Loose Screws Mental Health News

Ebselen, an experimental bipolar disorder drug, has been found by British researchers to work like lithium but without lithium’s side effects. In mice. In testing, mice that were somehow made manic with “small doses of amphetamine” were placated with ebselen. Researchers are now moving on to testing on healthy human volunteers before studying those suffering with bipolar disorder.


A study, published in JAMA Neurology, discovered that retired NFL players were more likely to suffer from depression and brain impairment. The study comes on the heels of the suicides of Dave Duerson, Ray Easterling, and Junior Seau. Researchers suspect a link between “hard hits to the head and depression.” These problems have also been noted in NHL players and combat soldiers who have suffered a brain injury. Many of the retired NFL players developed a type of brain damage called chronic traumatic encephalopathy (CTE). Duerson and Easterling were found to have CTE during autopsy. In related sports news, the UK’s Telegraph reports that depression is a problem for soccer players in England and Scotland.


According to Time magazine, ketamine—a drug that induces hallucinations and other trippy effects—may hold potential as an antidepressant.

And now scientists report on two formulations of drugs with ketamine’s benefits, but without its consciousness-altering risks, that could advance the drug even further toward a possible treatment for depression.

Ketamine is seen as a fast-acting antidepressant for those at high risk for suicide. GLYX-13, mentioned here previously, is a ketamine-like antidepressant currently in clinical trials. AstraZeneca has AZD6765, a “ketamine mimic” that does not appear to be as effective as actual ketamine.

New research has discovered that people with mental illness are more likely to be victims of domestic violence. Even though the study evaluated men and women, the results for women were overwhelmingly striking.

It finds that women with symptoms of depression were 2.5 times more likely to have experienced domestic violence over their lifetimes than those in the general population, while those with anxiety disorders were more than 3.5 times more likely to have suffered domestic abuse. The extra risk grew to seven times more likely among those with post-traumatic stress disorder.


An analysis of more than 1 million Scandinavian women has shown that taking SSRIs during pregnancy may not increase the risk of stillbirth. This study could help revolutionize treating depression in pregnant women.

“From our study, we don’t find any reason to stop taking your medication, because untreated depression may be harmful for the pregnancy and the baby,” [Dr. Olof Stephansson, the lead author of the new report] told Reuters Health.


Finally, “gender identity disorder” has been removed from the DSM-V and has been replaced by “gender dysphoria,” a condition in which people are concerned about their gender identity. “Gender identity disorder” seemed to stigmatize gays, lesbians, and transgender individuals. The continuing inclusion of “gender dysphoria,” however, ensures that people suffering with gender identity disorder still have access to health care treatment. (In my opinion, the renaming of “gender identity disorder” to “gender dysphoria” is really a politically correct change. Homosexuality was removed from the DSM back in 1973.)

Loose Screws Mental Health News

An antipsychotic inhalation powder has been approved by the FDA for the treatment of agitation in adults with schizophrenia or bipolar I disorder. While loxapine (brand name: Adasuve) by Alexza Pharmaceuticals acts rapidly, the side effects include “bronchospasm and increased mortality in elderly patients with dementia-related psychosis,” according to Medscape. In case you don’t know, bronchospasm can lead to acute respiratory problems in people with lung disease, asthma, or COPD (chronic obstructive pulmonary disease).

Plans are for the drug to only be accessible through a medical facility with the ability to treat bronchospasms.

In related and somewhat interesting news, the Medscape article also notes that 3.2 million people in the U.S. are being treated for schizophrenia or bipolar I. “Of these, approximately 90% will develop agitation during the course of their illness.”

That’s an incredibly high number of people who develop agitation. Just sayin’.


According to an article in U.S. News & World Report, patients in a study dealing with depression seemed to have high levels of C-reactive protein (CRP), a marker for increased risk of heart and inflammatory disease. The lead researcher notes that “people with increased CRP have a two- to threefold risk of depression.” It is not clear whether CRP causes depression or is simply a sign of it. Increased levels of CRP tend to be seen in obese patients and those with chronic diseases.

“More than 21 million Americans suffer from depression, a leading cause of disability, according to Mental Health America.”

Note: the 2011 estimate of those residing in the U.S. stands at more than 311 million.


Depression is increasing among Japan’s public school teachers.

“A report by the Ministry of Education, Sports, Culture, Science and Technology shows that in 2011, around 5,200 public school teachers had to go on sick leave due to various mental illnesses, including severe depression.”

The Japan Daily Press article also notes:

“The study also highlights the fact that the main reason for the increasing depression is a school environment that puts too much workload and pressure on the teachers that they cannot have a healthy work-life balance anymore, much less deal with students, their guardians and the paper work that comes with all of these. (emphasis mine)

I recently finished a book by actor Tony Danza called I’d Like to Apologize to Every Teacher I Ever Had in which he chronicles his yearlong stint in Philadelphia’s inner city public school system. He echoes some of these sentiments as well. After trying to teach his students, he notes that it is difficult not to get involved in their personal lives as well. In the Epilogue, Danza writes:

“…I can only do so much. Where does teaching stop, and start? Where should it? I don’t really know. To engage my students, I found that I had to become engaged in their lives, their problems, and their futures. That connection was what made the job the most rewarding. Yet it was also the intensity of that involvement that, by the end of the year, had made the job of teaching so much tougher than I’d ever expected.”

It seems that Japan’s public school teachers are no different from American public school teachers.


Although 38 states require mental health background checks, only a quarter of states actually report their statistics to the federal NICS (National Instant Criminal Background Check System).


And surprise, according to a recent study, pot could lead to psychosis in teens or teens who smoke pot can later develop psychosis. I find it interesting that teens were actually evaluated after smoking pot.

Lamictal and Abilify: Back on Medication

Images from rxlist.com & drugs.com

After 2 years of not being on medication, I am back to a daily regimen of lamotrigine (Lamictal) and aripiprazole (Abilify) with lorazepam (Ativan) as needed.

Many of you may know, or may not know, what I decided to taper off of medication so that I could get pregnant. Well, that hasn’t happened. And my thoughts got to a point where it became life and death again. I didn’t want to go back to the psych hospital so I asked my psychiatrist for help.

My psychiatrist (God bless him) is a very conservative psychiatrist. He was the one who helped me off of medication 2 years ago, and he’s the one titrating my dosages up now. Lamotrigine is for long-term maintenance of the bipolar disorder, aripiprazole is for short-term maintenance of bipolar disorder and SAD (seasonal affective disorder), and lorazepam assists with severe anxiety as needed. I started taking the medication four weeks ago, and I’m only on 50 mg of lamotrigine and 5 mg of Abilify. There will be no increase on Abilify and I titrate up on lamotrigine every 2 weeks. My next big jump is 100 mg.

My psychiatrist expects me to come off of aripiprazole within the next few months (hopefully by December). If not, I will have to get regular blood sugar and cholesterol tests performed. He will adjust all medications as necessary in the event that I am pregnant. He’s a great psychiatrist; he’s willing to work with me based on my situation rather than him throwing drugs at me. He allows me to have complete control over my treatment regimen, which is something I like and respect.

In the past, I may have come off as anti-medication, but really, I’m not. I advocate for use of medication in a necessary, responsible manner. In 2010, 253 million prescriptions were written for antidepressants.¹ (Keep in mind that the U.S. is estimated to have 307 million people in the country.² That’s about 82.4% of the population taking antidepressants.) This is not responsible; this is too much. In the comments, people have rightly corrected me in the assumption that 1 person can get multiple prescriptions in a year; I failed to remember that.

Let’s assume a person is on 1 antidepressant (the majority of people take 1). Beginning in January, that person gets 5 refills for 30 days. By May, the person will need another 5 refills. Then another prescription is dispensed in October. That’s 3 prescriptions per person. Of course, this can vary depending on how often the doctor will see a patient so let’s generalize and say 5 prescriptions per person per year. My calculations for prescriptions per American mean that nearly 20 percent (about 17%) of the population is on antidepressants. Sure, it’s not my original ridiculous number of 82.4%, but I still think this is pretty high. (By the way, feel free to correct my stats in the comments if necessary; I don’t claim to be a math wizard.)

While I am not on an antidepressant, I am one of the millions of Americans who is on medication for mental illness. For 2 years, honestly, I’d forgotten I had anything relating to mental illness. It was nice to wake up and be myself without thinking about me plus bipolar disorder. Every morning and every evening, it’s now me plus bipolar disorder plus SAD plus anxiety. These are all real symptoms that need to be managed. I don’t want to be dependent on this medication forever, but I may have to. If it helps me manage my suicidal thoughts and function with people in life, then it’s worth it.

Your turn: What do you think about taking psychotropic medication? Do the symptoms outweigh the risks for you? What’s been your experience in taking (or not taking) psych meds?

Notes:

1. Shirley S. Wang, “Antidepressants Given More Widely,” The Wall Street Journal. Published on August 4, 2011. Available at: http://online.wsj.com/article/SB10001424053111903885604576486294087849246.html. Accessed October 20, 2011.
2. Google Public Data Explorer. Population in the U.S. Last updated: July 28, 2011. Available at: http://www.google.com/publicdata/explore?ds=kf7tgg1uo9ude_&met_y=population&tdim=true&dl=en&hl=en&q=us+population. Accessed October 20, 2011.

Celebrity Sensitivity: Catherine Zeta-Jones & Demi Lovato

Image from people.com

Catherine Zeta-Jones has bravely put her face on the cover People magazine—and on the face of bipolar disorder. And in a less publicized interview, 18-year-old Demi Lovato of teen Disney fame admitted last month to People that she too also suffers from bipolar disorder.

“This is a disorder that affects millions of people and I am one of them,” the [Zeta-Jones], 41, tells PEOPLE in an exclusive statement in this week’s cover story. “If my revelation of having bipolar II has encouraged one person to seek help, then it is worth it. There is no need to suffer silently and there is no shame in seeking help.”

Last month, Lovato said:

“I never found out until I went into treatment that I was bipolar. Looking back it makes sense,” she says of her diagnosis. “There were times when I was so manic, I was writing seven songs in one night and I’d be up until 5:30 in the morning.”

I’ve said before that I’m not a fan of mental illness fads, but bipolar disorder has such a stigma attached to it that celebrities who seriously suffer from the disorder have a chance to put a face on and say “There’s no shame in getting help.” And while psychotropic drugs certainly aren’t a cure-all in conjunction with talk and behavioral therapy, bipolar disorder can be managed—not just for these celebs but also for anyone who suffers from the disorder.

Celebrity Sensitivity: Catherine Zeta-Jones

Image from people.com

Of all the celebrities I would have pegged with some kind of mental health disorder, Ms. Zeta-Jones would have never made the list. After supporting her husband Michael Douglas through his cancer treatment, she remained quiet about herself only outspoken on issues pertaining to how upbeat and positive the couple was on Douglas’s treatment.

But clearly, being a bedrock for her husband has taken its toll on her. Last week, she checked into a mental health facility seeking treatment for her bipolar II disorder. Bipolar II is characterized by frequent depressive episodes rather than a constant swing of manic-depressive ones. While only Ms. Zeta-Jones knows what’s been going on inside her mind and her heart, I can only imagine that she’s been suffering with some depression for a while but quietly put it aside as her husband struggled to become healthy again.

In the past, I’ve used the Celebrity Sensitivity feature of this blog to mock celebrities who seem to be diagnosed with nearly any mental illness fad that goes around (normally, depression), but this time my heart goes out to Ms. Zeta-Jones who decided to seek treatment for herself instead of putting on a face like everything’s okay and toughing it out.

Bipolar disorder covered under Americans with Disabilities Act

This is old news but I’ve been wanting to write about this for a while.

In 2008, bipolar disorder became a list of covered psychiatric conditions under the American Disabilities Act (ADA). While I support the move, I’m somewhat guarded about it since there are a variety of symptoms within bipolar disorder that can make it difficult for a person to perform his or her job. From PsychCentral’s post about it in September 2010:

For ADA purposes, major life activities that may be limited by a mental health disorder could include learning, thinking, concentrating, interacting with others, caring for oneself, speaking, or performing manual tasks. Sleep also may be limited in such a way that daily activities are impaired.

Someone with bipolar disorder may temporarily experience “limits” to handling life activities. A deep bout of depression or insomnia may create a need for time off or for flexible hours. An individual may need time off for doctor appointments. In the daily work environment he or she may need a quieter work area to decrease stress and enhance concentration or more frequent breaks to take a walk or do a relaxation exercise. He or she may need office supplies to help them organize and focus more effectively.

I’ve experienced all of these issues at one point or another (sleep issues have been the most frequent and debilitating) in the past and I completely understand how it can affect someone’s ability to work. However I worry that someone might use this to their advantage to cover bad behavior rather than someone who legitimately needs this protection. But alas, abuses to systems exist everywhere.

This coverage prompts me to ask the question: is bipolar disorder (and depression as well) a legitimate disability?

Celebrity Sensitivity: Pete Wentz

Pete WentzI’ve written about fellow bipolar sufferer Pete Wentz before here. How has he managed to keep his highs and lows in check?

His son, Bronx.

“While I’ll always be bipolar, I find it easier to deal with now. With marriage and fatherhood, I’ve finally found two fixed points in my life. They’ve taught me patience. They’ve also taught me that I don’t need to feel guilty about being happy. My emotional seasons are less extreme.

“In the past my brain would never stop. Now I’m a father, the world no longer revolves around me.”

I’ve always wondered whether having a child would change the way I deal with bipolar disorder. Of course, I’m not going to have a child simply as a test case in the hopes that he or she would “cure” me but I think having someone so completely dependent upon me would cause me to think twice about trying to kill myself.

Lamictal withdrawal: Insomnia

I thought the wine was working but I guess isn’t or I didn’t have enough. No matter, I’m out of the light blush anyway.

It’s nearly 4 in the morning and I crawled in bed sometime between 11:30 and 12. Reasonable bedtime for this nightowl. But I’m not sleepy. Not at all. Laying I’m bed for 4 hours ends up being restless. I’m surprised I can blog at all but this is really mindless drivel since I’m not doing much else other than typing this post out via the Typepad app for the iPhone.

Am I manic? I don’t think so. I am feeling a bit weary. I’ve been manic; i’ve experienced that energy of cleaning the apartment and rearranging the room at 2 am. I don’t have that kind of superhuman energy right now. In fact, I’d love to do nothing more than sleep but it eludes me. I’ll be trying to snag some natural remedies but in the meantime, I don’t feel like being up until 5! I have counseling at 7 tonight. However I fear I’ll see the sun come up. Five isn’t too far away.

I haven’t really read of anyone suffering from insomnia as a result of Lamictal withdrawal but I am. And by golly, if you like sleep like me, this is torture. I don’t know how I’m going to right myself. I can’t go on sleeping during the day.

Oh wait–I can’t sleep during the day either. And this is simply within the past month down from 200 mg to 125 mg. And to think! My doctor said I could just quit cold turkey.

WHAT IN TARNATIONS MADE HIM SAY THAT? Did he want me to die? Suffer from seizures? Seriously, doc, what the heck?

And then I’ve got the friend who is psycho stalker ex-girlfriend in training who doesn’t understand the meaning of, “I don’t want you get out of my life,” but we’ll save that story for another day.

(Btw, sorry for the misspellings if any. I’m typing this on my itouch keyboard and not spell checking too closely as I go along hoping autocorrect will catch most of mistakes. Guaranteed it has even if there are tons visible. I’m much too tired and apathetic to fix it or care right now. Maybe later. I just want sleep.)

Have you ever obsessed about sleep when you felt like it was constantly eluding you?

And I wrote a heckuva long post for typing this via mobile. :P

Loose Screws Mental Health News

As reported by The New York Times, people with bipolar disorder have a higher risk of suffering from fatal illness according to a study (that reviewed 17 other studies involving more than 331,000 people) reported in the February issue of Psychiatric Services.

In the larger studies, almost every cause of death was higher among bipolar patients: cardiovascular, respiratory, cerebrovascular (including strokes), and endocrine (like diabetes). In the smaller studies, mortality from cerebrovascular disease was higher among those with bipolar illness, but they showed inconsistent results, probably because they used smaller samples or less representative populations.

Gianna at Beyond Meds provides here take here.


Some crazy nurse in Minnesota convinced a Canadian college student to kill herself and walked her through the process of appropriately hanging herself. Ed Morrissey of Hot Air calls the nurse "the first serial suicide-inciter of the modern age." Couldn't have said it better myself.


Philip Dawdy at Furious Seasons is on a roll, holding AstraZeneca accountable for its actions regarding hidden information about Seroquel and now he hosts the Seroquel documents — alongside Lilly's Zyprexa documents — that indicate buried studies. Dawdy's also running a spring fundraiser and I suggest you get your butt in gear and donate to him if it's important to you that someone holds pharmaceutical companies accountable for their actions. I've already done my part.


Sorry this post isn't filled with my normal snark and cynicism. I'm behind on a lot personally — still trying to get the hang of this self-employment thing — and this is what I can throw out for now.

…and on to AstraZeneca's problems with Seroquel

Eli Lilly seems to be passing along its misfortune off to AstraZeneca, which now appears to be having issues with masking evidence of Seroquel side effects. From Furious Seasons:

A great article appeared in the St. Petersburg Times over the weekend, revealing that lawyers for AstraZeneca will argue in court later this month that the company wants documents introduced into a federal court hearing in a case over various allegations around Seroquel sealed and hidden from public view. They want an upcoming hearing in the federal class action lawsuit against AZ closed to the public as well. Lawyers argue that they are protecting patients and, oddly, the public at-large.

Read the rest of Philip's post.

Loose Screws Mental Health News (the ODD version)

I came across an article in my Google Alerts titled, “Harvard study: Under-treatment of mental illness contributes to crime.” Intrigued, I clicked on the link to read more of the article. Turns out the lede is:

Two thirds of prisoners nationwide with a mental illness were off treatment at the time of their arrest, according to a new study by Harvard researchers that suggests under-treatment of mental illness
contributes to crime and incarceration.

The article is poorly titled. The headline was designed to be alarming: “Watch out for those crazy people! They’re violent!” It’s not “under-treatment of mental illness” that “contributes to crime” so much as it is “two-thirds of inmates with mental illness are off medication.” There’s nothing in the article that asserts people with mental illness contribute to the crime rate in America. An interesting read but an inaccurate head.


shoppingThe New York Times had an article a few weeks ago on compulsive shopping eventually becoming a legitimate disorder. I’d been wanting to write about this for a while but Gianna at Beyond Meds beat me to it. She aptly titles her post, “It’s called poor impulse control, people .” She writes:

It’s a psychological problem. But let’s relegate out of control shopping to a brain disorder too, so people can have one less thing to take responsibility for. This is really getting ridiculous. Pretty soon we won’t be responsible for any of our bad behavior as it all becomes pathologized and out of our hands. And you can be sure they’ll be a drug for it, too. Since their calling it OCD related it’s a good bet they’ll try out SSRIs.

The DSM-V is currently being crafted in secret but everyone in the medical field fully expects new disorders (such as subthreshold bipolar disorder and Internet addiction) to pop up. Don’t be surprised if CSD (compulsive shopping disorder) pops up in it too. (pic via pro.corbis.com)


In related let’s-give-everything-a-diagnosis news, some mental health experts are assigning a new label to women obsessed with having children: baby addiction.

baby…Sometimes the desire to keep having children can be rooted in complex psychological issues dating as far back as one’s childhood. In certain cases, experts say, it can become a compulsion, an obsession or even a “baby addiction.”

While the current book of psychiatric diagnoses, the “Diagnostic and Statistical Manual of Mental Disorders,” has no entry on baby addiction, mental-health professionals say they see patients, mostly women, who desperately want to keep having newborns, even when they already have several children and aren’t managing their family situation well. That, they say, is a big red flag, no matter what term is used to describe it.

“It can be an addiction,” says Gayle Peterson, a family therapist in the San Francisco area and author of “Making Healthy Families.”

Peterson has seen several women in her practice who’ve been overwhelmed with four or five children, including those with special needs. Some of the women were suffering with depression or panic attacks and yet when their youngest child became a toddler, they wanted another baby. These women can be driven to have more children in an effort to make up for some sort of void or loss, usually from their own unhappy childhood, explains Peterson.

“If you’re just having babies to complete something in yourself that never got completed, you really are talking about an addiction,” she says.

While it might be an addiction, it’s not DSM-V diagnosis-worthy and it definitely doesn’t need medicinal treatment. Get some psychotherapy and call it a day. An addiction like this is behavioral more than anything else. (pic via sodahead.com)


And last but not least, we’ve also got a new case of “climate change delusion.” (Ha!)

Last year, an anxious, depressed 17-year-old boy was admitted to the psychiatric unit at the Royal Children’s Hospital in Melbourne. He was refusing to drink water. Worried about drought related to climate change, the young man was convinced that if he drank, millions of people would die. The Australian doctors wrote the case up as the first known instance of “climate change delusion.”Robert Salo, the psychiatrist who runs the inpatient unit where the boy was treated, has now seen several more patients with psychosis or anxiety disorders focused on climate change, as well as children who are having nightmares about global-warming-related natural disasters.

–snip–

Of course, no one can predict what effect warming will have on our psyches. The links between mental illness and the weather can be tenuous or even downright contradictory. Depending on which studies you read, suicide is more common, less common, or equally common in hot weather. Ditto dry weather.

It looks like my post just turned into an ODD (OverDiagnosis Disorder) case. I’ll get back to you once I’m free of my concern for the environment, my desire for multiple children, and my penchant for window shopping.

Coming off of Lamictal (lamotrigine)

Medication

I am officially joining the ranks of those who are facing the challenge of Lamictal withdrawal.

On Wednesday, I went to see my psychiatrist with a plan to come off of Lamictal:

  • 150 mg for 3 months
  • 100 mg for 3 months
  • 75 mg for 3 months
  • 50 mg for 3 months
  • 25 mg for 3 months
  • 12.5 mg (depending on whether my side effects on the 25 mg are bad)

I told him that my husband and I were looking to have a child sometime next year and that I’d like to taper off of Lamictal but was open to the possibility of getting back on it should I encounter severe suicidal ideation and mixed episodes. He warned me against it and thought it was a bad idea.

He proceeded to say that it’s a maintenance medication, I have a lifelong disorder, it won’t just go away, my symptoms would probably return, I have a higher risk of attempting suicide, blah blah blah — am I aware of all these risks?

He explained people with bipolar depression after coming off of meds can actually be worse, undergo severe depressive episodes, have more suicide attempts, and yadda yadda yadda. To sum it all up, I was risking my life just to get off of Lamictal.

My pdoc was trying to scare me into staying medicated.

He then added if I really wanted to come off of my meds, I could “just stop.”

WHAT?! My eyes flew open.

He stated he’d had patients who had stopped cold turkey without a problem. According to him, anticonvulsants don’t have severe withdrawal effects.

WHAT?! His advice just flies in the face of what most doctors recommend. In fact, quitting Lamictal immediately increases the risk of seizures, which is exactly what I’m afraid of.

Philip’s experience and Gianna’s experience along with the comments on each blog are proof that many people have experienced tremendous withdrawal effects from decreasing Lamictal’s dosage. In the past, I’ve quit Paxil and Lexapro cold turkey — both with not-so-good results to put it mildly.

I insisted that I wanted to come off of it slowly so he said I could just cut my 200 mg pills in half and jump down to 100 mg and stop after 2 weeks.

For real? Two weeks, doc? I had a plan that would take me over a year and you’re reducing it to a mere two weeks? On 100 mg dosage?

Again, I insisted that I wanted to take more time. He reluctantly wrote me a 30-day prescription for 100 mg and said since I was off the medication, I had no need to see him anymore. “Good luck,” he flatly told me.

When I came home after the appointment (and a bitching session to my husband), I remembered that I’d stashed a few 150 mg pills away sometime ago after I jumped back up to 200. So as of Wednesday, my arsenal included:

  • A bottle of six 150 mg pills
  • A bottle twenty-five 200 mg pills
  • A prescription for thirty 100 mg pills

I dropped down to the 150 mg on Wednesday and have been doing all right so far. I intend to keep myself at 150 mg (cutting the 200 mg and the 100 mg in half) for at least 2 weeks, then drop down to 75 mg for 2 weeks and then 50 mg for 2 weeks. I’m most worried about coming off of the 25 mg. This is a way more accelerated plan that I hoped for but I’ve got to work with the cards that I’m dealt.

We’ll see what happens.

Bipolar Awareness Month

Bipolar Awareness RibbonApparently February is Bipolar Awareness Month. (Who decided this?) I’m well aware that I suffer from bipolar disorder, thankyouverymuch. Looking forward to Bipolar Overawareness Week in May.

Do I have bipolar disorder because my father had schizophrenia?

According to researchers at Stockholm's Karolinska Institute, schizophrenia and bipolar disorder may have common genetic causes. Researchers studied 9 million Swedish people during a 30-year period and discovered that "relatives of people with schizophrenia or bipolar disorder had an increased risk of both disorders." The study may also suggest that "the two conditions may simply be different manifestations of the same disease."

The article from Reuters also points out that Seroquel and Zyprexa are used to treat both disorders, which may lead people in the psychiatric industry to further investigate the link between the two illnesses. Here are some interesting discoveries from the study:

 *  First-degree relatives (parents, siblings, or offspring) of people with either schizophrenia or bipolar disorder were at increased risk for both of these conditions.

 * If a sibling had schizophrenia, full siblings were nine times more likely than the general population to have schizophrenia and four times more likely to have bipolar disorder.

 * If a sibling had bipolar disorder, they were eight times more likely to have bipolar disorder and four times more likely to have schizophrenia.

 * Half siblings who shared the same mother were 3.6 times more likely to have schizophrenia if their half sibling had schizophrenia and 4.5 times more likely to have bipolar disorder if their half sibling had bipolar disorder. Half siblings who shared the same father had a 2.7-fold increase in schizophrenia risk and a 2.4-fold increase in bipolar disorder.

 * Adopted children with a biological parent with one of the disorders had a significant increase in risk for the other.

Creepy. My father's schizophrenia didn't begin to manifest itself until he was in his 40s. The same is true for my two other aunts as well. It may be silly but I live in fear that I may have the same problem. I'll eventually get a psychiatric advance directive in place just in case that day ever comes. After seeing three family members with debilitating schizophrenia/paranoia, sometimes it gets to the point where the benefits of being drugged up outweigh the risks.

Mood rating: 6

Eli Lilly settles with U.S. Gov't for $1.42 billion over illegal Zyprexa off-label marketing

payoutYes, you read that right. Eli Lilly has reached a settlement for $1.42 billion with the U.S. government over the illegal off-label marketing of Zyprexa. The company also pleaded guilty to criminal misdemeanor charges. Basically this is how I see it:

U.S. Gov’t: Eli Lilly, you did a bad, bad thing by doing illegal things. Pay a fine, please, and then you can go.

Eli Lilly: Okayyyy. [reluctantly hands over $1.42 billion to the government]

U.S. Gov’t: [slaps Eli Lilly on the hand] Now, don’t you ever, ever do this again!

It’s a record settlement for a whistleblowing case. According to Philip Dawdy at Furious Seasons, Eli Lilly has paid over $2.7 billion in settlement payouts so far. (With certainly more to come.)

Christian counseling: Nouthetic vs. Biblical

Last night, I spent some time on the phone with my husband’s friend’s sister (aka my former pastor’s sister). We’ll call her Natalie.

Natalie was very sweet and kind, really encouraging and strengthening me by sharing her testimony of faith in God. She suffers from anxiety and panic attacks, which has led her to take Paxil (on and off) for the past 7 years. She says the drug has helped her tremendously and who am I to knock the drug (knowing what I know about Paxil/Seroxat) when she has seen the wonders that it has worked in her life?

I briefly explained my story of depression, history of suicide, and diagnosis of bipolar disorder. Although she couldn’t fully relate, she was very sympathetic and understanding. In fact, our conversation was so fruitful, I ended up taking notes!

Jay AdamsWe briefly touched on the issue of Nouthetic counseling (NC). She has undergone the course and simply needs to be certified. The counselor I currently see is associated with the Christian Counseling Education Foundation (CCEF), which has roots in NC and was founded by the man—Jay Adams—who developed the method. However, CCEF is now known for what is called biblical counseling. The organization has since moved away from pure Nouthetic methods and become more a bit more varied, taking bits and pieces of psychology (and perhaps psychiatry) that line up with the Bible. Adams, disagreeing with the organization’s approach, founded the Institute for Nouthetic Studies and uses the Bible as the sole counseling textbook. According to the wiki entry on Nouthetic counseling, Adams developed the word Nouthetic based on the “New Testament Greek word noutheteō (νουθετέω), which can be variously translated as ‘admonish,’ ‘warn,’ ‘correct,’ ‘exhort,’ or ‘instruct.’”

NC was developed back in the ’70s as a response to the popularity of psychology/psychiatry. Many Christians reject some of the teachings of such popular psychologists as Freud, Jung, Adler, Maslow, etc. Adams’ highly successful book, Competent to Counsel, criticizes the psychology industry and counters its teaching with a Nouthetic approach.

But NC has its Christian critics.

Read the rest of this entry »

Lamictal in consideration of pregnancy

My husband and I are talking about expanding our family. While that sounds all well and good, I just have one issue:

Lamictal.

For most women, they think, “Well, I want a kid” and the most they have to do is probably get off birth control. Just finish off their contraceptives, maybe feel a little nauseous, and move forward with their plans.

(sigh) Not me. If I want to do this right, it might be a good 6 months or so before I can consider trying.

Read the rest of this entry »

Loose Screws Mental Health News

The mastermind behind Stavzor is Noven Pharmaceuticals (in conjunction with Banner Pharmacaps Inc.). The new “small, easy-to-swallow soft gel capsule” is available in three strengths: 125, 250, and 500 mgs. The pills are are “up to 40% smaller than han Depakote® and Depakote ER® tablets at the 500 mg dosage strength.” From Noven’s PR:

Stavzor is approved for the treatment of manic episodes associated with bipolar disorder, as monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures that occur either in isolation or in association with other types of seizures, and for prophylaxis of migraine headaches.

The drug will hit the market in mid to late August.

The hotline receives an average 250 calls each day from veterans that have fought in Iraq, Vietnam, and Afghanistan.

The issue of soldiers with mental illness has recently come to light with studies showing that 1 in 5 soldiers returning from Iraq and Afghanistan have shown symptoms of post-traumatic stress disorder. The issue of the high suicides rate has been a high priority of the VA since mental health director Ira Katz tried to hide the significant number of suicides committed by veterans.

The National Suicide Prevention Lifeline is available 24 hours a day by calling 800-273-TALK (8255); veterans should press “1″ after being connected.

“We have seen a 60 per cent increase in demand for our child anxiety classes in the past six months,” said [Dr. Kimberley O'Brien, of the Quirky Kids Clinic at Woollahra in Sydney].

It sounds more like the article is speaking of children who are exposed to constant physical and emotional abuse. If that’s the case, shouldn’t there rather be an increase in parenting properly classes?

An inhalation drug for schizophrenia and bipolar disorder???

Oh no they didn’t. From Alexza Pharmaceuticals’ recent PR:

Staccato system-inhalationAlexza Pharmaceuticals, Inc. announced today that it has initiated its second Phase 3 clinical trial with AZ-004 (Staccato(R) loxapine). AZ-004 is an inhalation product candidate being developed for the treatment of acute agitation in patients with schizophrenia or bipolar disorder. Alexza believes the novel, non-invasive nature and rapid pharmacokinetic (PK) properties resulting from inhaled loxapine administration via the Staccato system (click on the photo to the right to see an enlargelarement) have the potential to make AZ-004 a viable product to treat acute agitation.

The supposed benefits:

  1. Rapid onset
  2. Ease of use
  3. Consistent dose and particle size
  4. Broad applicability

Is this pharmaceutical company really developing a product to treat schizophrenic and bipolar disorder symptoms by inhaling? I thought the injectable Risperdal was bad. Check out how the Staccato system works. It blows my mind that psych drugs are being developed for injection and inhalation.

More Famous People With Mental Illness

The local NAMI chapter has literature all over a counter at my local library. One of the pieces of literature actually was a 5×7 index card with a list of famous people who struggled with mental illness. It was kind of interesting so I figured I’d share it. Some I’d already known about; others were a bit of a surprise. How did they figure out who had bipolar disorder back in the 1800s?

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The Bipolar Child, Part II: Childhood bipolar disorder criteria

CLPsych wrote a post on the "Growing Up Bipolar" Newsweek cover story. I agree with most of his points. Especially:

1. Max's problems are described by the journalist as "incurable" and as "a life sentence." It is true that the kid is likely in for a life of trouble. But stating that such difficulties are a certainty for the rest of his life? That's a little too certain and it's not based on any evidence. Show me one study that indicates that 100% of children like Max will always have a high level of psychological difficulties and essentially be unable to function independently.

The article even mentions that "Max will never truly be OK." Apparently, I just learned from my recent viewing of Depression: Out of the Shadows that diagnoses are not static.

Miracles have happened but to say that Max's future doesn't have a grim tint to it is unrealistic. Not because of his diagnoses but because of all 38 different medications that he's already been on.

By 7½, Max was on so many different drugs that Frazier and his
parents could no longer tell if they were helping or hurting him. He
was suffering from tics, blinking his eyes, clearing his throat and
"pulling his clothes like he wanted to get out of his skin
," says
Richie.

By the time Max had reached 8 years old, he was already showing the symptoms of side effects that can occur long-term. Tardive dyskinesia, hyperglycemia, diabetes, akathisia, neuroleptic malignant syndrome are all very real side effects that could develop in Max's teenage years and stick with him permanently. "Max will never truly be OK." Not because of his disorders but because these medications have given him a different "life sentence" — a life sentence of physical, visible afflictions in addition to the emotional and mental disorders he already struggles with.

I haven't really gotten into the child bipolar disorder conversation on this blog because

  • it's such a controversial diagnosis that would require lengthy posts that I didn't have time for
  • I found the entire diagnosis to be a bunch of hooey

But I will now.

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The Bipolar Child, Part I: Reactions

Newsweek If you haven’t been reading the news recently, Newsweek magazine published a feature article on Max, a 10-year-old who struggles mainly with bipolar and attention-deficit/hyperactivity disorders among other mental illnesses. I read the article and was astounded at what Amy and Richie Blake, Max’s parents, have to contend with. I’m astounded at what Max suffers with.

The article was educational but for all the 8 computer pages that I printed, I didn’t read about Max; I read about his diagnoses:

Max Blake was 7 the first time he tried to kill himself. He wrote a four-page will bequeathing his toys to his friends and jumped out his ground-floor bedroom window, falling six feet into his backyard, bruised but in one piece.

He cried for hours at a time. He banged his head against his crib and screamed until his face burned red. Nursing, cuddling, pacifiers—none of them helped.

Richie carried his son to the backyard and tried to put him down, but Max shrank back in his father’s arms; he hated the feel of the grass beneath his small bare feet. Amy gave Max a bath and turned on the exhaust fan; he put his hands over his ears and screamed. At 13 months, he lined up dozens of Hot Wheels in the same direction, and when Amy nudged one out of order, he shrieked “like you’d just cut his arm off.” At day care, he terrorized his teachers and playmates. He wasn’t the biggest kid in the class, but he attacked without provocation or warning, biting hard enough to leave teeth marks. Every day, he hit and kicked and spat.

By 7½, Max was on so many different drugs that Frazier and his parents could no longer tell if they were helping or hurting him. He was suffering from tics, blinking his eyes, clearing his throat and “pulling his clothes like he wanted to get out of his skin,” says Richie. In February 2005, under Frazier’s supervision, the Blakes took Max off all his meds. With the chemicals out of his system, Max was not the same child he had been at 2. He was worse. … Off his meds, Max became delusional and paranoid. He imagined Amy was poisoning him and refused to eat anything she cooked. He talked about death constantly and slept little more than two hours a night.

During a recent appointment at Frazier’s office, he went into full-fledged mania. Laughing wildly, he rolled on the floor, then crawled over to his parents and grabbed an empty medication bottle, yelling, “Drugs! I’ve got drugs! It’s child safety!” Richie grabbed it back, Max screamed, Richie threw the bottle across the room, as if playing fetch. Max squealed and dove for it, then began to sing into the neck of the bottle: “Booorn to be wiiiiild …” Amy rolled her eyes: “Two kids.” And then: “It’s hard not to laugh.” (I’m not the only one who doesn’t think this is mania.)

All throughout the article, I couldn’t help but think to myself: Who is Max? Max without meds — does he have a personality? What does like to do for fun, even for short periods of time? Karate is mentioned — does he read? He has trouble writing for long stretches. He’s got a friend. What makes Max so charming other than the fact that he’s 10 years old?

(Image from Newsweek)

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Breggin takes on Newsweek's "Growing Up Bipolar" article

Breggin’s post on Newsweek‘s "Growing Up Bipolar" article makes good points but steers clear into wackiness throughout. My only wish is that instead of pointing out the problems of the psychiatric industry, he would have offered some suggested solutions.

Oh, and he flat-out gets some things wrong:

Newsweek makes clear that Max’s parents have serious conflicts over how to raise their son, but they have not pursued therapy, marriage counseling or, apparently, not even parenting classes.

The article DID mention that they tried to pursue marriage counseling but dropped out.

He says he has never been to therapy. But late last year, Amy demanded that the two of them see a marriage counselor. Richie agreed. They went a few times, but there were "scheduling issues," says Richie, and they haven’t gone back. For the moment, they are getting help from the same people who help Max. Anything that makes his life easier makes theirs easier, too.

Then he applies a broad brush from the cases of "out-of-control" children that he’s seen:

In every case of an out-of-control child I have seen in my psychiatric practice, either the parents were unable to reach agreement on a consistent approach to disciplining their child, or a single working mom was trying to raise a young boy without the aid of a male adult in the child’s life.

I like Peter Breggin’s approach to psychotropic drugs for the most part, but sometimes he just gets a little off-base for me.

Pharma's "me-too" drugs face skeptical docs and health insurers

As patents expire on a variety of drugmakers’ moneymakers, pharma companies have gone to great lengths to structurally reinvent the successful drugs then tout the benefits that differ from their predecessors.

InvegaCase in point — Johnson & Johnson’s Invega. Invega is the successor to the popular antipsychotic drug, Risperdal, and competitor to AstraZeneca’s widely used antipsychotic Seroquel. Scott Hensley at The Wall Street Journal’s Health Blog (WSJ) reports that Risperdal is going generic in June. Gianna at Beyond Meds recently said it will not. According to the Dow Jones Newswires (DJN), these “junior” drugs face skepticism from health insurers and doctors. California-based Kaiser Permanente and Minneapolis-based UnitedHealth Group Inc. (UNH) are example of companies that have somewhat discouraged use of the drug. Kaiser doesn’t cover Invega at all, and members of UNH are required to pay higher copays for the brand name. The wire reports New York-based psychiatrist Jeffrey Lieberman wasn’t “buying it” the difference between Invega and Risperdal.

Invega is “basically a me-too drug, and the company hasn’t done the studies that would be required to really distinguish it,” Lieberman, chairman of the psychiatry department at Columbia University’s medical school told Peter Loftus of Dow Jones Newswires.

Ouch.

The blog also quotes Daniel Carlat from the The Carlat Psychiatry Report.

Dan Carlat, a psychiatrist and a tough critic of Invega, wrote that J&J’s “marketing team apparently missed the fact that the word in the English language that sounds most like “Invega” is “inveigle,” meaning “to entice, lure, or ensnare by flattery or artful talk or inducements.’ ” He asked doctors: “Will you be doing your patients a favor by taking the plunge? Or will you simply be giving them the same wine in a fancier bottle?”

Even J&J’s Group Chairman of Pharmaceuticals, David Norton, admitted that Invega is a tough sell.

“We need to do a better job at drawing a differentiation in a difficult-to-treat population.

So far, Invega sales have been incredibly disappointing compared to the Risperdal blockbuster.

Wyeth (antidepressant Effexor XR cum Pristiq) and Shire (ADHD drug Adderall XR cum Vyvanse) face the same uphill battle. Wyeth’s Effexor faces generic competition from Teva Pharmaceuticals despite efforts to halt generic sales of the drug and the patent on Shire’s Adderall is set to expire next year.

Hensley, in his analysis, raises a question in which the answer remains to be seen:

Cheap generics abound to treat a broad assortment of illnesses these days. What’s the point, the critics ask, of paying more for drugs that are at best only slight improvements over tried and true medicines available at bargain prices?

It’s something that I’ve questioned myself.

In an attempt to have the “me-too” drugs compete with its derivative, both Wyeth and Shire are slashing their prices, or as the DJN reported, “emphasizing improved dosing for the newer drugs.” Although Pristiq’s efficacy comes at higher doses, it’s being priced 20 percent lower than Effexor.

[Deutsche Bank pharmaceutical analyst Barbara Ryan] thinks the odds of
Pristiq’s success are slim because it appears to offer few benefits
beyond those of Effexor.

That remains to be seen. So far, a few patients have commented on my blog that Pristiq has already begun to help them. I haven’t seen any DTC ads for Pristiq so I can only assume that drug reps are doing a fine marketing job at selling the different benefits of the drug to doctors.

Vyvanse, on the other hand, is looking promising for Shire, already having 7 percent of U.S. ADHD drug prescriptions. Chief Executive Matthew Emmens says the drug is chemically different from Adderall (aren’t they all?) and has better pricing. Shire expects to beat Adderall’s 26 percent peak market share. Seems like a lofty goal to me.

As for Invega, J&J is currently seeking FDA approval to use the drug for bipolar disorder and not just treatment for schizophrenia. It is also l0oking to get approval for an injectable Invega XR.

(Invega logo from Janssen.com)

Celebrity Sensitivity: Maurice Benard

This one’s for the women.

If you’re anything like me, sometime during the 90′s you watched the long-running soap opera General Hospital at one point or another. Well, remember bad boy Sonny Corinthos?

Maurice BenardMaurice Benard, the actor behind the character, has openly admitted to struggling with severe bipolar disorder and is a spokesperson for Mental Health America. While I’m not sure which came first (the chicken or the egg), Benard’s charcter, Sonny, also struggles with bipolar disorder on the show. In the past, I’ve read that he flew into rages so bad that he needed to be hospitalized and had to take time away from the set to recover. It’s only fitting that Sonny’s character — as ruthless as he is — shows a true side of Benard who seeks to educate viewers about the disorder.

Combined with his stressful career in organized crime, Sonny’s bipolar disease has caused him to routinely break out in acts of senseless violence.  The most infamous example of Sonny’s violent side was when Sonny, during one of his “manic” moods, shot his wife Carly in the skull while she was in the process of giving birth to his son.

That episode sounds like it might have pissed me off instead. But Benard seemed okay with it.

“Two years ago the head writer came up to me about doing a breakdown story. I said as long as it’s done to educate people and to make it right.  And we did it.  It was fantastic,” the General Hospital actor added.

I wonder what people learned from the overall storyline.

Diagnosing myself

Celebrity Sensitivity: Christina Ricci, Mel Gibson, and Britney Spears

Liz Spikol has a new post on celebrities talking about mental disorders. This time, it’s Christina Ricci and Mel Gibson. Ricci has previously admitted to suffering from anorexia but now admits to suffering from depression. Gibson, on the other hand, said in a 2002 interview that he was bipolar (manic-depressive back in the day). Then she’s got a whole list of people who have recently admitted to depression.

Then there’s Britney Spears. If you don’t know who she is, be thankful. For the rest of us who spend our time following celebrity news, there have been rumors swirling around recently that she is pregnant because she’s got a big, protruding belly (bigger than the botched VMA’s last year) even though she’s been exercising regularly.

Britney SpearsAccording to the Daily Mail, Spears isn’t pregnant but seriously bloated as a result of her medication.

A source close to the family says that Britney has been struggling with her weight ever since she had her second son Jayden James, 20 months, and the medication has not helped.

The pop star has been back in training in preparation for a comeback, spending plenty of time on the treadmill – but despite all the effort, she is failing to regain the svelte figure which made her famous.

I wonder what antipsychotics she’s on. Seroquel?

Finally, ABC News wrote about celebrities who suffer from various mental illnesses. I’d been wanting to blog on this some time ago but never had the chance. BPD in OKC beat me to it.

Thoughts on Bipolar Overawareness Week: Part III

In all seriousness, I have wondered about the BPD diagnosis but in my mind, have somewhat fallen short. I don’t think my symptoms are strong enough to be plastered with a BPD label.

To conclude my several-post rambling, I should answer the question that I initially posed. Do I think bipolar disorder is overdiagnosed?

No.

Many of my fellow bloggers will likely disagree with me. Zimmerman’s study at Rhode Island Hospital took into account whether those “diagnosed” with bipolar disorder had a family history of the diagnosis in the family. Maybe I’ve turned to the dark side. Just because I don’t have a family history of bipolar doesn’t mean that I can’t suffer
from the disorder. However, I have a family history of schizophrenia: one father and two aunts. Does this put me at a higher risk for schizophrenia? Definitely. Does this mean I could suffer from bp and have the schizo gene pass me by? You bet. I don’t think that I need a first-degree relative to suffer from bp to make me a classic diagnosis for bp.

For instance, when it comes to my physical appearance, I’m the only one on both sides of the family who suffers from severe eczema to the point where my dermatologist suggested a punch biopsy. Does that mean that I need to have a family history of eczema to obtain the malady? Not necessarily. Why is bipolar disorder any different?

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Thoughts on Bipolar Overawareness Week: Part II

Here are some things that have occurred in my life:

  • racing thoughts
  • spending sprees when I have no money
  • cleaning at odd hours of the night
  • thinking that I’m the most amazing job interviewer ever
  • worrying that people are watching me through video cameras or the wall in public bathroom stalls
  • afraid that a video camera exists in our bedroom (I know it doesn’t. I think?)
  • talking to "friends" who don’t really exist
  • disobeyed parents
  • talked back to authority
  • suicide attempts
  • rage/anger/hostility/irritability
  • temper tantrums
  • violent outbursts
  • socially awkward
  • extreme mood swings (happy to sad or angry in the same day)
  • doing things and barely remembering them
  • memory loss/forgetfulness
  • chronic fatigue
  • indecisiveness
  • no interest in sleep
  • inability to focus on one thing for an extended period of time/lack of concentration
  • anxious about being around people I don’t know/don’t like
  • anxious to go out and spend time with friends and/or family
  • impulsiveness
  • overeating
  • persistent, negative thoughts

All right. So those are some things that have occurred over the course of my life. Let’s see what I diagnoses I can pigeonhole myself into.

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Thoughts on Bipolar Overawareness Week: Part I

I finally sat down and read all those posts that I linked to about Bipolar Overawareness Week. I mentioned in my previous post that I feel like I had a contrarian view. Well, I do. Somewhat. Although it’s probably not as contrarian as I’d think.

Let’s take my experience, for example.

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Tardy Bipolar Overdiagnosis Week Post

Ok, so I’m incredibly late on this bipolar overdiagnosis week thing (one week, of course) but a bunch of blogs that I know of have already blogged about it. In fact, there have been so many posts on it that I haven’t been able to read and keep up on them all. All I know is that a recent study came out saying bipolar disorder is overdiagnosed. In the meantime, read blogs that have commentary on the matter (most of the links from Furious Seasons):

Furious Seasons — Study: Bipolar Disorder Overdiagnosed

Furious Seasons — Making Sense of Bipolar Disorder Overdiagnosis

Furious Seasons — Major Researchers Support Bipolar Overdiagnosis Study

Furious Seasons — Mental Health Month Meet Bipolar Overdiagnosis Awareness Week

PsychCentral — Bipolar Disorder Overdiagnosed

Psychiatric Drug Withdrawal and Recovery — Celebrating Bipolar Overawareness Week

Clinical Psychology & Psychiatry: A Closer Look — Bipolar Overawareness Week Starts on Monday

I’ll give many of these posts a read before I say anything about it. But as of right now, I’m sitting here with a contrarian view, believe it or not.

Suicide Attempt: 1,346,985 (number is an exaggeration)

I had a serious mixed-mood episode during the weekend. I remember wanting to buy brownie mix at 1 am and refusing to answer my
husband’s question, "What’s your mood rating at?" because I knew I’d
answer 10. But then my husband woke up in the middle of the night to find his cell phone charger cord wrapped around my neck as I tried to strangle myself. I vaguely remember it.

Abilify is starting to sound better. Abilify or brain fog on Lamictal? I can’t decide. Sometimes, I do wonder if he’d be better off without me. I often think I’d be better off without myself.

Current Mood Rating:
4.9

Gone but I don't know where

You have been drifting for so long / I know you don’t want to come down / Somewhere below you, there’s people who love you / And they’re ready for you to come home / Please come home
~ Sarah McLachlan, “Drifting”

I have an appointment with my psychiatrist on Tuesday morning. I’m not quite sure what to do.

My “symptoms” are back. Now that I know what to look for as someone with bipolar disorder, I am aware of them. I’m having mania moments. I don’t want to sleep. I have no desire to. My husband sometimes MAKES me go to sleep. I’d rather be up doing the laundry, washing the dishes, blogging, reading other blogs, making to-do lists, and organizing the apartment–all at the same time–at 2 or 3 am. (This doesn’t mean all of this stuff gets finished.)

My husband and I have had physical fights in the past where he has had to restrain me because I wouldn’t go to bed and I wouldn’t sleep. It would be 4 in the morning and I refused to sleep and I’d fight him tooth and nail. I don’t know why. I have no problem wanting to sleep at 2 pm. Make it 2 am and there’s too much to do suddenly. I have the superhuman ability to get things accomplished between midnight and 5 am more than I can during the hours of 9 am to 11 pm. Right.

So now it’s almost 1 in the morning and I have nursery duty at church later in the morning. Then I have a hair appointment in the afternoon. Then I’m paranoid about what my hair stylist thinks of me.

She says she’s my friend but I wonder if she’s just pretending to like me because she feels sorry for me. I’m really lame you know. People at work acted nice to my face and then dissed me behind my back. She does the same thing to others, why wouldn’t she do the same to me? She just keeps me around and kisses up to me because I tip well.

Thinking like that scares me. It reminds me of the way my father used to think. Paranoid. (You can stop reading here. At this point on, it’s just a manic ramble that’s basically full of nothing but stream-of-consciousness just because i can.)

Read the rest of this entry »

Bipolar teen missing in Colorado

A 14-year-old girl who suffers from bipolar disorder has gone missing according to local news reports.

The Arapahoe County Sheriff’s Department is asking the public for help in finding Michelle Jung. Deputies say she is in need of her bipolar medication and has not been seen since 1 p.m. Monday at Hampden Academy located at 14301 E. Hampden Ave.

Deputies described Jung at 5 feet tall and weighing 120 pounds with black hair and brown eyes. She was last seen wearing a gray jacket and blue jeans.

Deputies believe she was heading home from school but are unable to find her. Anyone with information should contact local authorities immediately.

Neurontin 0, Placebo 1. Pfizer loses, Placebo wins.

Stephany at soulful sepulcher has a post up on how Neurontin has not shown itself to be more effective for bipolar disorder than placebo in clinical trials.

It's actually kind of funny that this discovery has been made in April 2008 because I'd reported on this back in January of 2007:

So let's recap: gabapentin is FDA-approved for epilepsy ONLY. But gabapentin has a slew of off-label uses.

Don't know what off-label means? It means "not FDA-approved to be prescribed for this use."

Now that we've got that out of the way, gabapentin is prescribed off-label for migraines, bipolar disorder, social anxiety disorder, OCD, treatment-resistant depression, insomnia, multiple sclerosis, neuropathic pain, and in some instances, post-operative chronic pain.

Where did this off-label usage come from? Basically, one journal article published data on beneficial effects for patients on Neurontin for bipolar disorder and then other articles would cite that article as supporting evidence then more articles cited all the other articles that published the positive efficacy data on the drug, creating what UNC researcher Tim Carey calls the "echo chamber effect."  From Fierce Pharma:

Hearing it over and over, doctors were led to believe that Neurontin worked for bipolar patients, and prescribed it to lots and lots of them.

These articles that touted the benefits of Neurontin were cited 400 times. Carey:

It “becomes a rumor mill in which physicians may be exposed to these types of articles, and citations of articles, which then gives credibility to off-label use.”

The conclusion?

“No scientifically acceptable clinical trial evidence supports use” of the drug in bipolar disorder.

Ouch. Hitting Pfizer where it hurts.

"You can do this"

From October 10, 2006:

carI’m tempted to go crash my car.

Again, the boy cried wolf.

Except I’m a girl.


Right now, I’m going through what my old pastor used to say is a “spiritual winter.” I just fall into moments when I just cease praying and reading my Bible for whatever reason. I’m not mad at God or anything; I still struggle with believing in a God that I’ve never seen with my own two eyes. But then I think about the specific events that have taken place in my life and I know He exists.

With that being said, I sat in my car this morning with the ignition turned on, ready to drive my car over the bridge into the Schuylkill River. I was ready to run home, make the stupid “goodbye world” post on this blog, text my husband “I love you. Goodbye” and then ram my car into a divider on I-76. It’s the worst suicidal thought I’ve had since I ended up in the hospital in October 2006.

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Loose Screws Mental Health News

If the state gets its way, hundreds of children could be put in foster homes, in what could be a wrenching cultural adjustment that may require intensive counseling.

Wow. That's all I can say. How do you place 400 different children in foster homes and ensure they'll get proper care? You can't.

Home bipolar test? What. In. The. World.

DNA strand

I stumbled upon an AP article on Yahoo! News titled, “Home bipolar disorder test causes stirs.” No kidding.

I read the article trying to figure out how this company, Psynomics, is able to genetically figure out who is more predisposed to what.

To take the test, patients receive by mail a plastic cup that they spit into, seal and send back to Psynomics. The company analyzes DNA in the saliva.

Psynomics will send patients’ test results only to their doctors to avoid the risk of self-diagnosis.

Here’s a sample report located on the Web site (PDF file).

Are you interested? If you’re anyone other than a white person of Northern European ancestry who shows some bipolar symptoms and has at least one other bipolar family member, then you don’t meet the criteria for this testing. Even if you do, save your money and buy something else – the test costs a steep $399 and the results aren’t entirely certain. In fact, researchers and doctors say there is very little data at the moment to support testing DNA for bipolar disorder or other mental illnesses.

[Dr. John] Kelsoe, 52, acknowledges that bipolar disorder probably results from a combination of genetic factors and life experiences, and that the presence of these gene variations does not at all mean that someone will, in fact, develop the disease. He admits, too, that his findings about the genetic basis of the illness are far from complete.

“The goal of this is to try and help doctors make an accurate diagnosis more quickly so the patient can be treated appropriately,” Kelsoe said. “Anything is going to help, even if it just helps a little bit.”

I’m worried that people are going to think that they have bipolar disorder, fork over the money for gene testing, and be told when that they have bipolar disorder when they really don’t. Why manufacture a mental illness for a person that may not exist?

In coming months, at least two other startups led by genetic researchers are set to release their own psychiatric genetic tests. One test claims to predict the risk of developing schizophrenia. The other is designed to forecast the likelihood that some medications for major depression could heighten suicidal thoughts in patients.

As much as I’m not a fan of psychiatrists and there’s always the chance for misdiagnosis, I call this company a scam designed to prey upon people’s insecurities. (Perhaps bipolar people would purchase this in the midst of a spending spree?) Regardless, some people are buying into this product that even the maker admits isn’t entirely accurate.

Psynomics has sold only a few tests so far but is projecting sales of 1,800 tests in 2008 and 30,000 in the next five years.

Considering that it now has major media coverage, it’s likely to take off even more.
(Image sciam.com)

Bipolar & the Workplace

I was surprised to see an ABC News article on bipolar disorder. Bipolar disorder is the “hip” mental illness these days — especially when used to characterize someone with extreme mood swings. One section addressed admitting to bipolar disorder in a work environment:

One day, he let it slip.

“I just blurted it out. ‘I’m sorry I’m getting shock treatments. I can’t remember anything,’” Steve said. His colleagues’ reactions were less than encouraging, he recalled.

“I would say that they were afraid of me,” Steve said. “They stopped referring their clients to me.”

Steve said that eventually his colleagues’ attitudes forced him to leave his job.

I admitted my problem to three people at my job: my managing editor at my last job and three of my coworkers (one with whom I am still friendly).

  • The managing editor, who had picked on me mercilessly, finally backed off. As far as I know, she didn’t tell anyone which I appreciated.
  • One of my coworkers admitted she had depression to me first before I told her I had bipolar disorder. It’s understood between us that we won’t go around and talk about these things.
  • The other coworker also told me about her journey through depression and her treatment afterward. I then revealed my struggle with bipolar disorder. We are friends outside of work now.
  • I’d told the last coworker about this shortly after I received my diagnosis after being released from the psych hospital. As far as I know, she didn’t tell anyone. But in the end, she’s the one who said the hurtful things about me in the e-mail I inadvertently received. It’s anyone’s guess if she told other coworkers or if she completely forgot.

From Bipolar Journey:

My experience is: work is work.  Outside of work is where one gains support for any illness they struggle with.  Acknowledging my response is skewed on the basis of recent events, I can’t recommend telling anyone you work with about one’s illness.  I should have kept to my Psychology professor’s advice:  “Never tell anyone you work with about your illness, trust me when I tell you:  they will treat you differently.”

I attended an outpatient group in late October 2006 after my hospitalization. One lady said that one of her coworkers admitted she was bipolar; since then, the coworker was teased and verbally abused by her supervisor and other coworkers. I’m not positive but I think the person might have even gotten fired lest her disorder interfere with her ability to do her job. (She cleaned pools.)

People with the disorder often have trouble keeping a job and are 40 percent less likely to be employed than the average person, said Ronald Kessler, a public health researcher at Harvard University.

On the other hand, Kessler said, if treated properly, they can be creative and invaluable individuals. Many highly successful authors, artists and professionals have the disorder.

I’ve seen statistics like this before and they worry me. I constantly wonder whether I’ll ever be able to hold down a full-time job for a long period of time. I’m currently unemployed and – to my disbelief – enjoying it. I’m afraid I’ll get lazy and never go back to work. I’m afraid that I’ll start to go in and out of jobs like a revolving door. One of my psychotherapists in college flat out told me that I’d never be able to hold down a job.

As I try to venture into editorial freelancing, I’m afraid of a host of things: outdated skills, inexperience, lack of confidence, failure, libel, confrontation, socializing, networking, creating expectations (of myself) that I never live up to. My counselor told me to just jump in and do it first then worry about the details later. [deep breath]

failureI fear failure the most. Failure that I’ve forgotten my editorial skills because they haven’t been used daily since 2005. Failure that editors will write me off because I’m a 26-year-old with unimpressive clips like “Bees Infest Dorm Hall” (yawn), “Student Organization Rallies Youth to Vote” (so cliche), and “Penn State Strikes Deal with Napster on File-Sharing” (Nov. 2003 = old). Failure that I’ll write an article, misinterpret the facts, and then get the publication slapped with a lawsuit. Failure that I’ll have to be “pleasantly persistent” in calling up editors, asking for prompt payment of my freelance services. Failure that I will intentionally avoid things that would otherwise propel my career: attending social mixers, networking, doing all the social things that makes my blood run cold because I hate meeting new people (in person). Failure that I’ll look at past awards I’ve received and then never live up to the reason why I received them in the first place. I don’t want to blame bipolar disorder from holding me back but sometimes, I can’t help but think where I’d be in my professional career without it.

(Image from gobears.wordpress.com)

Loose Screws Mental Health News

"Can an antipsychotic drug from the 1950s be paired with a 1980s antibiotic to shrink 21st-century tumors?"

That's the first line from the NYT's recent article on biotech companies mixing two unrelated generic drugs to treat medical problems. Alexis Borisy, the executive of CombinatoRx, is spearheading the movement to mix and match two different generic drugs in the hopes that the combo will cure or effectively treat a disease that may be unrelated to the drugs' initial purposes.

"Orexigen, in creating its obesity drug Contrave, took a treatment used for drug and alcohol addiction and combined it with an antidepressant sometimes used to help people quit smoking." (My guess is that the antid was Zyban.)

It's a nice concept, but I'd hate to see risk of side effects doubled. One med can be a doozy; coupled with another could turn out to be problematic.


More from the NYT: Pharmaceutical companies pay psychiatrists (to push their products) more than doctors in any other specialty.

"For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved."

The bipolar child paradigm.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.

The number most likely represents a small fraction of drug makers’ total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.

Doesn't the last sentence make you feel all warm and fuzzy inside? It's great to know that getting people to use drugs are more important to these companies than making sure these drugs are safe to use. Yeah, yeah, I know, it's a company and companies are only out to make profits. Whatever kind of optimist is in me wants to believe that maybe there's one doctor out there who is more motivated by helping others than by pharma-backing money. But I'm only a slight optimist.

Take two pills and call me if there's a birth defect

A recent article in the NYT reported that two studies released in The New England Journal of Medicine claim that an antidepressant could potentially increase the risk of a baby being born with a birth defect, but, uh,  it's unlikely and "confined to a few rare defects."

Benedict Carey, author of the article, points out that the studies didn't have a good sampling to really prove that assertion:

"In both studies, researchers interviewed mothers of more than 9,500 infants with birth defects, including cleft palate and heart valve problems. They found that mothers who remember being on antidepressants like Zoloft, Paxil, or Prozac while pregnant were at no higher risk for most defects than a control group of women who said they had not taken antidepressants."

So what's it's sounding like for me is that researchers got a group of expecting moms together, basically said, "Hey, have you taken an antidepressant?" and the ones who said yes were placed in one control group and the ones who said no were placed in another. How reliable.

Having been part of a clinical trial for bipolar disorder, I know it's likely these women got paid for their participation in this study. (Most people do, from what I understand.) So some could essentially have lied in the hopes they could snag $100. It doesn't sound like these women agreed to have their past medical history released to researchers that could prove they've been on antidepressant medication, they could have just been like:

"Uh, yeah. I took the antidepressant with the happy little egg sad face thingy."

Doctor: "Zoloft?"

"Yeah, yeah! That one. It maketed me alllll better."

Remember – it's mothers who "remembered" being on antidepressants while pregnant, not medical histories that proved that they've at least been prescribed the medication.

One doctor, not involved in the research, had reservations about the so-called findings:

"These are important papers, but they don't close the questions of whether there are major effects" of these drugs on developing babies, said Dr. Timothy Oberlander, a developmental pediatrician at the University of British Columbia, who was not involved in the studies.

Despite the seemingly positive outcomes that "support doctors' assurances that antidepressants are not a major cause of serious physical problems in newborns," both studies uncovered some pretty serious – but considered rare – conditions.

"One of the studies, led by Carol Louik of Boston University and financed in part by the drug makers GlaxoSmithKline and Sanofi-Aventis, found that use of Paxil was associated with an increased risk of a rare heart defect, which the company had previously reported.

The other study, led by Sura Alwan of the University of British Columbia, found that use of antidepressants increased the risk of craniosynostosis, a condition in which the bones in the skull fuse prematurely. Rare gastric and neural tube defects may also be more common in babies exposed to the medication, the studies suggested."

But don't worry, pregnant moms – the risks are low, "appear remote, and confined to a few rare defects." So, hey, even if your baby DID develop a rare defect, at least it's rare! [sarcasm]

I'd take the chance of depression if it meant my baby had a better chance of being born healthy. I'm lucky – I couldn't take Lamictal if I got pregnant. I wish antidepressants would have the same instruction.

Loose Screws Mental Health News

Let’s start off small and build up, shall we?

A blog I came upon, Providentia, has a post on the suicide rate in Kentucky over a 10-year period. Male schizophrenics have the highest rate of suicide. The leading methods of suicide in the state are firearm use, overdose, and hanging.


Mary WinklerMary Winkler, the preacher’s wife who killed her husband, has been moved from jail to a mental health facility, where she will serve the remainder of her three-year sentence.


East meadow, a poster on the drugs.com message board, asks about Lexapro’s correlation to suicide. Her sister committed suicide while on Lexapro and questions whether the Lexapro might have affected her in that way. As a former Lexapro user, I can empathize with the change in her sister’s behavior.


The Depression Calculator: see how much depression is costing your company and see if treatment is worth your while. I went through it for kicks and basically, I walked away feeling like it cost too much to hire someone with depression, especially if I were running a small business. Blah.


Apparently, bipolar disorder is covered under the Americans with Disabilities Act (ADA). Starbucks is settling an $85,000 lawsuit with Christine Drake, a former Starbucks employee who suffers from bipolar disorder. It seems that Drake’s first manager was willing to work with her “psychiatric impairment” and allow her to gain “extra training and support.” Then, get this:

“But, during her third year, new management told her she was “not Starbucks material,” refused to continue the accommodation and ultimately fired her for discriminatory reasons, the agency alleged.”

Starbucks probably put up one helluva fight, but in the end, they’ve tried to put a good face and good spin on the situation:

Starbucks agreed to pay Drake $75,000 and donate another $10,000 to the Disability Rights Legal Center, which provides legal representation for low-income people with disabilities facing discrimination, as part of the settlement.

“The facts of this case illustrate how relatively minor accommodations are often all that disabled people need to be productive members of the work force,” said the EEOC’s San Francisco district office director, Joan Ehrlich. “It is important that all of Starbucks’ managers understand their legal duties regarding disabled employees and provide them with the tools necessary to succeed. This is in everyone’s best interest.”

Ms. Drake, who seems to be more than capable of handling a job well, has probably eeked out several years of a barista’s salary from the Starbucks suit.


I’m amused, but it’s not necessarily a good thing.

RisperdalJohnson & Johnson is gearing up to put Risperdal for children on the market. I’m sure other blogs have beat me to the punch on this, but I just came across this info and found it absolutely retarded. (But what do drug companies care?)

The FDA has approved “expanded use” for Risperdal in teenagers who suffer from schizophrenia and the short-term treatment of bipolar mania in kids ages 10-17. I’m leery enough about antidepressants in kids let alone antipsychotics.

“J&J said the agency has not requested the company perform any additional studies, implying that it need only agree with the FDA on acceptable labeling for the expanded uses in order to gain final approval.”

I wasn’t sure what “expanded use” was so I looked it up. This was the best I could come up with:

“Applications for a new or expanded use, often representing important new treatment options, are formally called “efficacy supplements” to the original new drug application.”

Well, I didn’t know what efficacy supplements were so I looked that up too:

“The legislative history indicates that this provision was directed at certain types of efficacy supplements (i.e., supplemental applications proposing to add a new use of an approved drug to the product labeling).”

So – correct me if I’m wrong – it sounds like the studies performed that led up to this “expanded use” are not as rigorously evaluated by the FDA as the initial studies that allowed the drug to be released on the market in the first place. It just seems like a company and the FDA simply need to agree on “acceptable labeling.” So if we’re following the theory that I’m still correct, the FDA doesn’t follow up on the clinical trials performed on these children, they just agree with J&J on the “acceptable labeling.” Doesn’t that thought make you feel all warm and fuzzy inside about your health?


Christopher PittmanOn the subject of children and psychotropic medications, 12-year-old Christopher Pittman shot and killed his grandparents and then set their house on fire in November 2001 all while on an adult dosage of Zoloft. It looks like the drama is still playing out in June 2007.

According to CourtTV.com, Pittman suffered from hallucinations while on the 200 mg dose and while in jail, displayed symptoms of mania.

“Three years after the killings, Pittman was tried in adult court and convicted of murder. He was sentenced to 30 years in prison. He was then 15 years of age.”

No doubt Pittman should be held responsible for what occurred, especially if he admitted to the killings (which he did). However, the situation raises a few questions. First of all, why was he on 200 mg of Zoloft when he was TWELVE? Why wasn’t he considered mentally ill and placed in a mental health facility? I could go on and on. While Pittman “did the crime and needs to do the time,” why isn’t the doctor who prescribed this not present in any of the reported stories? If this incident was 2001, it can only be worse for antidepressants and other psych meds today.

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.

Nothing you didn't already know

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…

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

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

Celebrity sensitivity: Britney’s mental illness

Britney SpearsI originally posed a theory that Britney Spears might be suffering from a mental illness such as postpartum depression (PPD) or bipolar disorder. Furious Seasons linked to an article on tmz.com (by way of Celebrity Baby Blog – wtf?) where “sources say doctors at her rehab facility think the underlying reason for her trouble may be post-partum depression.”

As for my theories:

“Sources tell TMZ that Britney’s doctors have two operating theories — either that she suffers from post-partum depression or bipolar disorder. The doctors strongly believe post-partum is the problem.”

At least I got the plausible diagnoses. Damn, I’m good.

(A nice pic of the former ‘sexy’ days of Ms. Spears.)

UPDATE: The Trouble With Spikol also wrote her own take on it too.

Mind Over Matter, Pt. 2

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

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

Read the rest of this entry »

Catching up: Furious Seasons

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

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

The judge ruled in favor of Lilly.

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

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

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

Classic quote:

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

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

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

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

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

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

Astute observation from Furious Seasons:

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

More to come on other blogs…

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