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.)

It’s Official: I’m on Abilify and Prozac

A cursory search on Google for Abilify + Prozac didn’t yield too many helpful results. I suppose it’s not a common drug combination. So far, I haven’t had any real side effects. I take Prozac in the morning and Abilify at night. I’ve also started taking my vitamins again after shirking them for quite a while: Fish Oil with Omega-3s, Iron (for slight anemia), Vitamin B-Complex with Vitamin C, and a women’s multivitamin.

I am a little nervous about taking an SSRI again because the last SSRI I was on (Effexor/venlafaxine) produced some nasty side effects (mania, night sweats, vivid dreams, brain shivers) along with the one I liked (significant weight loss). When I last blogged about Prozac, my only side effect was somnolence—a side effect I don’t appear to be experiencing this time around.

Are you on a drug combination? If so, what and is it working for you? If you used to be on a drug combination, what was it and did it help?

Lamictal & Abilify: Wacky Side Effects

Images from rxlist.com & drugs.com

Here’s a list of the side effects I’ve experienced recently taking Lamictal and Abilify (I can’t attribute any side effect to a specific drug since I am taking both):

1. Somnolence (I am sleepy within minutes after taking the drugs.)

2. Dizziness/vertigo

3. Tremors (At night, I think I’m having convulsions but my husband says I don’t move.)

4. Delusions (I think I’m dying before I go to sleep.)

5. Disciplined sleep regimen (I wake up for the day when my alarm goes off. That’s consistently been 5:20 in the morning.)

6. Poor balance (This may be related to the dizziness and vertigo.)

 

I’ll add more to this list as I experience any additional side effects.

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.

Lamictal-free and lovin’ it

freeI’ve been off of Lamictal for the past month and a half thanks to a wonderful supportive mental health community of bloggers. I’ve replaced my Lamictal dosage with 1000 mg of Omega-3s derived from fish oil capsules. So far, so good. I haven’t felt suicidal although I do admit I’ve caught myself wanting to feel suicidal. Believe me when I say it’s significant progress to go from feeling suicidal to wanting to feel that way. (By the grace of God.) Special thanks goes to Gianna at Beyond Meds and Stephany at soulful sepulcher.

I haven’t blogged on mental health lately because I haven’t had much to blog about. Any attempt at regular blogging now is mostly done at This Journey Is My Own, which is distinctively personal, reflective, and an unabashedly Christian blog. I guess it can be considered a scrapbook. Thoughts and rambles flowing freely through the blog. I don’t have the attention span, dedication, and motivation to do anything like I used to with depression introspection. I’m not averse to updating this blog every now and then but the months with 80-some odd posts are now gone. The Quotes of the Week should continue updating through early 2010. Enjoy.

Christopher Pittman seeks new trial

Christopher PittmanFrom Furious Seasons:

I simply don’t know what to make of the case of Christopher Pittman who was convicted of shooting his grandparents to death when he was 12-years-old–except that it argues for how risky it is to put young children on anti-depressants. Pittman, sentenced to 30 years in prison, is seeking a new trial and a hearing on that matter is underway in South Carolina.

You can read more about the Zoloft-rage/violence connection is relation to Pittman’s case.

Lamictal’s withdrawal effects at 12.5 mg

Half of 25 mg LamictalI’m at half the starting dose now. This means my body still has trace amounts of the drug but it’s so low that it’s not really effective. Here are the side effects I’ve been experiencing:

  • Major brain fog
  • Fatigue
  • Dizzy spells
  • Lethargy (ie, no energy)

I’m also having trouble losing weight but I can’t say for sure if that’s attributable to the medication. If you were on Lamictal or are on Lamictal, what side effects have you experienced?

Ladies & Gentlemen

Landing plane

We are now beginning our descent into Lamictal-free Airport. Please make sure your previous medications are stowed and that your side effects are fully behind you.

At this time, we request that you turn off all dependence on psychiatric devices.

Federal regulations require that you put your seat belt on in the event of any side effects. We hope you enjoyed your flight on GSK Airlines and hope to see your business again on a future medication.

Once again, ladies and gentlemen, we are now at 12.5 mg and are beginning our descent into Lamictal-free Airport.

(Photo source: Wired.com)

Should psych drugs be avoided at ALL costs?

My brain isn’t functioning today quite honestly so my apologies if the following makes no sense whatsoever. It’s long and I ended up rambling.


Lately, I’ve been thinking about whether there are any benefits to using pharmaceutical drugs. I have blogger friends who are very much anti-pharmaceuticals anything, try to avoid drugs as much as possible but take them if necessary, or think pharmaceutical drugs are a Godsend.

I’m still trying to figure out where I stand.

Pharmaceutical companies are in the business of making money. It is not to their advantage to put out completely shoddy products that do not work. I’m sure many of them bury negative data and findings that do not shed a positive light on their drugs but if something works overall, they’ll put it out there. I don’t believe the doctors who are involved in these trials are all dirty, rotten sell-outs. Some of them are very well-meaning and honest who work to make these drugs as effective as possible. Call me naïve if you like but I just can’t bring myself to believe there are more greedy docs who skew results than there are those who are concerned with advancement.

I don’t think twice about popping Excedrin Migraine when I’ve got a painful, debilitating migraine; I have no problem taking naproxen (aka Aleve) when I’ve got menstrual cramps, and taking ibuprofen isn’t an issue if I have severe muscle pain. I don’t question the safety of these drugs. I’ve used them for so long, they’ve proven to be relatively safe for me (not everyone can tolerate those drugs) and efficacious. The safety risk of taking Excedrin Migraine sometimes outweighs the benefits of not taking it. (Note: I only speak of adults in terms of ingesting this kind of medication.I don’t believe developing bodies, such as youngsters, are able to handle medication that can significantly affect mood.)

When it comes to psych meds, I am not anti-medication. Psych meds should be taken on a case-by-case basis. There are some people who consider these meds to be a life-saver while others complain that it has made them miserable and worsened their lives. This is the gamble people take when choosing to ingest a psych med—most people don’t know that. Trouble is, most people don’t know when the stakes are high enough to take that risk.

I shouldn’t be in a position to judge anyone but when I hear people taking antidepressants based on circumstances—a job loss, failed relationship, loss of a life—I worry that it’s unnecessary. We are becoming a nation that is more reliant on “quick fixes” rather than developing coping mechanisms. It’s easier to pop a pill and dull your emotions than it is to face problems, tackle issues head on, and learn to work your way through it. Case in point: rising unemployment hasn’t slowed sales of antidepressants or sleeping pills.

  • I have an aunt who was a violent paranoid-schizophrenic. She was placed in a mental institution and drugged up the wazoo. Now, she’s basically existing; the lights are on but no one’s home. The drugs have killed her. She’s alive but not really.
  • My father was a non-violent paranoid-schizophrenic. It got to the point where we needed to medicate him to get him on track. The medication helped him to function “normally” but his thought processes and physical ability was significantly slowed. He once told me that he felt useless because my mother was busting her butt at work to pay for my college and he was basically an invalid because his mental illness had prevented him from being able to work. He died 4 months later. A few days after the funeral, my mom began to find his psych meds hidden all around the house. I often wonder if the drugs killed him.
  • Another aunt (this is all on the paternal side of the family) also became a paranoid-schizophrenic. She was a brilliant woman who was basically reduced to moving from place to place to the point where she eventually became homeless and could not hold down a job. She disappeared for a while but during one cold winter, was found and brought into a homeless shelter. She was placed on meds and her cognitive functions returned despite the fact that her speech was sometimes garbled. She traveled the world, went on cruises and various excursions. The change was remarkable. Psych meds improved her life and saved her—the benefits of the drugs outweighed the side effects.

As I withdraw from Lamictal, I am curious to see who I am without this drug. Will my creative juices flow freely once again or are they now somewhat hindered? Will my cognitive functioning correct itself or will I forever suffer from problems? Will my short-term memory loss issues smooth out or will I still suffer from intermittent forgetfulness? I have some side effects that may remain with me for a while or perhaps forever (though I hope not) but seeing others fully recover after taking drugs for 10 times longer than I have gives me hope.

I feel the majority of my progress has come from intensive counseling and being infused with the truths as laid out in the Bible. I’d say 90% of my progress has been due to counseling. I give the meds 10%. You can tell I don’t place much stock in them. But they’ve helped to cut down on the mixed episodes.

So far, I haven’t had any suicidal thoughts are behaviors that are out of the ordinary. (Thank GOD.) I’ve been dealing with a mild depression but that stems from basing my worth based off of my career rather than any biological imbalances. The last time I suffered a severe depression, I was on Lexapro (if that tells you anything).

I’ve gotten a lot of resistance and concern from family members who question my decision to come off of the medication. They’ve seen a miraculous change in me and attribute it to being on meds. Meds aren’t a cure-all. They don’t see the counseling and shifting of thought processes going on that has helped me to develop coping mechanisms. Meds may help people “cope” but they don’t develop the tools needed to cope.

I’ve decided that I’ll probably give that Christian psychiatrist a call. My counselor recommended him and she said that he’s very neutral on meds and doesn’t shove them on anyone. I mentioned that I wasn’t sure if anyone would accept me as a patient only to lose me in the end—she insisted he wouldn’t mind. The intake cost is hefty but since I was able to temp a few days for my job this week—I’m not permanently returning, I can swing it.

Which brings me back to my position on psych meds: I said it earlier but I think it’s a case-by-case basis. In my personal life, I’ve seen the benefits outweigh the side effects and I’ve seen the side effects outweigh the benefits. And I’ve seen benefits (not necessarily beneficial) as a result of side effects. Psychiatry is the biggest medical guessing game of all medical specialties. There are no certainties, and there’s no one medication that works best for everyone. Pharmaceutical companies make it a point to put the disclaimer on the patient information sheet that they’re not exactly sure HOW these drugs work. All that stuff about serotonin, dopamine, and neurotransmitters is pure speculation when it comes to depression. You’ll have me convinced about chemical imbalances once I can get a MRI and blood test done. Until then, it’s all trial-and-error.

So if I do suffer from relapses while withdrawing from this medication and it gets to the point where I may need to be hospitalized, I’m not averse to remaining on the drug. Better to be alive and on a psych drug than dead because I was determined not to use it at risk to my safety. If I end up having to stay on the drug, the future of giving birth to children will seem a bit more uncertain.

Drug-induced suicidal ideation

This is a great post from Ana on how she struggled with suicidal thoughts while tapering off of Effexor. She was a lot better about identifying this stuff than I’ve ever been. I’m linking to this because I want people to know that suicidal thoughts CAN be drug-induced. I’m well aware of that now coming off of Lamictal. No problems so far but I have struggled with it in the past when I tried to jump down from 200 mg to 150 mg.

Loose Screws Mental Health News

Portland, Oregon has been recently declared the most depressed city in the country. BusinessWeek determined this based on “antidepressant sales, suicide rates, unemployment, divorce, and crappy weather.” Philly didn’t make the top 20 list. That’s because we’re too busy enjoying the highest suicide rate in the country.


smokingA great way to avoid depression, however, is to simply stop breathing. Yes, that’s right. Just stop breathing. A new study presented at an American Psychological Society meeting shows people who are consistently exposed to secondhand smoke are twice as likely to suffer from depression. So that’s my recommendation to you: STOP BREATHING. I guarantee you won’t be depressed after a while. (By the way, that’s a joke so you can go ahead and take a deep breath now.)


Apparently all this talk of an economic depression is causing people to be depressed enough to buy more antidepressants. I don’t get how it works but it seems as though antidepressant prescriptions (along with sleeping aid prescriptions) are rising alongside the unemployment rate in this country. Big Pharma isn’t filing for bankruptcy anytime soon. And if they do, it’s their own freakin’ fault.


In what appears to be a landmark ruling (correct me if I’m wrong), the U.S. Supreme Court ruled that pharmaceutical companies are still liable for injuries cause by FDA-approved drugs and devices and juries can legitimately award damages. The buzzword I’ve learned for this case is preemption.

A woman who was injected with an antinausea drug (Phenergan, if you’re wondering) brought a damage suit against Wyeth after her arm had to be amputated. After a jury awarded her with $6.7 million, Wyeth took the case to the U.S. Supreme Court, expecting a cool victory after the court sided with Medtronic in last year’s Riegel v. Medtronic case. Wyeth, the defendant in the case, hoped the Supreme Court would rule in their favor since the FDA had already evaluated their product for safety—a preemptive act. However, this time the court ruled 6-3 in favor of allowing the woman to keep her award money. The decision also sets a precedent for pharmaceutical consumers to sue pharmaceutical companies for injuries despite FDA approval—striking down preemption. For further information, check out Doug Bremner’s and Philip Dawdy’s blogs that have already covered this. In the meantime, I leave you with this:

Ronald Rogers, a spokesman for Merck, said, “We believe state courts should not be second-guessing the doctors and scientists at the F.D.A.”Merck was hit with several huge damage awards over its painkiller Vioxx before agreeing to a $4.85 billion settlement in 2007. Allowing juries to make determinations about drug risks, Mr. Rogers said, would cause “mass confusion.”

Hm. Make of that what you will.

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.

Antidepressant rankings: Zoloft and Lexapro considered best overall

A number of antidepressants were recently ranked in different surveys:

Zoloft and Lexapro came in first for a combination of effectiveness and fewer side effects, followed by Prozac (fluoxetine), Paxil (paroxetine), Cymbalta, and Luvox among others.

The first was efficacy — or how likely patients were to experience the desired effects of the drug.

Efficacy:

1. Remeron (Mirtazapine)
2. Lexapro (Escitalopram)
3. Effexor (Venlafaxine)
4. Zoloft (Sertraline)
5. Celexa (Citalopram)
6. Wellbutrin (Buproprion)
7. Paxil (Paroxetine)
8. Savella (Milnacipran)
9. Prozac (Fluoxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

The second was acceptability — the likelihood that a patient would continue using a drug for the duration of the study (it is generally assumed that a high ratio of patients dropping out indicates the presence of undesirable side effects for a drug).

Acceptability:

1. Zoloft (Sertraline)
2. Lexapro (Escitalopram)
3. Wellbutrin (Buproprion)
4. Celexa (Citalopram)
5. Prozac (Fluoxetine)
6. Savella (Milnacipran)
7.
Remeron (Mirtazapine)
8. Effexor (Venlafaxine)
9. Paxil (Paroxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

antidepressantsMy experience with Lexapro was a disaster and I’ve written about Zoloft’s connection with irritability and rage. Paxil’s side effects are especially rough (see Bob Fiddaman’s Seroxat page) while Effexor’s withdrawal effects proved to be significantly challgenging. Although Prozac offset Effexor’s withdrawal symptoms, it causes severe somnolence that can impair cognitive functioning. And last but not least, Cymbalta contributed to the unfortunate death of Traci Johnson who had no history of depression.

These drugs may be effective for many people but it’s still a guessing game. Dr. Mark I. Levy, quoted in ABC News’s article on the rankings, mentioned that while psychiatrists may not have much use for the rankings, he sees them as beneficial for primary care physicians. And Dr. Harold G. Koenig, a professor at Duke University Medical Center, adds:

“I would be likely to start patients on either Zoloft [because it’s cheaper] or Lexapro … Unfortunately, that is almost none of my patients. By the time they get to me [a psychiatrist], the primary-care doctors have tried Zoloft and other antidepressants, so my patient are not the “new to medication” kind of patients,” he said.

I won’t rehash my thoughts on PCPs prescribing antidepressants and other psych meds. You can read about them here.

Coming off of Lamictal (lamotrigine): 200 mg to 150 mg

I'm currently experiencing significant blurry vision and fatigue. I feel like my eyes keep crossing and I have to blink several times and keep my eyes wide open to focus well. It's annoying. My mood is stable at a 6. I also think I have a slightly weakened immune system as I'm starting to get sick.

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.

Done deal: Pfizer buys Wyeth for $68 billion

Pfizer-Wyeth merger

The New York Times puts it this way:

The deal, if completed, would not only create a pharmaceutical behemoth but would be a rarity in the current financial tumult: a big acquisition that is not a desperate merger of two banks orchestrated by the government. [emphasis mine]

Funny the writers decided to add that. A year ago, that clause would have never been considered yet alone thought of.

Pfizer isn’t doing badly; in fact, despite the credit crunch, they’ve been able to snag $22.5 billion in loans since they also have $26 billion cash on hand. The NYTimes also reports that this merger would be the biggest since AT&T and BellSouth merged back in March 2006. But of course, with mergers always come layoffs. And what a time to have layoffs. Pfizer today announced that they’ll be cutting 8,000 jobs.

But as I said in a previous post, Pfizer’s biggest challenge is get some pipeline products out to market soon since some of the patents on their big names (ie, Lipitor) are expiring soon. Don’t hold me to this but I think Wyeth has a bit more sitting in their pipeline, hence why the merger would make sense. But I hope Wyeth can produce a new blockbuster drug for Pfizer otherwise Pfizer’s really going to be hurting for money. Especially since Wyeth’s best-selling drug, Effexor, is now generic and Pristiq isn’t completely cutting it.

Pfizer may be buying Wyeth

Pfizer-Wyeth merger

Is Wyeth being hurt by the failing economy? I’m not so sure but Pfizer may be buying up Wyeth for up to $60 million. According to news reports, this could help the pharmaceutical giant by bringing in some of Wyeth’s brand name products while many of Pfizer’s own manufactures (think Lipitor) go generic. However, it could also be a drawback as one of Wyeth’s biggest sellers—our favorite antidepressant Effexor (venlafaxine)—has gone generic. Also, Pfizer doesn’t have the best track record of buying up other companies and turning them into blockbuster gold. Should be interesting to see what happens in the next few years if the deal does go through.

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

Study shows atypical antipsychotics pose a higher risk for cardiac arrest

The New York Times has reported that a recent study found atypical antipsychotics, which include the friendly family of Clozaril, Abilify, Risperdal, Zyprexa, and Seroquel (maybe Saphris soon), can increase a patient’s risk of dying from cardiac arrest twofold.

The study published in The New England Journal of Medicine also concluded that the risk of death from the psychotropic medications isn’t high. However, an editorial also published in the same issue “urged doctors to limit their prescribing of antipsychotic drugs, especially to children and elderly patients, who can be highly susceptible to the drugs’ side effects.”

A U.S. News & World Report article linked to the FDA’s atypical antipsychotics page for further patient information. If you’re on an atypical, I’d recommend reading each word in the patient safety info that applies to you. Proofreaders like me shouldn’t be the only ones tortured with reading all the fine print. *winks*

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.)

FDA: No link between Singulair and suicidal behavior

On Tuesday, the FDA announced that an investigation into Merck’s clinical trial data did not discover a link between Singulair (montelukast) and suicidal behavior. The investigation, which began 9 months ago, was prompted by a number of reported suicides, especially that of 15-year-old Cody Miller who took the drug and appeared to have no history of mood or behavioral problems. (It is worth noting here that Singulair “is the top-selling drug for people under 17 years old” and Merck’s biggest seller with annual sales of close to $4.5 billion.)

In attempt to assess Merck’s data better, the FDA also investigated AstraZeneca’s Accolate (zafirlukast) and Cornerstone Therapeutics’s Zyflo (zileuton). Although the FDA did imply that “the data were inadequate to draw a firm conclusion” and said that the clinical trials were not set up to observe any psychiatric behavior. Here are the data the FDA discovered during their review of these trials:

SingulairSingulair: 41 placebo-controlled trials that included 9,929 patients

  • Reports of suicidal thoughts: 1 (treated with Singulair)
  • Attempted suicides: None reported
  • Completed suicides: None reported

AccolateAccolate: 45 placebo-controlled trials that included 7,540 patients

  • Reports of suicidal thoughts: 1 (placebo group)
  • Attempted suicides: 1 (placebo group)
  • Completed suicides: None reported

ZyfloZyflo: 11 placebo-controlled trials (number of patients unknown)

  • Reports of suicidal thoughts: None reported
  • Attempted suicides: None reported
  • Completed suicides: None reported

Forgive me for being cynical but the data sounds fishy. I can’t pinpoint why but it does. The suicide numbers and patient involvement data seem to deviate some from the numbers listed in Merck’s PR issued last March. (I’m seeing 11,000+ patients vs. 9,929 patients.) Regardless of the clinical trial data, it appears that the FDA as of yet have not reviewed post-marketing data.

Scott Korn, a senior safety surveillance executive for Merck said in an article for Reuters:

“‘At the time we did not believe, and we still don’t think a link has been established’ between Singulair and the suicides.”

In the same article, Sanford Berstein analyst Tim Anderson had this to say about the possibility of the FDA finding a link:

“If the… safety review leads to a stern warning about behavioral changes in the Singulair label, this could frighten users of the drug or their parents and give Merck’s competitors ammunition to attack the brand.”

The Washington Post has Dr. David Weldon, director of the Allergy and Pulmonary Lab Services at Scott & White in College Station, Texas, on record saying that he had not “seen any increase in psychiatric problems with the drug but that some patients had complained of nightmares after starting on Singulair.” (Note: It appears that the closest conflict of interest Weldon would have here is that he served as a consultant and is honoraria for AstraZeneca.)

Dr. Rauno Joks, head of the SUNY Downstate division of allergy and immunology, made an interesting point in the Washington Post article:

“The physician really needs to review whether there are symptoms that have developed since patients started taking the medication, if there’s an underlying depression that was there before medication started.

Also, seasonal allergies in and of themselves can cause fatigue and lethargy, which makes it harder to assess, because those are some of the symptoms you have with depression.”

The FDA says they’ve completed analyses of submitted clinical trial data but their “safety review will continue” for several more months before they come to a concrete conclusion. For customer testimonials, check out medications.com that has over 2,300 people reporting side effects and askapatient.com that has an average 2.3 rating from 524 reviewers. The most commonly reported mood-related side effect on both of the sites is irritability.

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 »

FDA: Doctors don't disclose conflicts of interest? We don't really care

According to a NYTimes article, government investigators have reported that the FDA doesn’t seem to care much about the financial disclosure of doctors who participated in clinical trials of medication and diagnostic devices. Then get this:

Moreover, the investigators say, agency officials told them that trying to protect patients from such conflicts was not worth the effort. (Despite the fact that the FDA’s rules require it.)

Doctor making moneyThe article goes on to say that in 42 percent of clinical trials, the FDA did not receive financial disclosure forms that might report conflicts of interest and never followed up on them. In 31 percent of the trials in which the forms were received, “agency reviewers did not document that they looked at the information.” And then, in 20 percent of the cases in which doctors disclosed significant financial conflicts—”neither the FDA nor the sponsoring companies took any action to deal with the conflicts.”

Apparently, the NIH has been investigated for the same thing and government investigators came to the same conclusion as in the FDA case.

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 »

Beware XYZAL — allergy drug

I’m having a terrible allergy reaction that’s last 2 days. I visited my physician who gave me a few 5-mg samples of an allergy medicine, Xyzal (levocetirizine). This is supposed to be an alternative to Allegra, Zyrtec, and OTC Benadryl. I took time in the middle of the workday for this impromptu appointment so when I got back to work, I immediately took the drug. Then, I began feeling incredibly drowsy. I decided to look up the side effects on the xyzal site and found:

Patients taking XYZAL should avoid operating machinery or driving a motor vehicle. … Take XYZAL at bedtime. Do not increase the dose due to increased risk of sleepiness.

Great. I wish my doctor had warned me of this before I popped one at 3:45 in the afternoon at work, 13 miles away from my home. Not only that, but after doing some more reading in the Prescribing Information, I found:

Besides these events reported under treatment with XYZAL, other potentially severe adverse events have been reported from the post-marketing experience with cetirizine. Since levocetirizine is the principal pharmacologically active component of cetirizine, one should take into account the fact that the following adverse events could also potentially occur under treatment with XYZAL: hallucinations, suicidal ideation, orofacial dyskinesia, severe hypotension, cholestasis, glomerulonephritis, and still birth.

A one-time dose probably won’t affect me negatively in the ways reported above but still — it’s an allergy drug. ALLERGY drug. All this crap comes from something that’s supposed to make you feel better? Sheesh. Glad I read it. I’ll be sure to avoid regular consumption Xyzal in the future.

So now it’s 4:50 pm and I can barely keep my head up but I figured I’d make this quick post to warn anyone with mental illness who:

a) takes Xyzal or
b) thinks that allergy drugs are free from side effects triggering mental illness.

Granted, the risk is low but it exists. It also sounds like it can impair renal and hepatic functions somehow. Watch out if you’ve got kidney problems.

When work is over, I’m going straight home and making a beeline for my bed.


Mood Rating: 4

Generic Lamictal (lamotrigine)

I'm on "Day I-don't-know" of lamotrigine (generic Lamictal). It's been at least 2 weeks. I haven't had any significant side effects except for extreme fatigue. I am often tired. Some days, I can give myself a boost of energy by playing the Wii Fit (which I snagged Saturday afternoon) and other days, exercising just wears me to out to the point where I head to the shower and then to bed. I can have 3 cups of coffee, never become fully awake, and still go to sleep at a decent time.

I'm still not sleeping well. Haven't slept well since before I went into the hospital in October 2006. I can't remember the last time I had truly restful sleep.

My symptoms remain at bay. I haven't had many suicidal thoughts or impulses. In fact, some days, I can go without thinking about suicide at all. I can't say it's all the medicine — my counseling and faith play a much bigger role — but I'm sure the medicine helps.

I've recently noticed that I'm not suffering from as much social anxiety. Again, I don't know if this is due so much to the medication as it is to the resurgence of my spiritual life. I ventured out on Sunday to a meetup writers workshop group that I'd never been to before. It was extremely weird. Not the situation, but the fact that I walked into a room full of strangers, made myself comfortable on the couch at the coffeehouse and offered input quite freely without worrying about what the others thought of me. I even had the audacity to network with a woman who works at a trade magazine in the area. How strange. I don't have balls. This is not me.

What the heck has happened to me?

Lamictal's generic equivalent, lamotrigine, has now hit the market

So much for Miss Up-on-Pharmaceuticals.

I’ve been paying so much attention to Pristiq that the very medication I take slipped out from right under my nose.

How did I find this out? It hit me where it hurt.

In the pockets, of course.

I went to CVS yesterday night for my Lamictal refill. Since I’ve been under my husband’s plan, we’ve been paying about $40 for the medication. So I nearly doubled over when the pharmacy cashier said $54.

WHAT?

I was in a bit of a foul mood about money anyway so the last thing I wanted to do was argue about the cost of my prescription that had jumped up by $14. (Which, in retrospect, I probably should have done because I could have saved $49 right there.)

I came home and made my husband’s day go from bad to worse. He flipped out and got on the phone with his insurance immediately. He said that the max he should pay on any medication is $50 so why was he paying $54 and why the cost rose so sharply.

“Well, sir, it’s because Lamictal has now gone generic and you’re paying the difference between the cost of the medication and the cost of the generic.”

Bob gets off the phone and goes straight to Google News to find out when Lamictal went generic.

Money & drugsAccording to MarketWatch.com, Teva Pharmaceuticals commenced shipment of lamotrigine tablets on July 22nd
. So instead of either the pharmacist asking me if I wanted a generic version or the insurance company letting us know a generic version would be available (it would have saved them money), we ended up paying $49 more than necessary. It appears that Teva’s generic is AB-rated, which means that it has similar strength, bioequivalence, and efficacy. Overall, it likely shouldn’t be a problem if I go from Lamictal to lamotrigine. At least I hope not. We’ll see.

Mood rating:
5

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?

Chemical imbalances do not exist; dying brain cells do

Researchers have never been fully confident in the chemical imbalance theory, yet the media continue to purport it as fact. Dr. John Grohol over at PsychCentral recently wrote:

We’ve all heard the theory — a chemical imbalance in your brain causes depression.

Although researchers have known for years this not to be the case, some drug companies continue to repeat this simplistic and misleading claim in their marketing and advertising materials. Why the FTC or some other federal agency doesn’t crack down on this intentional misleading information is beyond me. Most researchers now believe depression is not caused by a chemical imbalance in the brain.

How did we come to this conclusion? Through years of additional research. But now some are jumping on the next brain bandwagon of belief — that depression is caused by a problem in the brain neuronal network.

Grohol cites Jonah Lehrer's article in the Boston Globe in which he posits that researchers now think depression comes from "brain cells shrinking and dying." Lehrer writes:

Read the rest of this entry »

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.

Pristiq's side effects: Too close to Premarin and Prempro for comfort?

Back in January 2007, I’d mentioned that Wyeth was not only seeking to market Pristiq (desvenlafaxine) for depression but also for the use of vasomotor symptoms in menopausal women.

I just learned that Wyeth produces two major menopause drugs, Premarin and Prempro, that allegedly has produced hormones causing cancer in more than 5,000 women. This added up to a loss of 40 million users and $1 billion annually.

With Effexor going generic in 2 years and the introduction of Pristiq to the market, Wyeth hopes to lure some of those customers back and net an annual $2 billion. However, serious questions linger about Pristiq’s side effects in menopausal women.

Why did two women in the study group taking Pristiq have heart attacks
and three need procedures to repair clogged arteries compared with none
taking placebo? How can Wyeth assure long term safety when 604 of the
2,158 test subjects took Pristiq for only six months and 318 for a year
or more? And what about serious liver complications seen in the studies?

Martha Rosenberg, reporting on Pristiq’s use as a menopausal drug, culled comments from CafePharma’s message boards and found one thread rife with mixed comments on the new drug. From an Anonymous commenter:

Read the rest of this entry »

The Era of Quick Fixes

Pink Magazine: Out of DarknessPink magazine has an article called “Out of Darkness” on high-powered, successful women (likely in corporate America) who suffer from depression and try to hide it. There’s an online exclusive but the actual article can only be read in the print version of the magazine.

Apart from the three resourceful sidebars accompanying the article, the one thing that I felt was missing from the article more of an emphasis on psychotherapy. The article seemed to focus heavily on women whose condition improved as a result of medication. There appears to be only one mention of a women whose condition improved with psychotherapy and medication.

While I understand that medication can be an important factor in assisting those with mental illness to recovery, it should not be the sole form of treatment. Mental illness does not only involve the chemical/biological activity of the brain, but it also involves the psyche — the part of us that comprises of our personalities and behaviors. This is why cognitive behavioral therapy (CBT) and dialetical behavioral therapy (DBT), among other forms of treatment, can be so beneficial. I’m not a fan of being on medication but I feel that 80 percent of my recovery comes from my weekly Christian counseling sessions. Therapy, medication, or other forms of treatment are not cure-alls, and I’m concerned when I read that people rely solely on medication for treatment. These are the people who are most likely to suffer relapses because after a while, their medication just “stops working.”

Most people today are looking for a “quick fix.” We do this with weight loss (alli), food (McDonald’s), exercise (Fast Abs), and so much more. Then, it should be no surprise that people desire a quick fix to control their emotions. Some people use illegal drugs to dull the emotional pain in their life. Is it possible that psychotropics are the “legal” drugs that accomplish the same purpose?

Crazy Psychiatric Treatments

As if some psychotropic meds out on the market aren’t bad enough, out from the archives of Neatorama is a post on 10 Mind-Boggling Psychiatric Treatments. Somehow Insulin-Coma Therapy made it to #1 and lobotomy was listed as #10. I don’t know if they were placed in order of craziness. I didn’t even read the text of most of the treatments. The graphics and headlines were enough to make me cringe.

(Hat Tip: Bob Thompson)

John Grohol interviews Wyeth's VP of Medical Affairs on Pristiq

Dr. Grohol interviewed Dr. Phil Ninan, Wyeth’s VP of Medical Affairs on Pristiq, its efficacy, and surrounding issues. It was quite an interesting interview (and long) but here are some highlights that I chose to comment on. I’ll be making some comments in between Dr. Ninan’s answers due to the extensive length. Some parts of the answers have been truncated.

Read the rest of this entry »

Light posting again

POSTING
Posting may be light through Friday as I’m proofing an ENTIRE website — medication-related, actually — and making all the web copy is correct, the links work, and that the design/layout isn’t funky. Since it’s a website, it’s a huge job and it may take me until Friday. Here’s an example (not the real site I’m working on) of the monstrosity of the kind of work I’m doing.  I’m proofing every single piece of text on every page.  Funny thing is, I don’t mind. I love what I do.

PSYCHIATRIST APPOINTMENT
I have my psychiatrist appointment at 3:30 pm so I might be able to get a quick post in to let you know what happens. He’ll probably be concerned that I didn’t take my Abilify, but I just stopped taking fexofenadine (Allegra’s generic equivalent) and have begun to drop weight. I don’t need Abilify to help me pack it back on it again. I can do it quite easily with the help of the amazing bakery across the street.

COUNSELING
I had counseling last night but will be going again next week. I usually go once every two weeks, but my counselor is concerned since I’m having a consistent reoccurrence of suicidal thoughts. Even when I’m in a good mood, I still think of finding a way to kill myself. That’s not depression so much as it is my negative way of thinking. However, it’s still cause for concern considering that dwelling on the idea could actually lead to another attempt.

RISPERDAL WITHDRAWAL
I’ve read a few blogs in which people are enduring Risperdal withdrawal. I have a friend who’s currently coming off of Risperdal because her blood sugar is so high. She’s been on it for years. That’s one of the reasons why I don’t want to take an antipsychotic. Doctors put patients on it for long-term maintenance when most of the clinical trials have only studied short-term effects.

LAYOUT
I’ve become dissatisfied with how narrow the layout is on my blog so it’s possible that if you visit the site, it’ll look funky every now and then as I play around with it and decide on one I like. I’m not an expert with CSS so I tinker with it until I’m satisfied. I’d like my text area wide enough to post YouTube videos and pictures without them getting cut off. Just letting you know so you don’t wonder what happened to your browser.

FURIOUS SEASONS
Last but not least, if you like this blog, then please go to this one and donate $1, $2, or $5. If you know me in person, please donate as well. (I made a plea about this last week.) That blog provides me with inspiration to keep on going.  You can donate to Philip Dawdy via PayPal, check, or money order. (I guess you could send cash too but that’s never recommended.) Philip’s blog, Furious Seasons, has helped many people in the mental health community including myself.

Lexapro maintains status as first-line antidepressant therapy

Lexapro vs. Pristiq According to a Decision Resources (DR) press release, Lexapro (escitalopram), a SSRI, “retains leadership among first-line therapies in the treatment of major depression” despite the fact that physicians have increasingly moved toward the use of SNRIs, eg, Effexor (venlafaxine). However, the reason why SSRIs still retain their first-line status is due to

  • cost
  • efficacy
  • familiarity

SSRIs have been out on the market for much longer than SNRIs so it’s what physicians are more comfortable with. As far as I know, there currently aren’t any generic SNRIs in the U.S.

As a result, SNRIs are likely pricier.

DR’s survey of psychiatrists found that the majority believe SNRIs work better in treating clinical depression than SSRIs and about 44 percent believe they have fewer sexual side effects. PCPs were also included in this survey and it seems that the majority of them believed the opposite despite DR’s spin that a lot of PCPs are on board with psychiatrists. From personal experience, four SSRIs were prescribed to me before I was shifted to a SNRI.

In the up-and-coming SNRI department, DR forecasts a bright future for Pristiq (desvenlafaxine).

Physicians are expected to move patients from Effexor to Pristiq-a newly approved SNRI- over the next two years. … Pristiq will begin to replace Wyeth’s Effexor XR and Lilly’s Cymbalta, especially in
psychiatrists’ practices.

This is an interesting analysis from DR considering that psychiatrists, health insurers, and even some investors seem less than impressed with the slight advantages the “me-too” drug has over Effexor.

(logos from Forest Pharmaceuticals, Inc. and Wyeth)

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.

Read the rest of this entry »

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)

"What's wrong with you?"

"You’re the most promising person that’s walked through my doors in a long time."

So says the new psychiatrist I went to see today. It was a pretty funny visit but worthless. I’m not sure that this post will communicate that effectively.

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Loose Screws Mental Health News

ABC News covers the potential legal wrangling that might occur for Internet users as a result of the MySpace suicide case. I mentioned this in a recent post.

In some sad news after this Memorial Day weekend, Greg Mitchell at the Daily Kos reports that Chad Oligschlaeger, a 21-year-old Marine suffering from PTSD, committed suicide. According to family members, he was taking 8 different kinds of medication to control the disorder. Mitchell has an update on the story.

In some (somewhat) good news, mental health specialists from across the board are offering free services to current troops in an effort to help out with the shortage of mental health assistance in the military.

My Chemical RomanceAlso in a recent post, I also mentioned how people (namely in the UK) have been in an uproar over the fact that some people are equating “emo” music with the glorification of suicide, cutting, and death. My Chemical Romance (MCR), the band seen at the forefront of the emo music scene, has released a statement concerning the uproar and 13-year-old Hannah Bond’s death:

We have recently learned of the suicide and tragic loss of Hannah Bond. We’d like to send our condolences to her family during this time of mourning. Our hearts and thoughts are with them.

My Chemical Romance are and always have been vocally anti-violence and anti-suicide. As a band, we have always made it one of our missions through our actions to provide comfort, support, and solace to our fans. The message and theme of our album “The Black Parade” is hope and courage. Our lyrics are about finding the strength to keep living through pain and hard times. The last song on our album states: “I am not afraid to keep on living” – a sentiment that embodies the band’s position on hardships we all face as human beings. If you or anyone that you know have feelings of depression or suicide, we urge you to find your way and your voice to deal with these feelings positively.

I blame MCR for Hannah’s death about as much as I blame Nirvana and “grunge” music for making me suicidal. (I don’t blame Mr. Cobain at all.) Granted, Nirvana’s music put me in a mental state where I was much more open to depression but I can’t blame a band for my actions. Besides, every generation has the band that every parent feels the need to hate. Nirvana and “grunge” music were “it” for the 90s. MCR and “emo” will soon be out for the 00s. We’ll see what the next band and music genre will influence teenagers in the next decade.

Word of the Day: Paroniria

Paroniria: Terrifying dreams causing sleep disturbances.

I was looking at the Allegra Web site to double-check whether my recent mixed-mood episodes might have been induced since I began taking the allergy drug regularly. (It’s not a far-fetched idea. Think Singulair.) "Sleep disturbances and paroniria" are a few of the many adverse effects listed for the drug.

Depression Overawareness and Overmedication Week

The Pursuit of Happiness

This post kicks off Depression Overawareness and Overmedication Week.

Two weeks ago, CLPsych and Gianna, among others, celebrated Bipolar Overawareness Week. To cap off Mental Health Awareness Month, I’ve declared this last week of May Depression Overawareness and Overmedication Week. Use this checklist to identify whether you may possibly be “overaware” and “overmedicated” for depression:

  • If you’re on Zoloft because you’ve never been sad or anxious.
  • If you get a prescription for Lexapro on Thursday because you had a bad day on Tuesday.
  • If you take Paxil because you’re never restless or irritable.
  • If you are on Pristiq as a result of sadness and guilt over your Wii-related injury (eg, throwing your shoulder out or tripping over the coffee table).
  • If you are on Celexa because you hate the job that you disliked anyway before you began the medication.
  • If you are on Cymbalta because you are tired after normal long, exhausting days at your job(s).
  • If you are on Effexor only because you overate during the holidays.
  • If you take Prozac because you’ve never had passing thoughts of suicide.

If you meet any of the criteria above, this is a medical emergency. You are overaware and overmedicated. Go see your doctor immediately and discuss treatment options that involve non-medication and/or talk therapy.

Now, the disclaimer.
The checklist above is satire. It is not intended to poke fun at those who suffer with real clinical depression (of which I am one). It is intended to mock the extremely high number of people in the U.S. who are diagnosed with depression and medicated with antidepressants. This is not a medically based checklist for anything. It is not a professional recommendation or intended for professional use. It is not intended to be serious. In fact, it is not intended to be seriously serious. If you take this to your doctor, he or she will probably diagnose you with something other than depression. If you have been offended by this post, don’t be; you shouldn’t come close to meeting the criteria above. And if you do, then you really should go to a doctor. While I meet the criterion for sadness over my Wii-related injury, I don’t take Pristiq for it. If you have something nice to say, click on the Comments link below. If you don’t have something nice to say, click on the Comments link below.

(comic from problogs.com)

Physician ratings work for patients; work against some doctors

Thanks to Kevin M.D.'s post, I decided to look up the ratings on a psychiatrist I plan on trying out. She had a poor rating of 1.5 out of 5. Here's the lone comment:

This woman does not believe in medication and that there is no such thing as a chemical imbalance.

I don't know if that's necessarily a bad thing. In fact, I'm curious to see what she has to say.

Besides, It's not as if she's Dr. Mark Lipschutz. Oof. A rating of 1.7 from 30 people is NOT a good sign.

I know some doctors are nervous about having patients rate them on their care but I don't see what the big deal is. If the overall care from a doctor is good, doctors should be relishing the opportunity to have free word-of-mouth (so to speak) advertising. For example, this rating works to Dr. Ottenberg's advantage. Naturally, a few patients are going to go out there and ramble on about mistakes that were made, tardiness, mean staff, and the like — nobody's perfect — but ratings from a variety of people can give prospective patients a sense of the bigger picture. It'll help keep the good docs in business and (hopefully) knock some of the bad weeds out.

Loose Screws Mental Health News

John Grohol at PsychCentral reports that the fate of the mental health parity bill is uncertain as its main champion, Sen. Ted Kennedy, takes a leave of absence to focus on treatment of his brain tumor. I echo John’s thoughts in hoping to see that other senators are willing to carry the torch and pass this important piece of legislation.


I came across a post from Kalea Chapman at pasadena therapist in which she linked to a WSJ article on whether veterans suffering from PTSD should be awarded the Purple Heart.

Supporters of awarding the Purple Heart to veterans with PTSD believe the move would reduce the stigma that surrounds the disorder and spur more soldiers and Marines to seek help without fear of limiting their careers.

Opponents argue that the Purple Heart should be reserved for physical injuries, as has been the case since the medal was reinstituted by Congress in 1932.

I side with the opponents. The Purple Heart should be awarded to be people who have visible evidence of bravery. With the rising number of PTSD prevalence, I’m afraid that the award would be handed out like candy. The rising number of veterans with PTSD on disability has caused enough of an issue that a Texas VA facility wanted mental health officials to stop diagnosing veterans with the condition.


Jordan Burnham, an 18-year-old student who survived a nine-story jump from a building, plans on walking at his graduation with the assistance of two canes. A family who used to attend my church knows this family and put him on my church’s prayer list. It’s a small world, after all.


Finally, it looks like expecting moms should have no fear of causing birth defects in their baby while taking antidepressants, according to a study being published in the British Journal of Psychiatry.

A research team from Montreal University studied more than 2000 pregnant women on antidepressants and discovered the drugs did not present any adverse effects. However, it sounds like they only oversaw the women while they were pregnant in their first trimester. I haven’t seen the actual study but it doesn’t seem to mention whether the women discontinued the antidepressants after the first trimester.

Poor Wyeth — New drug delayed in FDA approval

From Forbes.com:

Wyeth Pharmaceuticals just can't seem to catch a break. The company is not only increasingly worried that it will lose a large chunk of its revenues to generic competition, it also faces the ongoing threat that its pipeline is starting to go dry. A further delay in the approval of its postmenopausal osteoporosis drug has become one more nail in the pharma company's coffin.

The drug, bazedoxifene, has had a hard time getting approval from the FDA since April 2007.  The FDA is concerned about bazedoxifene's effects on causing myocardial infarctions or blood clots.

This is some pretty disheartening (to say the least) news considering that Effexor will soon be going generic and Pristiq has received some less-than-stellar reviews.

Analysis of "Depression: Out of the Shadows"


The show is essentially Depression 101 – for those new to learning
about the illness.
As someone who struggles with depression (within
bipolar disorder), I found a lot of the two hours pretty boring (90
minutes on personal stories and about 22 minutes for "candid
conversation"). The "a lot" comes from the stuff that I've either heard before or flies over my head, eg, how depression affects the brain, prefrontal cortex, neurotransmitters, synapses, etc. The personal stories were powerful: depressingly heartwarming. (Yes, I mean that.)

My heart sank as I heard the stories of Emma and Hart, teenagers who were diagnosed with depression and bipolar disorder, respectively. Both were such extreme cases that they needed to be sent away for special psychiatric care. They are on medications for their disorders; the specific drugs are never mentioned.

While watching Deana's story of treatment-resistant depression, I instantly thought of Herb of VNSDepression.com whose wife suffers from the same malady.

I tried to listen attentively for the antidepressant that Ellie, who suffered from PPD after the birth of her first child, would be taking during her next pregnancy. It was never mentioned.

My jaw nearly dropped to the carpet as Andrew Solomon, carefully plucked brightly colored pills from his pillbox that he takes every morning for his unipolar depression: Remeron, Zoloft, Zyprexa, Wellbutrin, Namenda, Ranitidine, and two kinds of fish oil. He might have even mentioned Prozac. He takes Namenda, an Alzheimer's drug to combat the effects of an adverse interaction between Wellbutrin and one of the other drugs that I can't remember. Solomon says he's happy. I'm happy for him and I'm happy that his drug cocktail works for him but I couldn't help but sit there and wonder, "Isn't there a better way?"

While I thought the stories covered the gamut, in retrospect, I'm surprised they didn't interview a veteran or U.S. soldier to discuss PTSD. If the producers were able to fit in dysthymia, I'm sure they might have been able to throw in a story about a soldier who struggles with depression and suicidal thoughts stemming out of PTSD. Considering all the stories coming out of the VA, it's rather relevant. It would have been more interesting than the Jane Pauley segment. But I'll get to that in a minute.

As I listened to the narrator, I couldn't help but wonder what alternate perspectives could have popped up. For what it was, I fear none. This was a Depression 101 show — a program designed to either get people to fight against fear and stigma and get help or to open the eyes of loved ones to this debilitating disorder. I'm not sure how to slip in an opposing view on medication from a doctor without confusing or scaring people away. What would Healy or Breggin say that would encourage people to seek appropriate care?

Holistic or natural treatment was not mentioned. It's not mainstream and it's not recommended by most doctors as first-line therapy. I would have been surprised had something been said about it.

The depression portion of bipolar disorder was briefly discussed in Hart's story then Pauley added commentary about her personal experience in the remaining 22 minutes of the program.

Pauley appears at the end of the show promising a "candid conversation" on the topic. The three experts: Drs. Charney, Duckworth, and Primm sit and smile politely as Pauley rattles on occasionally about herself. Some people might find her exchange endearing and personal. After the first 3 minutes, I found it annoying. As a journalist, I wish she would have taken the impartial observer approach rather than the "intimate discussion" approach. In my opinion, she seemed to have dominated the "discussion."

It ended up being a Q&A with each doctor. Her questions were focused and direct. I expected a little bit of an exchange between doctors, talking not only about the pros of medication and treatment like ECT and VNS but also the cons. (Should I apologize for being optimistic?) Charney interjected into the conversation maybe once or twice but was only to offer an assenting opinion. Primm spoke least of everyone on the panel. I think she was placed on the show solely to represent diversity.

There were no "a recent study said…" or "critics say such-and-such, how do you address that?" It was a straightforward emphasis on encouraging people to get help or for those suffering to get treatment. Pauley's segment didn't discuss any negatives (not with the medical director of NAMI there!). The closest the entire 2 hours gets to any cons is with ECT shock treatment and giving medication to growing children. The childhood medication thing isn't dwelt on. The basic gist is: Doctors don't understand how medication works in children but are working on trying to understand it and improve its efficacy.

Forgive me for being negative. The point of the program was designed to give hope to those suffering. Instead, it just made me feel even worse. Thoughts raced through my head: "Well, if this doesn't work, then it's on to that. And if that medication doesn't work then I'll probably be prescribed this therapy, and if that doesn't work, then I'm treatment-resistant at which point, I'll have to do…"

I hope the program does what it's designed to do and that's to get those suffering with depression to seek appropriate care. The one upside is that talk therapy was stressed. I'm a huge proponent of talk therapy myself. Let me know what you thought of the show if you were able to catch it.

In the meantime, this depressed girl is going to cure herself for the night by going to bed.

P.S. Is it really fact that depression is a disease?

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