more likely to realize that his death will have a significant impact.  Perhaps he’ll think twice before making an attempt.

5. Suicidal thinking and intent

A.     "Evaluate the person’s felt experience." Use a mood scale from 1-10 to gauge how good or bad a person is feeling. (Feel free to use mine on the right.)
B.     "Determine how often the person has suicidal thoughts and how intense or compelling they are."  Frequent "passing" thoughts are no longer passing thoughts.
C.     Dry run. A person contemplating suicide might have “tried out” the way he plans on killing himself.

“Has she ever taken a few pills to see what it feels like, tied things around her neck, driven at high speed, or practiced with an unloaded gun? Dry runs help the person to resolve any ambivalence she might feel about suicide.”

If a person admits to attempting a “dry run,” the person likely is in extreme danger of following through.

6. Noble End – A person who is at the point of beautifying suicide as a glorious end to his life is completely disillusioned and should be seen as a high risk.  Watch out for talk of "No one needs me anymore" or "Everyone would be better off without me."

An addendum: A person who says "I hate myself" may be a suicidal risk, but not always.  An admission of self-hatred provides evidence that he may want to eliminate the hatred in some way.