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.

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

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.