Loose Screws Mental Health News

Call me old-fashioned (I am 26 after all; that's 62 in technology years) but I don't like the idea of putting my personal health records online. Google Health has just launched in an attempt to rival Microsoft's Revolution Health. GH's site appears way more personalized than RH and the idea of uploading medical records doesn't thrill me. GH has features where you can put in the "general" information people don't mind giving out (ie, height, weight) and personalize the diseases, disorders, or conditions you might suffer from (somewhat like WebMD). This is about as far as I would go in using the site. No way would I upload a PDF from my doctor with my name, address, social security number, and health insurance information on the a site — I don't care HOW secure. Medical identity theft is a reality now and the last thing I need to worry about is some idiot hacker stealing people's medical records online. We already have enough problems with people stealing VA SSNs.

On the topic of health, the AP is reporting that an estimated 300 to 400 doctors commit suicide every year — a rate that rivals that of the general population. (Hat tip: GP Essentials)

As for the VA, the news keeps on getting better and better. The Washington Post reports that psychologists at VA facilities are being told to keep their PTSD diagnoses to a minimum so the VA can stem the tide of veterans seeking disability payments for the condition. Depending on the severity of the disorder, veterans can receive up to a little more than $2500 per month. Norma Perez, PTSD coordinator for a Texas VA facility, sent an internal e-mail to mental health and social workers saying:

Given that we are having more and more compensation seeking veterans, I'd like to suggest that you refrain from giving a diagnosis of PTSD straight out."

Instead, she recommended that they "consider a diagnosis of Adjustment Disorder."

VA staff members "really don't . . . have time to do the extensive testing that should be done to determine PTSD," Perez wrote.

The Post quotes psychiatrist Dr. Anthony T. Ng who says that "adjustment disorder is a less severe reaction to stress than PTSD and has a shorter duration, usually no longer than six months." This means less payout for the VA.

After the e-mail went public, VA Secretary Jim Peake issued a statement saying that Perez "has been counseled" and "is extremely apologetic." Of course. She has to be. She still has a job. (Credit to Kevin M.D.)

My official position on pharmaceutical companies and psychotropic meds

In previous posts, perhaps I’ve come off a little bit as “I hate Big Pharma.” I did. For a while.

I’m not in love with pharmaceutical companies either. I’ve quoted it before but “to whom much is given, much is required.” As a result of accumulating knowledge through reading and research, I know a whole lot more about pharmaceutical companies, the treatment options they put out there, and what lengths they go to get those treatments out there. Most of the things I read are negative. Much of what I’ve said is negative. Perhaps “ignorance is bliss.” My husband said this recently:

“The Internet is the great bitching ground. No one’s going to talk about how great medication is. Everyone’s going to go on and just bitch about side effects and bad experiences.”

I agree. “Effexor really helped me feel better today” doesn’t make for an interesting blog post. No one pays attention to medication when it’s working, however, everyone will complain if something is going wrong. The most “positive” drug comments I’ve seen are on my seemingly “negative” posts from people who are being helped by a drug.

Take, for instance, the following comment from Suffering:

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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.

Read the rest of this entry »

The Great Medication Debate, Part 1

"For everyone to whom much is given, from him much will be required; and to whom much has been committed, of him they will ask the more." — Luke 12:48

Gianna at Psychiatric Drug Withdrawal and Recovery has written a post about reconnecting with her spirituality and working with her doctor on more med tapering. Toward the end, she wrote:

I went for a walk the other day with a woman who could’ve been my client from years ago when I worked with the “severe and persistent mentally ill.” She was so sweet and warm—yet there was a deadness in her that I recognized as familiar from the clients I worked with on heavy neuroleptics. I was so glad to walk with her as an equal and not as a social worker—she is my peer and we talked to each other as such. She is getting tardive dykinesia from her neuroleptic. I asked her how long she’s been on it and it’s been 2 decades. I asked how long she has been stable and she said 12 years. I wanted to scream. This poor woman is half dead inside for no good reason. She is on three medications for bipolar disorder and has had no symptoms in 12 years. I see that as criminal, especially since it’s clear a part of her is dead, just as I’ve been dead for many years but am now coming back to life.

I gently talked to her about talking to her doctor. “If you’ve been symptom free for 12 years maybe you don’t have to be on a toxic drug that is giving you tardive dyskinesia,” I suggested. I didn’t add she struck me as part dead too. I want to help all of us who are being over-medicated and poisoned. How can I do that? This blog is simply not enough.

In response, I wrote this comment on her blog:

Read the rest of this entry »

Better off dead or living continually on meds?

I’m tempted to go back on Effexor. I miss the weight loss. The side effects sucked but boy, I loved the weight loss. (It actually caused me to be anorexic, which I know is unhealthy but I think I’d rather be 117 lbs—which, in fact, is within my BMI range—than the 155 that I’m approaching.) I’m considering trying gabapentin as well. I’m weighing my options to see which drug will cause the least amount of side effects. I’m still feeling incredibly overwhelmed. So many medications to treat me and there’s so much research for me to do before I settle on one. Gianna has a post up on the number of Americans on pharmaceuticals and Susan is writing on bipolar medication. I’m feeling incredibly overwhelmed. I think of people who have gotten off of medication and seem to be functioning well while I’m here wishing I was dead instead of having to figure out what med is going to keep me living.

Current Mood Rating: 4

BJ Harroun left this comment for me on one of my posts Pristiq's FDA Chances: Depression – Yea; Menopause – Nay:

I have just completed my first two weeks on Pristiq. I have suffered from MDD for 35 years. I cannot take Effexor because it increases my appetite. Pristiq has really helped me. I have taken everything and I think I have finally found something that works for me. Don't dismiss this drug because it is an Effexor metabolite.

I didn't expect to see much of a difference between Pristiq and Effexor in terms of side effects since I figure since they're from the same class (SNRI). But I'm glad that Pristiq seems to be helping BJ. It would behoove me to take a look at the PIs for Effexor and Pristiq and check out the clinical trial data and see how they shaped out differently. But there's only so much time for me during the day.

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

The Effexor Chronicles: Lucky Her

One woman had a near trouble-free time getting off of Effexor.

I was taking effexor for about 4 months due to having a anxiaty attack one day.

One day I just felt like I was ready to get off of them.

I started by slowly bringing down my dosage. Did that for 2 weeks. The 3rd week I stopped taking them all together.

The worst sympton I felt was the dizzy feeling, I think they call it vertigo. That lasted for up to 2 weeks after stopping the medication.

I am proud to say I am now completly effexer free, with no side affects any longer. It can be done. Just go slow !

Good luck.

Great editorial in NYTimes

The New York Times published a great editorial supporting a ban on much of the lavish treatment that doctors get from drug reps. If adopted by medical schools, restrictions would include:

  • Ban on personal gifts, industry-supplied foods and meals, free travel (not reimbursed for services), and payment for attending industry-sponsored meetings
  • Ban on ghostwriting, the practice of drug companies drafting an article and then getting a doc to slap his or her name on it making it look at though the doc actually wrote it
  • Drug samples would have to be submitted to a central pharmacy not individual doctors

The restrictions, however, end there. The editorial says the proposal goes far but not far enough.

Patients need to be assured that their doctors are prescribing what’s best for them, not what’s best for companies.

Can someone get a doctor to read this?

Thank you

Thank you, everyone, for your well-wishes and outpouring of support. I saw my psych today and he is adding 2-5 mg of Abilify to my medication regimen. He had me choose between Geodon and Abilify. Of course, I am hesitant to do this. Take a look at Philip’s post on Abilify and then take a look at CLPsych’s post about how Abilify performed against placebo. My psych pointed out that I did better on 200 mg of Lamictal but I distinctly remember feeling cognitive impairment on 200. The 150 seemed to work well for a while but I don’t know what’s happening. And to be quite honest, I’m always a little wary of alternative treatments even though I know they have helped so many people. I wonder if they are for me.

More thoughts soon…

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 »

Loose Screws Mental Health News

Anti-smoking pill drug Chantix has been linked to mental illness, according to Attorney Daily.

Chantix’s safety is currently under fire, as similar stories of patients with suicidal thoughts, depression and aggressive behavior surface. The FDA received reports of 37 suicides and 491 cases in which people had suicidal thoughts. The FDA also said it “appears increasingly likely that there is an association between Chantix and serious neuropsychiatric symptoms.” An estimated 5 million people use the drug.

How scary is it that people are having mental health issues related to non-mental health drugs?

Steven Kazmierczak, the shooter at NIU, wrote about his problems with mental illness in his graduate school applications. He said he hoped he could be an encouragement to others. I find this interesting that he wrote about his struggle with mental illness considering that at the time, there appeared to be no official record of him having a mental illness.

Last but not least, here’s news that would make the TAC proud: Dr. Jeffrey Swanson, a medical sociologist from Duke says that people suffering from mental illness are three times as likely to commit violent acts than "normal" people. To his credit, he adds:

“It’s also correct to say that the large majority of people with mental illness don’t commit violent behavior,” he said.

Further down in the article, WRAL Health Team Physician Dr. Allen Mask answers where all the violent acts come from if not from the mentally ill.

“Dr. Swanson says that if we could eliminate drug and alcohol addiction, we would see violent crime go down by a third. We also have the issues of people being abused as children and children growing up in violent, impoverished environments. They’re at greater risk of becoming violent adults,” Mask said.

Maybe I’m wrong here but isn’t substance abuse classified as a mental illness?

Wyeth Pushing Pristiq Hard

PristiqThe Wall Street Journal reports that Wyeth, desperate to make money off of its Effexor XR-knockoff, Pristiq, says it will slash the antidepressant at a 20% discount compared to Effexor’s price. The price slash, CNN money reports, is a result of less-than-impressive clinical trial data on Pristiq’s “safety and effectiveness.”

Wyeth SVP Joe Mahady told analysts that Pristiq will sell for a flat $3.41 per tablet for both mid- and high-dose, Dow Jones Newswires’ Peter Loftus reports.

Wyeth, apparently, has done this in the past. Back when it was known as American Home Products, the company slashed its price on Protonix, its heartburn drug, to compete with AstraZeneca’s Prilosec. The drug generated $1.9 billion in profits for Wyeth last year. CNN Money reports that Teva Pharmaceuticals and Sun Pharmaceuticals began selling the generic version of the drug and handily cut into Wyeth’s profits: the company reported a 4.6% decline in profit and a 66% drop in sales for the drug for the first-quarter. What will happen with Pristiq remains to be seen. I’m not sure that doctors in 2010 will want to dole out prescriptions for Pristiq when they can save patients—and insurance companies—money by prescribing what will then be known as venlafaxine. WSJ also notes:

A month’s supply of sertraline (Pfizer’s old hit Zoloft) or fluoxetine (Lilly’s Prozac) goes for 50 cents a day at drugstore.com.

$3.41 or $0.50 per tablet. It wouldn’t surprise me if some insurance companies choose to exclude Pristiq from its list of covered drugs. Regardless, Wyeth expects sales of the drug to exceed $1 billion in its first year.

The drug will hit the shelves in May.

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.

Wyeth reps no like Pristiq

Oof. I'm just starting to read The Carlat Psychiatry Blog and stumbled upon this post about Wyeth drug reps trashing Pristiq. Wow. Carlat pulled an excerpt of a Wyeth rep mocking Pristiq's new marketing slogan: "People, Passion, Performance… Pristiq!"

"PEOPLE – 1/2 of you will be gone in less than 27 days

PASSION – There is no passion now, but for those that remain with Wyeth, we will bribe the passion out of you by taking you to Vegas for 4 days.

PERFORMANCE – You thought it was hard to reach your performance incentive before? Wait until 2nd quarter

PRISTIQ – Good luck selling both Effexor XR and Pristiq at the same time. So Dr., would you like to hear about my antidepressant that has been around for 12 years, with proven efficacy with the ability to titrate the dose as need to better care for each patient's needs that will have generic competition in 4 months, or would you like to hear about my brand new antidepressant with one dose, less indications and less evidence of efficacy? You want me to choose, let me check with my bonus plan to see which one pays more."

Carlat:

If this is the typical attitude within the Pristiq sales force, Wyeth may end up a little shy of the blockbuster they were hoping for!

I couldn't have said it better myself.

Ghostwriting

According to the International Herald Tribune (IHT), the Journal of the American Medical Association (JAMA) has published an article about Merck’s practice of writing research studies and then asking doctors to slap their names on them. This practice has called into question Merck’s marketing of Vioxx, a profitable cardiovascular drug that was pulled off the shelves due to its link to heart attacks.

Merck acknowledged Tuesday that it sometimes hired outside medical writers to draft research reports before handing them over to the doctors whose names eventually appear on the publication. But the company disputed the article’s conclusion that the authors do little of the actual research or analysis.

Continue reading:

One paper involved a study of Vioxx as a possible deterrent to Alzheimer’s progression.

The draft of the paper, dated August 2003, identified the lead writer as "External author?" But when it was published in 2005 in the journal Neuropsychopharmacology, the lead author was listed as Dr. Leon Thal, a well-known Alzheimer’s researcher at the University of California, San Diego.

The second author listed on the published Alzheimer’s paper, whose name had not been on the draft, was Ferris, the New York University professor. Ferris, reached by telephone Tuesday, said he had played an active role in the research and he was substantially involved in helping shape the final draft.
"It’s simply false that we didn’t contribute to the final publication," Ferris said.

A third author, also not named on the initial draft, was Dr. Louis Kirby, currently the medical director for the company Provista Life Sciences. In an e-mail message on Tuesday, Kirby said that as a clinical investigator for the study he had enrolled more patients, 109, than any of the other researchers. He also said he made revisions to the final document.

"The fact that the draft was written by a Merck employee for later discussion by all the authors does not in and of itself constitute ghostwriting," Kirby’s e-mail message said.

Uh, yeah it does.

Read the rest of this entry »

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.

NYTimes

“The drugs save lives, and we often have no choice but to use them — even if we have questions about their long-term use. But the questions are big ones, and we owe it to our patients to try to answer them.”

Richard FriedmanDr. Richard Friedman, a frequent mental health columnist for the New York Times, has written a piece that questions the use of antidepressants and how dependent patients have become on them. I’ve read Friedman’s previous columns and appreciate his realistic take on the psychiatric and psychological field. His most recent piece is worth reading.

Pittman, Zoloft, and akathisia revisited

Christopher PittmanI’ve written about Christopher Pittman, now 19, who confessed to shooting and killing his grandparents when he was on psych meds at the age of 12. He appealed for a Supreme Court hearing but was denied, CNN reported today. He — and his defenders — appealed on the grounds that his 30-year sentence was “excessive for someone that age” and that the dosage of his antidepressants at the time (200 mg) “sent his mind spinning out of control.” Pittman was tried as an adult and, his lawyers argue, “no other inmate in the United States is serving so severe a sentence for a crime committed at such an early age.”

In previous posts here and here, I’ve questioned the link between Zoloft and violence/rage. Pittman, in 2001, had been switched to Zoloft a few days before the murder of his grandparents. However, it sounds like there had been some emotional problems in Pittman’s life that may have given prosecutors a solid case:

At the time of the crime, the boy had bounced around homes for years, experiencing a half dozen family splits and divorces after his mother had twice abandoned him as a child. She has not been in Pittman’s life for years.

Joe Pittman, the boy’s father, raised Christopher Pittman and his sister for much of their lives, but the relationship between father and son deteriorated. A state psychologist later testified this was a “young man who’d had difficulty with the adults in his life.”

On November 28, 2001, Pittman was sent home early for fighting in school and sent to bed by the grandparents. The boy claimed his “Pop-Pop” also beat him with a belt as punishment.

South Carolina prosecutors may easily have set Pittman up as a disturbed young man, which he very well may have been. But there are indications that this disturbance transcended his emotional state into his mental health:

After threatening to harm himself and suffering other emotional incidents, the boy was diagnosed as clinically depressed. His lawyers said Pittman was then given Paxil, a mild antidepressant no longer recommended for those under 18.

Just days before [shooting his grandparents], a doctor had begun prescribing Zoloft, another antidepressant. The family contends the abrupt substitution of drugs caused a bad chemical reaction, triggering violent outbursts.

At trial, a parade of psychiatrists offered conflicting testimony on whether the boy’s emotional problems excused his criminal behavior. Prosecutors called the Zoloft defense a “smokescreen.”

Juror Steven Platt later told CNN the crime appeared deliberate. “It always seemed like the defense was grasping at straws,” he said. “Just because you take prescription medicine doesn’t mean you can’t be held accountable for your actions.”

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Brief update on Singulair-suicide link

Merck issued a press release today responding to the FDA’s investigation. Along with the standard "we didn’t know about this problem until after it the market" disclaimer, the PR mentioned:

In a cumulative analysis recently provided to the FDA of Merck’s randomized, double-blind, placebo-controlled clinical trials, which included over 11,000 adults and children in over 40 studies who were treated with SINGULAIR, there were no reports of suicidal thoughts or actions and no completed suicides in the patients who received SINGULAIR.

Additionally, in a cumulative analysis recently provided to the FDA of Merck’s randomized, double-blind, clinical trials that compared SINGULAIR with other active agents to treat asthma (which included over 3,900 adults and children who were treated with SINGULAIR and over 3,400 who were treated with other asthma therapies), there was 1 patient who attempted suicide who received SINGULAIR, and there were 3 patients who attempted suicide who received other asthma therapies (including inhaled corticosteroids and long-acting beta-agonists).  These studies were not designed to compare the rate of suicide in patients taking SINGULAIR with the rate of suicide in patients taking these other asthma agents.

Did Merck report that one suicidal attempt when compared to "other active agents to treat asthma"? It doesn’t say anything in their patient safety or prescribing information when I checked. Perhaps someone can find out whether they reported this in their clinical trials?

In the meantime, the Singulair section of medications.com is ablaze with parents who are now expressing concern over their children’s well-being on the drug. Apparently, issues have cropped up with the drug even before the FDA announced their investigation.

Singulair and Suicidal Behavior

SingulairIn a particularly odd link, the FDA is looking into Singulair, the asthma and allergy drug and its correlation with suicidal behavior. I’ve taken Singulair in the past and not once did it ever occur to me to think about an allergy medication being linked to suicidal behavior. The FDA also says that it could cause mood and behavior changes. The situation that alerted the FDA to this possibility is the story of 15-year-old Cody Miller who killed himself 17 days after switching from allergy medication Allegra to Singulair. Miller’s mother, Kate, approached his medication switch with extreme caution and informed herself of the possible side effects:

She checked the Merck website and the information sheet she got from the pharmacist on Singulair and found no red flags, so they were stumped when Cody started acting out of character.

I have to hand it to Merck: Once the Millers reported Cody’s death, they immediately updated Singulair’s warnings to include suicidal thoughts and actions. However, Cody died on August 4, 2007. Merck updated their information two months later. As of February 29, 2008, the FDA still hadn’t taken any action. Despite the updated warnings, however, doctors and pharmacists were unaware of the new information.

The Singulair website carries the updated side effects, but you have to search it out in the patient information PDF on the fourth of five pages.

If you check with the FDA, you’ll find nothing. That’s because they admit they haven’t updated their website on Singulair since 2001.

According to the FDA’s MedWatch safety information, they have only begun their investigation today. They say it will take 9 months for them to “complete their investigation.” We may not hear of the FDA’s conclusions until early 2009. If this is a single, isolated incident, the FDA may just say the results are inconclusive and allow Merck rip the warning off their patient safety information. It is also important to note, however, that Singulair has also been linked to depression and anxiety.

Read the rest of this entry »

Generic drugs are not exactly like brand names

Gianna at Bipolar Blast stumbled upon an article at the LA Times that outlines the FDA’s standard for generics:

In almost all cases, the FDA permits a generic drug to release 80% to
125% of an active ingredient into the bloodstream, compared to that
released in a single dose of the original medication.

Gianna makes a good point for tapering down on brand-name meds then switching to generics:

And definately too broad when I’ve been cutting down my only 10% at a
time. If the drug is 80% of what I’m taking that is a 20% cut without
intending a reduction. It of course can work the other way and make
coming off the drug a longer task and more difficult if it’s actually
125% of the brand name.

eek – that’s something to think about.

Loose Screws Mental Health News

I recently wrote about the MOTHERS Act and the unnecessary scare tactics surrounding it. A Dallas-Fort Worth TV station picked up on the story and provided a short one-sided view of the issue, continuing to purport that the bill is solely about drugging new moms. I don’t discount Ms. Philo’s terrible experience with her medication. In fact, I’d be against the act if its sole purpose was to force treatment on pregnant women – medicated or not. Again, I’d like to reiterate that the bill’s purpose is to educate moms about postpartum depression and postpartum psychosis – not to shove unnecessary pills down women’s throats.

If you have sleep apnea, your CPAP (Continuous Positive Airway Pressure) machine may alleviate depression symptoms. My husband has sleep apnea and hasn’t been able to use the CPAP machine because of sinus problems. When he doesn’t use it (he hasn’t for a while), he’s noticeably moodier and prone to depressive symptoms. But then again, anyone who doesn’t get good sleep for several days is pretty moody.

Seroquel XRAstraZeneca (AZ) is going after Teva Pharmaceutical Industries and Novartis AG’s Sandoz unit after the two companies applied to make cheaper version of Seroquel available. AZ’s patent on Seroquel expires in 2011. The trial date for patent litigation is August 11. In the meantime, according to the Bloomberg report, the FDA is considering approval of Seroquel XR for bipolar depression and bipolar mania.

What is it about the U.K. that they seem to take pharma’s power more seriously than the U.S.? The UK Medicines and Healthcare products Regulatory Agency (MHRA) charged GlaxoSmithKline (GSK), the maker of Seroxat (Paxil in the U.S.), with not fully disclosing their clinical trial data that downplayed serious side effects such as increasing suicidal tendencies among those 18 years and younger. The MHRA also asserts that Seroxat didn’t alleviate depression as much as GSK’s initial data showed. GSK, of course, denied manipulating the data to show favorable results:

GSK denies withholding data, claiming the risks did not come to light until the results of nine studies were pooled.

The UK minister of public health, Dawn Primarilo, promised to address the issue of Big Pharma hiding negative clinical trial data.

“Notwithstanding the limitations that may exist in the law, pharmaceutical companies should disclose any information they have that would have a bearing on the protection of health,” she says.

In other news, I shouldn’t be a successful writer or novelist. The correlation between creative writers and suicide is ridiculously high. More than 70 well-known writers and poets have successfully committed suicide. How much more “unknown” writers and poets have as well?

(Image from Monthly Prescribing Reference)

Are Big Pharma murderers?

An book review in the NYTimes today focuses on Melody Petersen, a former reporter of the Times, who has written a book against  Big Pharma's marketing tactics called Our Daily Meds: How the Pharmaceutical Companies Transformed Themselves Into Slick Marketing Machines and Hooked the Nation on Prescription Drugs. In the book, she asks:

“Could drugs be killing people but escaping all blame, leaving them to harm even more Americans until someone, finally, catches on?” Ms. Petersen asks.

Few of us have. Most of America hasn't. Petersen outlines in great detail – the point of repetition according to Janet Maslin's review – Big Pharma's propensity for skewing clinical trial results so that their drugs perform better than placebo, the increased and ubiquitous DTC marketing, and the "payola-dispensing drug company representatives."

(“Hotel too cold inside,” one said, in an evaluation of a June 1998
drug company program, adding, “Resort places preferred.” From a
different doctor, miffed at the lack of a chauffeur at another event:
“Hired car would have been much preferable.”

Petersen also covers Big Pharma's tactic of fixing side effects of medications by creating medications to fix the side effects leading to medication on medication.

And when the side effects of sleeping pills or antidepressants mean
more elderly people fall down, the solution is not likely to be the
scaling back of such prescriptions. “Instead,” she writes, “the
companies have used the statistics on falls to create a new blockbuster
pharmaceutical market for drugs they claim will reduce the chances of
breaking a bone.”

According to the Maslin's review, the book calls for non-government watchdog agencies and closer oversight on published studies, which Petersen says are ghostwritten by pharma spokespeople. Overall, Petersen's book sounds like a must-read for anyone who is skeptical of Big Pharma's activities. However, I doubt her book will get much press or coverage considering that you can't read any major publication without turning the page and seeing a drug ad then the required 2-page side effect warning that everyone skips over. If anyone reads the book, I'd like to know your thoughts about it.

Sorry if this post sounds hastily written. I'm off to an interview to freelance for a company.

Alaska's "clinical" trial of Eli Lilly over Zyprexa

Since I've been gone, a trial has begun in Alaska against Eli Lilly because of its off-label drug marketing of Zyprexa. Then, Connecticut recently decided to join a growing list of states going after Lilly as a result of the Zyprexa deal. There is so much going on with this case I can't even keep up.

But that's what we keep Philip Dawdy around for. 🙂

Pregnancy is NOT a mental illness

I stumbled upon Yankee Cowgirl’s blog that mentioned Congress is working on the MOTHERS (Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression) Act which would “strongly encourage pregnant women into mental health programs – that means drugs – to combat even mild depression during or after giving birth.”

She links to a column written by Byron J. Richards on newswithviews.com. He writes:

The Mothers Act is pending legislation that will indoctrinate hundreds of thousands of mothers into taking dangerous psych drugs.

He goes on to slam Big Pharma about how they control Congress and how mothers don’t need psych drugs for a natural birth process.

The Mothers Act (S. 1375: Mom’s Opportunity to Access Health, Education, Research, and Support for Postpartum Depression Act) has the net affect of reclassifying the natural process of pregnancy and birth as a mental disorder that requires the use of unproven and extremely dangerous psychotropic medications (which can also easily harm the child).

These are some serious accusations. I got pretty riled up myself and decided to see what Congress said in the bill.

Read the rest of this entry »

Blood test for efficacy of antidepressants in the future?

Scientists have found that a biomarker for depression could show whether a person's antidepressant is working. The discovery could lead to something everyone in the psych world has been waiting for: a blood test of some kind.

The researchers looked at the interaction of neurotransmitters and a protein called Gs alpha. In brain cells, the protein acts like a kind of butler, passing messages from neurotransmitters on the outside and amplifying their messages, [study co-author Mark] Rasenick explained.

When the protein is working properly, it's like a butler whose "hands are just flying, cooking and cleaning at the same time," he said. But when the brain is depressed, "it just sits there in the corner."

That's an interesting observation. This might finally explain the difference between "depressed" brain activity and normal brain activity on an MRI. (By the way, has anyone had an MRI performed for depression?)

Researchers compared the proteins in the brains of people who committed suicide as a result of depression to those who did not. "They found the protein would have worked less effectively in the brain cells of the suicide victims."

Dr. Gregory Simon conceded that doctors cannot determine which antidepressant will work for which person.

"There's a long history of research using patterns of symptoms or biological measures — chemicals measured in blood or spinal fluid — to predict response to a particular antidepressant. None of those hoped-for predictors have significant value.

[Genetic tests] would not eliminate trial-and-error, but it would reduce the waiting time with each trial. But it's a long way from a study like this one to a test that's useful to patients and doctors."

Good news for the skeptics about this research study: It was funded by the U.S. Public Health Service and the American Foundation for Suicide Prevention. But a test simply to see if an antidepressant is working has the smell of pharma somewhere on it.

(Hat tip: Ephphatha)

Loose Screws Mental Health News

An article in the NYTimes addresses the issue of diagnosing mental health in developing countries. A startling fact:

Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year.

emoIn India, as in much of the developing world, depression and anxiety are rarely diagnosed or treated. With a population of more than one billion, India has fewer than 4,000 psychiatrists, one-tenth the United States total. Because most psychiatrists are clustered in a few urban areas, the problem is much worse elsewhere.

Looks like depression is really more than just a whiny rich American kid who chooses to be upset because he’s got nothing better to do. That’s “emo” for those who aren’t hip-to-the-jive. 😉


On The Elite Agenda, Dr. Fred Baughman mentions Swedish writer Janne Larson who asserts that “over 80 percent of persons killing themselves were treated with psychiatric drugs.” Thank God for FOIA that provides the docs to back this up:

According to data received via a Freedom of Information Act request, more than 80 percent of the 367 suicides had been receiving psychiatric medications. More than half of these were receiving antidepressants, while more than 60 percent were receiving either antidepressants or antipsychotics. There is no mention of this either in the NBHW paper or in major Swedish media reports about the health care suicides.

I guess Sweden isn’t the only country in the world that wants to sweep unfavorable mental health coverage under the rug. By the way, Sweden also is considered to be the seventh happiest country in the world.

While the FDA has recognized that antidepressants can cause an increase in suicidal behavior (as indicated by the “black box warning”), antipsychotics seem to have fallen under the radar. In fact in 2002, Clozaril was approved to combat suicidal behavior in schizophrenic patients. Since then, research has shown that antipsychotics can increase suicidal behavior in schizophrenic patients twenty-fold.

Akathisia – a serious side effect that has occurred for nearly all psych drugs in clinical trials – has been found to be linked to suicidal behavior with not only antidepressants but also in conjunction with antipsychotics.

Finally, Baughman closes with this:

It is important to note that nearly every school shooting that has happened in the United States over the last decade has been conducted by young males who were taking antidepressant drugs. The drugs not only cause suicidal behavior, they also seem to promote extreme violence towards other individuals. In most school shooting cases, the young men committing the violence also committed suicide after killing classmates and teachers. These are classic signs of antidepressant use.

I don’t know if that’s wholly true but it’s a trend I’ve seen with Cho, Kazmierczak, and Eric Harris of Columbine. Since 1996, there have been 55 major school shootings all around the world; 43 of them occurred in the U.S. Makes you wonder how many of these gunmen were on a psychotropic drug – prescribed or not – of some kind.

(Image from Style Hair Magazine)

Today's lesson: Paxil and Lexapro are not great antidepressants

Dawdy at Furious Seasons wrote a post on an editorial in the LA Times by Summer Beretsky’s experience with Paxil. After reading her editorial, I’m reminded that my own experience with one antidepressant wasn’t all that unique. Her drug was Paxil for panic attacks; mine was Lexapro for depression following a 3-month (on-and-off) stint with Paxil. I’m struck by the similarity of our experiences; not only did the same thing happened to me but I was also a communications major in college as well.

Paxil had one pretty undesirable effect on me: I started to lose interest in just about everything. I stopped initiating social activities (who needs that sort of thing?) and was no longer motivated to perform well academically.

My emotions had flat-lined: I hadn’t cried in months, nor had I proverbially jumped for joy. I felt — nothing.

I can still remember sleeping in bed at home on a weekday when I should have been at class. It was 2 in the afternoon, around the time my copy editing class was to begin. My boyfriend at the time (now my husband) lived in Kentucky while I attended college in New York. He planned to visit me that weekend but was getting fed up with my depression and listlessness. He called from work to tell me to get up and go to class. I mumbled on the phone, half-confused, and said no. He demanded, “Why not?” I said quite plainly, “Because I don’t care.” He said, “If you don’t get up and go to class, I won’t visit you this weekend.”

I replied, “I don’t care.”

Read the rest of this entry »

I hate to brag, but…

I hate to brag, but…

February 28, 2007
Pristiq's FDA Chances: Depression – Yea; Menopause – Nay

It wouldn't surprise me if they said yea to antidepressant use and nay to vasomotor use because of lack of evidence in improved symptoms.

April 19, 2007
Wyeth looking for Pristiq's FDA approval in 2008

I'll follow Pristiq as the information continues to trickle out but don't expect to hear much about it until next year when Wyeth becomes the proud papa of a brand new (and approved) product.

This is one of the few times I can actually say I was right. (Teenage-like "squee!" goes here.)

More recent posts from:

Pristiq receives approval from FDA

PristiqMore than a year ago, I promised to keep tabs on Wyeth’s new (renamed, rather) drug Pristiq. So I’m living up to it.

On February 29, 2008, the FDA granted Wyeth approval to move forward with putting the drug out on the market.

Wyeth said the company planned a big sales effort to introduce the product to psychiatrists and primary care doctors.

There’s a problem with that sentence. I’ll give you a second to figure out what’s wrong with it. Haven’t got it yet?

Primary care doctors. PCP should not be in the business of prescribing or providing psych meds. I’ve gone on and on about it at length before, but I’ll mention it again. PCPs are trained to treat overall conditions that have no need of referral to specialists. Think about it this way: If your psychiatrist prescribed anti-inflammatory medication because you mentioned that you’ve been having problems with your foot, you’d be taken aback, right? If a dermatologist prescribed heartburn medication after a patient mentioned he’d been having heartburn trouble, that would seem almost illogical, wouldn’t it?

(Pristiq logo from Pristiq.com)

Read the rest of this entry »

Depression: Theory or fact?

UPI has an article on a study which finds that the media presents depression's "chemical imbalance" as a fact instead of a theory. According to Jeffrey Lacasse and Jonathan Leo, the DSM says "the cause of depression and anxiety is unknown." Lacasse and Leo asked members of the media to submit evidence that supports chemical imbalance as a fact but no one did. This finding comes after the near-damning U of Hull study that asserts antidepressants don't work much better than a placebo on the majority of depressed patients. If the efficacy of antidepressants are this dubious, how much more are antipsychotics?

This article gets me thinking about the idea of media responsibility. I feel like what we call "news" has reverted to the days of yellow journalism. Sometimes, even worse than that. While the majority of publications strive to adhere to ethical practices and accuracy, many major publications will resort to printing anything that sells — even if it's libelous. But I'm getting off track here.

I can't wholly blame the media for sensationalism on certain topics like depression.  Most of them aren't scientists or research experts – they only report what they're told. Take NIMH's explanation of the way medication works for depression:

Antidepressants work to normalize naturally occurring brain chemicals called neurotransmitters, notably serotonin and norepinephrine. Other antidepressants work on the neurotransmitter dopamine. Scientists studying depression have found that these particular chemicals are involved in regulating mood, but they are unsure of the exact ways in which they work.

NIMH isn't presenting the way antidepressants work as a theory. It's an authoritative paragraph that sounds as though it's fact. If the chemical imbalance that causes depression is only theory then one must conclude the way antidepressants work as a theory as well, no? The NIMH has a section that explains what causes depression:

There is no single known cause of depression. Rather, it likely
results from a combination of genetic, biochemical, environmental, and
psychological factors.

"Likely results" leaves the door open to interpret the sentence as "maybe it's a combination of…" However, most people aren't scrutinizing words that carefully. Most people see this: "Rather, it results from a combination of…" Yes, I'm being nitpicky but the word "likely" still strikes me with a more authoritative connotation than maybe or perhaps. Here's a quote from a recent report from a local news station News 8 Austin:

Depression is more than just a negative state of mind. There are physical changes that occur in the brain that disrupt that natural balance of chemicals called neurotransmitters. (emphasis mine)

There is no single factor that causes depression. In fact, many experts believe most cases
[sic] of depression are a result of several sources. (emphasis mine)  

Again, I'm being nitpicky. "There are" is an authoritative phrase. People are unlikely to argue with a statement that includes the verb "are." Take for example, "There are people outside" or "There are five cats at the door." There's no question in the speaker's mind about whether people exist outside or the number of cats at the door. With subjects like depression that involve psychiatry and neuroscience, the majority of people aren't going to question these assertions either. I'm surprised that second paragraph didn't read, "many experts say …" Unless you're an expert yourself, you'd be unlikely to argue on what an expert says versus what the expert believes.

While I appreciate Lacasse and Leo's study on the inaccurate way depression is presented in the media, the "authoritative" sources on the issue would be loathe to correct it. Right now,  the big picture of raising awareness about depression is more important than to correct a trivial thing about the chemical imbalance being a theory. Pharmaceutical companies don't like correcting minor nuisances like theories.

To sum it up, I think the idea of a chemical imbalance causing depression is a theory. That's not a dubious statement. Unless it depends on your definition of what is is. 

Selective publication on antidepressant efficacy and data

After the release of the U of Hull study on Tuesday, the AFP has written an article about doctors who are urging patients on antidepressants to continue taking them.

Louis Appleby, national clinical director for Mental Health, told the Press Association: "… the message to patients and doctors remains the same — anti-depressants are an appropriate treatment for moderate or severe depression."

I agree that patients on antid's should not cease medication cold turkey. (Trust me on this one. Even with proper tapering, the side effects are not pretty.) I waver on the idea that antid's are "appropriate treatment" for moderate-to-severe depression rather than a "form of treatment." Antidepressants can help, but I'm not sure I like the term "appropriate." But I likely am arguing semantics.

Since the results of the study originate from Britain (despite the fact that it also includes data from the FDA), I can only assume that news reports on this are more widespread over there. In my Philadelphia, USA-world, it seems a little bit off the radar to me. Let me know if I'm wrong.

To Mr. Appleby's credit, he has acknowledged that the British government plans to rigorously pursue routes of alternative treatment in light of the study.

The government has plans to expand the availability of psychological therapies as an alternative to drugs, Appleby explained, with extra investment and more psychological therapists.

"The evidence shows that these therapies are effective and often preferred by patients."

WebMD also covered the recent study.  Dr. Nada Stotland of the American Psychiatric Association insists that the study is not reflective of real psychiatry.

"We know that many people who are depressed do not respond to the first antidepressant they try," she says. "It can take up to an average of three different antidepressants until we find the one that works for a particular individual. Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve."

Stotland has a point. Patients usually do not respond to the first antidepressant that is prescribed to them. About 30 percent of patients do not respond to antidepressants or experience no improvement until several weeks later.  Even then, patients who are on antidepressants for long-term maintenance, experience the return of depressive symptoms. An article from The New England Journal of Medicine evaluated the selective publishing of antidepressant trials with a positive efficacy:

Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive.

The authors' conclusion: "Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients." It's an obvious statement; so obvious, it can be easily overlooked.

While it's important to shed light on the issue of treating depression with antidepressants, it seems as though many authors are cherry-picking favorable results to publish. Considering that much of these research studies are backed by drug companies, it's no surprise. Also, I can't fault the authors only. I recently freelanced for a medical publication and learned that many of the submitted articles are heavily rewritten by the editors. Editors are hard-pressed (and probably loath) to publish a piece that criticizes antidepressants when their biggest advertisers include such big names as Wyeth, Eli Lilly, and GlaxoSmithKline. Run enough of those pieces and a publication is quickly on its way to folding.

That's why it's stunning to read the U of Hull study that has somewhat of a negative slant toward antidepressants' effectiveness. While doctors are wisely advising patients to continue any antidepressants they may be on, currently drug makers have launched into damage-control mode.

In a statement, GlaxoSmithKline (GSK) representatives express "disappointment" at how the study was being reported by the media, suggesting that news reports may have caused "unnecessary alarm and concern for patients."

Of course these news reports are "unnecessary" to GSK. Letting patients know that their antidepressants might not work better than sugar pills isn't good for business. However, GSK's reps were kind enough to balance out their statement, adding "counseling and lifestyle changes" also are important aspects of treating depression. Then, the company accuses the researchers of selectively reporting their data:

"GSK fully endorses public disclosure of clinical trial results for its medicines and is actively committed to communicating data relevant to patient care," the statement reads. "All the data related to GSK's clinical trial results of [Paxil], regardless of study outcome, are available at the company's clinical trials register at 20 www.gsk.com."

Tell that to the estimated 5,000 Americans who have filed a lawsuit against GSK regarding Paxil. Still, Kirsch, who has received consulting fees from Squibb and Pfizer, insists "the [drug companies] certainly do publish selectively."

I'm inclined to agree.

Do antidepressants provide psychosomatic improvement?

Despite all the hype surrounding antidepressants and their effectiveness, the AP has reported on a new study from the University of Hull in Britain that says antidepressants only help severely depressed people and “work no better than placebos in many patients.”

The drugs used in the study: Prozac (fluoxetine), Effexor (venlafaxine), Paxil/Seroxat (paroxetine), and Serzone (nefazodone).

Irving Kirsch, who headed the study, said: “Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great. This means that depressed people can improve without chemical treatments.” (AP)

This is a pretty controversial finding considering the widespread use of antidepressants among those who have been diagnosed with clinical depression and other forms of mental illness, i.e. anxiety.

According the NIH, depression (the clinical term is major depressive disorder) affects an estimated 14.8 million American adults. CNN cites a study from the U.S. Centers for Disease Control and Prevention that says 2.4 billion drugs were prescribed in 2005; of those, 118 million were antidepressants. I can only imagine as “awareness” of depression increases, the number of prescribed antid’s has increased as well.

Adult use of antidepressants almost tripled between the periods 1988-1994 and 1999-2000.

Between 1995 and 2002, the most recent year for which statistics are available, the use of these drugs rose 48 percent, the CDC reported.

Many psychiatrists see this statistic as good news — a sign that finally Americans feel comfortable asking for help with psychiatric problems. (CNN)

CNN quoted Dr. Kelly Posner, an assistant professor at Columbia University College of Physicians and Surgeons in New York City, who said that “25 percent of adults will have a major depressive episode sometime in their life, as will 8 percent of adolescents.” If 25 percent of adults have a “major depressive episode,” does that mean that those 25 percent will require antidepressants as well? I’m concerned about the relatively high number for adolescents. I’m not a fan of throwing pills at growing children.

In light of the U of Hull study, the first course of treatment regarding depression should be non-medicated therapy of some kind. Whether it be “talk” therapy or cognitive behavior therapy, tackling depression really should first be treated with psychologic therapy. Posner says “25 percent of adults will have a major depressive episode.” Major depressive episode does not equal clinical depression or major depressive disorder, for that matter. A major depressive episode could mean anything: bereavement, loss of employment, or a difficult situation without an immediate resolution. I am strongly against prescribing antidepressants to help people cope with “normal” life events. People feel as though that their grief is too much to bear so they go to the doctor in the hopes that an antidepressant will help “dull” their emotions. I can only hope that a doctor will be able to differentiate between true clinical depression and a difficult situation that could be helped without the use of psychiatric medication.

P.S. I looked up Dr. Posner’s conflicts of interest and they were “TBD.” I would feel better had it listed “no conflicts of interest to disclose.”

College shooting: Part 45,656

I don’t like this idea of college shootings becoming commonplace. I think there have been three or four major college shootings since the Virginia Tech incident.

Steve Kazmierczak, an alumnus of Northern Illinois University, went ballistic shooting up a geology class and killed five students before killing himself. The AP article sums up Kazmierczak’s demeanor:

Unlike Virginia Tech gunman Cho Seung-Hui — a sullen misfit who could barely look anyone in the eye, much less carry on a conversation — Kazmierczak appeared to fit in just fine.

The AP article cites that he "stopped taking [his] medication." It appears that he had no record of mental illness at all. He applied for and legally obtained a gun after a background check.

The issue of mental illness in these school shootings is constantly brought up. While I don’t dismiss the unstable mental health of Cho or Kazmierczak, I can’t help but wonder what this means for the rest of us who struggle with mental illness. If I tell someone that I have bipolar disorder, does that mean I’m likely to commit homicide and suicide despite the fact that I have a bubbly, outgoing, and talkative personality?

The link between mental illness and these school shootings will only continue to fuel the stigma relating to mental illness. Despite the fact that the majority of people who suffer from mental health problems are nonviolent, the minority who are violent will get the press coverage and become poster evidence for people like the TAC.

Loose Screws Mental Health News

Note: I’m manually typing HTML through my e-mail so if any of the formatting is funky, I apologize in advance.

1) It seems that FDA black box warnings on antidepressants targeted for teen use have led to a decrease in adults being diagnosed with depression. In all honesty, I’m not sure how a black box warning leads to a significant decrease in diagnoses, but I’m not a researcher from the study.

2) Doctors at McGill University in Canada are holding out hope for a faster-acting antidepressant. Most antidepressants take up to six weeks to finally kick in while the seemingly promising compounds, RS 67333 and prucalopride, appear to act “four to seven times faster” than regular antid’s.

3) Sad news: While American suicide rates overall have dropped, the rate of suicide among teenage girls have increased. The preferred method of dying? Hanging.

4) Recent reports have been released that Owen Wilson’s Aug. 26 suicide attempt wasn’t his first – in fact, it was his third.

Official reports confirm Wilson attempted suicide, and now a family friend has told The National Enquirer that the recent incident wasn’t Wilson’s first cry for help.

The unnamed source tells the publication, “A good portion of his (Wilson’s) life has been dedicated to fighting depression and addiction… This is the third time he’s tried killing himself.”

When I hear of celebrities who openly admit to being depressed, I immediately get skeptical. Mandy Moore… Zach Braff… Paris Hilton… Depression is the “hawt” mental illness of choice. Everyone can have it and remain normal! Bipolar’s too crazy and schizophrenia is too psycho. Being bipolar means that you’re spontaneously moody and being schizophrenic means that you’re, well, just not all there. No one wants to be the last two. You can be “sad” and “suffer” from depression — that is, sad about your goldfish of 2 days dying. Mr. Wilson appears to genuinely suffer from depression (among other problems) and my heart goes out to him. As for Britney Spears: I’m fully convinced that the woman has a mental illness. No joke.

Lack of posts

Sorry I haven’t been posting much. I haven’t abandoned the blog. But you all know my situation and as it stands, it majorly sucks right now.

I’m currently wrestling with the idea of having a kid soon. My husband and I talked about it and we knocked all  of our concerns down to the medication issue. I’ve been doing really well on the Lamictal, but there are warnings all over the prescription that say "Do not take while pregnant." My doctor’s pretty much, "You need to outweight the benefits vs. the risks." He said there’s a slightly increased chance of my kid developing a cleft palate but not much more than the average population. You know me – I need to do my research. I’d like to nurse my kid and I don’t want it to nurse on Lamictal.

Anyway, any advice you want to throw my way would be appreciated. Thanks.

ECT: Pros vs. Cons

I haven’t had any experience with ECT (Electroconvulsive therapy), but unfortunately, many others have – and not voluntarily. One reader of Furious Seasons, SS, details her traumatic experience with the treatment. Another reader, Crazy Tracy, explains how ECT saved her sanity.

For those who don’t know ECT – informally dubbed "electroshock" therapy – "involves the application of electrical stimulation to the brain using two electrodes attached to the scalp, resulting in a seizure." (ect.org) While there are many people who have benefited from ECT, there are just as many who haven’t. ECT’s reported side effects include memory loss (the biggest complaint) and the loss of some physical and cognitive functioning. Juli Lawrence, owner of ect.org, describes the controversy surrounding ECT:

"Since that time, the ECT industry has repudiated the complaints of ECT patients. Instead of trying to listen to the patients and find a solution to the problems, the industry has been on the attack, attempting to discredit those who speak out. They have taken a wide range of people and categorized them into one group of people: antipsychiatry and Scientologists. If that doesn’t deflect the attention away from those speaking out, they tell the public and media that they are too mentally ill to understand what’s going on.

Cancer patients are very aware – and told upfront – what the results may be with chemotherapy. ECT patients are not.

Instead, the industry bristles at any criticism, and points to a badly-designed study that concluded the majority of patients were happy with their ECT treatment. They do not mention that nearly half of the original participants either dropped out after treatment, or refused to participate."

The main issue about ECT is not so much whether it should be used or not (I’m not a fan of it), but rather letting patients make informed decisions about using that form of therapy. There are instances of forced ECT, which all patients seem to be against. Unfortunately, mental health professionals don’t seem to see it the same way, which is a shame. Furious Seasons linked to MindFreedom.org that has a campaign running to prevent NY State from forcing ECT on a patient who repeatedly refuses it. Perhaps VNS (Vagus Nerve Stimulator) would be a better option. I haven’t heard as many side effect complaints from that – if any at all.

Lies, damned lies, and statistics

A recent article in the New York Times reported on the link between suicide and depression. Two studies were released in The American Journal of Psychiatry (AJP) that question the findings that show an increased risk for suicide on antidepressants for all age groups. In the first study, psychiatrist Dr. Gregory Simon of Seattle’s Center for Health Studies analyzed the health records of just over 109,000 people who were being treated for depression. Simon found that “suicide attempts were most common in the month before treatment began, declined sharply in the month after it began, and tapered off in the following six months.” Medication therapy, psychotherapy, or a combination of the two continued to support data that “treating depression reduced suicide risk regardless of technique.” However, the issue is whether the medication really DID do an effective job of curbing suicide attempts. Obviously, this study would contradict many of the data presented to the FDA that have found an increased risk for suicide on an antidepressant. Furious Seasons reported on similar findings from different studies early last year.

The second study, led by Dr. Robert Gibbons of the Center for Health Statistics at UIC, gathered data from the Veterans Health Administration of nearly 227,000 veterans suffering from depression. Gibbons discovered that veterans who began antidepressant therapy had a suicide attempt rate one-third that of those who did not receive antid therapy. Researchers also found that “this was true for men 18 to 25 as well as for older adults.”

Given that veterans/those who serve in the armed forces are primarily men, it wouldn’t surprise me if the suicide rate was low to begin with.Women, on the whole, are known for more suicidal attempts. Guys are usually a “one and done” attempt – they use a violent means of suicide, e.g., firearms.

If I haven’t said it in the past, I’ll say it again: I’m not a whiz when it comes to statistics. Feel free to skip all my assumptions and theories and read a knowledgeable editorial by Dr. David Brent on these studies. But I’ll do my best to interpret the data from the first study from my perspective.

Read the rest of this entry »

The Zoloft-rage/violence connection

[This post is quite lengthy so I suggest you grab a cup of coffee or tea and sit down and read it. The following is not for the faint of heart (or those with a lack of time).]

It’s been amazing to me that I’ve received numerous comments on Zoloft inducing rage. I’m humbled by having a Pittman supporter visit my site and post some comments from the ChristopherPittman.org forums. Read the following:

In my senior year in high school I was diagnosed as being severely depressed and put on medication. The first medication that I was on I took for 5 months and it made me really aggressive. My friends and family noticed the change and I told my doctor about it and she changed my meds. After that I was fine. I am normally a very passive person and will let just about anything fly. But the medication made me really aggravated and aggressive toward my friends and family and it seemed that I wasn’t overcoming my depression. I just got done watching the 48 hours investigation on the Discovery Times Channel and felt a connection with Chris. I felt that I had to write this to let you know that Chris is not the only one out there that had these side effects. I think there should be a study done to see how many people that take antidepressants have increased aggression. The problem is that the pharmaceutical industry has deep pockets and many lobbyists. I hope this helps in some way.

And another:

I remember the case when it happened.

At the time I thought, “Zoloft right”.

Let me tell you my physician put me on Zoloft and it took about three weeks for my to become psychotic and I’m a 50 year old woman.

I have three children and I don’t make a lot of money but please let me know if I can do anything for the Pittman boy.

The jury should have been placed on Zoloft before they made they decision. Unless you’ve experience it you simply cannot believe its’ effect.

Brynn and Phil HartmanI did a bit of quick reading/research into Zoloft triggering violence in people who otherwise would have never been violent and it seems that are a few stories out there to support the assertion. I found a few comments on depressionblog.com that mentioned a link between Zoloft and rage fits. A Salon.com article published a story antidepressants inducing rage in 1999. Apparently, Brynn Hartman, the wife of famous comedian Phil Hartman, killed herself and her husband while taking Zoloft. While close friends attribute the sudden behavior on the antidepressant, others attribute it to a combination of the medication with cocaine and alcohol in her system. (Zoloft does have a warning against alcohol use in conjunction with the drug.)

One interesting thing I learned from the article is that this kind of behavior is often labeled under the name akathisia on patient safety guides. Most – if not all – of the major antidepressants list akathisia as a side effect. Here’s the initial description of this condition from Wikipedia:

Akathisia, or acathisia, is an unpleasant subjective sensation of “inner” restlessness that manifests itself with an inability to sit still or remain motionless… Its most common cause is as a side effect of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol (Haldol)), and rarely, antidepressants.

Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still, accompanied by overwhelming anxiety, malaise, and severe dysphoria (manifesting as an almost indescribable sense of terror and doom).

No real mention of extreme anger or irritability mentioned there. But if you read on…

The 2006 U.K. study by Healy, Herxheimer, and Menkes observed that akathisia is often miscoded in antidepressant clinical trials as “agitation, emotional lability, and hyperkinesis (overactivity)”. The study further points out that misdiagnosis of akathisia as simple motor restlessness occurs, but that this is more properly classed as dyskinesia. Healy, et. al., further show links between antidepressant-induced akathisia and violence, including suicide, as akathisia can “exacerbate psychopathology.” The study goes on to state that there is extensive clinical evidence correlating akathisia with SSRI use, showing that approximately ten times as many patients on SSRIs as those on placebos showed symptoms severe enough to drop out of a trial (5.0% compared to 0.5%).

Read the rest of this entry »

Can Zoloft induce rage?

Furious Seasons has a post on WWE wrestler Chris Benoit, who possibly may have taken Zoloft shortly before he committed the murder of his wife and child. The article on pwtorch.com that FS linked to refers to the possibility that Benoit's friend and doctor, Phillippe Astin III, may have prescribed the drug to Benoit on Friday, the day before he killed his wife.

There are definitely some funky mental issues behind Benoit's motives for killing his family, but it wouldn't surprise me if the Zoloft played a part in influencing him to do so. I recently mentioned Christopher Pittman who killed his grandparents in 2001 then proceeded to set their house on fire when he was on an adult dosage of 200 mg of Zoloft. He was 12. Stephany of soulful sepulcher commented that her daughter suffered from a similar problem while on 150 mg Zoloft:

Pittman was about the same age my daughter was then, and she was on 150mg of Zoloft a day, and that med changed her personality into a full blown all day raging person. She had to go inpatient to get off of it, and once off of it, she's never raged like that again. The Pittman story is very sad, as are all of the others associated with antidepressant use and teen violence. Columbine had Luvox, there's Accutane–it's beyond me how this can be overlooked in connection.

I wonder if there are other stories floating out there now about how Zoloft – an antidepressant – has caused similar behaviors. It'd be interesting to observe whether Zoloft causes hallucinations, delusions, and psychosis.

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.

NICS the anti-depressants

In my Google alerts, I came upon a link to The Center for Science Writings at the Stevens Institute of Technology. John Horgan, a professor on the blog, received an e-mail from a former student commenting on the future of anti-depressant therapy:

Introducing “pharmacogenomics,” the latest and greatest addition to the ever-growing collection of pseudoscientific portmanteaus. According to a recent article in the New York Times written by Richard A. Friedman, M.D., there will soon be psychological medication that is custom-tailored to a patient’s DNA and genetic structure to ensure maximum effectiveness.

He makes his case with an example: his patient Laura. Laura was depressed, so Friedman gave her Lexapro, a common selective seratonin reuptake inhibitor (SSRI) anti-depressant. But Laura was still depressed, so he switched her to Zoloft, another SSRI. Still depressed, Laura switched to Wellbutrin, a non-SSRI anti-depressant. No dice. Dr. Friedman was frustrated; after three months he still couldn’t find an effective treatment for Laura. Then, Laura decided that since Prozac (also an SSRI) had helped her father with depression, she wanted to give it a shot. And voila, it worked!

If only Laura’s genes were able to reveal that Dr. Friedman should have prescribed Prozac, arguably the most well-known anti-depressant in America, from the very beginning, that would have saved a lot of hard, aggravating diagnosis work on everybody’s part.

But wait! There might be salvation on the horizon; according to Friedman it will soon be possible for doctors to analyze a patient’s unique genetic profile and prescribe the appropriate medicine so that time and money would no longer be wasted on the circuitous trial-and-error process of expert diagnoses.

No, what “melted away” Laura’s depression was good, old fashioned SSRI Prozac. But Friedman doesn’t see the contradiction. Instead, he claims that this new process of genetic-based medical treatments, “pharmacogenomics” will revolutionize the medicine, allow doctors to enhance their already astute diagnosing skills, and reduce the pharmaceutical industry to a withering dinosaur.

But what about Laura? What about the Prozac? Could it be that she was genetically predisposed to a specific brand of medicine? Are we all designed to respond to one drug label instead of another? If indeed that’s the case, there is only one logical conclusion to draw: God exists and He’s a Big Pharma shareholder.

Somehow, I’m not so convinced. — Suhas Sreedhar

I'm with Suhas. I skimmed Dr. Friedman's article and the whole process sounds weird. I think Laura probably – haha – psyched herself into thinking that Prozac would work since it worked for her dad.

While genes play a role in generational and familial health, I'm not completely convinced that psych meds would affect a father in the same way as it would affect his son or daughter across the board. Even if it really did work for Laura, I am skeptical that the method could be applied to any psychiatric patient. If a patient doesn't have any family, there we go with trial-and-error. Or we could just search our future FBI DNA mental health database and see if the patient matches up with anyone currently on meds.


Last week, Attorney General Alberto Gonzales called upon the remaining 27 states who don't report mental health files to the  NICS to do so. (That was an awful sentence.)

Speaking during a meeting of the nation's state attorneys general, Gonzales urged [states] to participate in the National Instant Criminal Background Check System, more popularly known as "NICS."

Then the article (linked to above) jumped to protecting the public from sex offenders:.

Gonzales also called for ideas on how to protect the public from convicted sex offenders.

Mental health experts, however, say Gonzales is overreacting. Sex offenders are less likely to repeat the same type of crime than other criminals, only about 13 percent within the first five years, said Dr. James Stark, former president of the Georgia Psychological Association.

"The whole country is in a predator panic. They've gone crazy," said Stark, who treats sexual disorders at the Marietta and Ellijay clinics of Psychological Forensic Associates.

"There are very few sex offenders who are actually dangerous," he said, adding that most of the 13,000 people on Georgia's registry of sex offenders are there for flashing, being a peeping Tom or having consensual sex with an underage girlfriend.

Maybe I'm overreacting. If a sex offender isn't dangerous, why is he or she a sex offender to begin with? Yup, peeping Toms don't ever turn into psychos. On that matter, try watching Alfred Hitchcock's movie, Psycho. (Please don't watch the remake. You'll be better off for it.)

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.

YouTube vs. Big Pharma: Round 1

We seem to have a lot of contenders today. Kevin M.D. has a post (linking to PharmaGossip which links to Advertising Age) about the video "exposés" on pharmaceutical companies that have been popping up.

GlaxoSmithKline now has its own one minute, 43-second video on YouTube for Restless Legs Syndrome. Ms. Wetzel said she believes more drug companies and ad agencies will adopt such an approach. "The conversation about health care goes on," she said, "and we're going to have to deal with it."

My job blocks YouTube so I can't see the video, let alone link to the one I'd like to reference, but the other day, I saw (at least) a minute-long TV ad for Celebrex, but oh man, was it awful. See the craptasticness of it at celebrex.com. While I'm all for pharmaceutical companies being upfront and honest about their products, from a marketing standpoint, this commercial is an unbelievable disappointment. (Who agreed to this?) It's one of the most boring commercials I've ever seen and goes on and on for – oh say, a minute – about all the side effects of Celebrex before getting to the positive aspects about the drug. Has the FDA changed the rules on advertising NSAIDS that I'm not aware of? Here's your sampling:

"Lately, there has been some confusion about arthritis pain treatments. It is important to know that there are risks with all pain medicines, including the 3 most common NSAIDs: CELEBREX, naproxen, and ibuprofen. In fact,the FDA requires all these NSAID pain relievers, including CELEBREX, to have the same cardiovascular warning. Understanding the risks and benefits of different NSAIDs is important. All NSAIDs, including CELEBREX, help relieve arthritis pain, but only you and your doctor can decide which one is right for you. An NSAID like CELEBREX might be an option."

* I just timed it: It was 2½ minutes long.

Cognitive functioning

Lately, my cognitive functioning has been absolute CRAP. My thoughts feel slow and dulled. I find myself constantly at a loss for words, especially verbally, which hinders my communication skills. I think this is not only affecting my job performance, but also my social skills on the job. This is probably why I’m making so many mistakes and forgetting things to do despite my endless lists. As a result, I’m worried about applying for a new job and feeling incredibly slow and dull like I do now. I wonder if it is the Lamictal or something else. I didn’t feel this way before I got bumped up to 200 mg, but the problem is quite apparent right now. I’ve become a whiz at solving sudoku puzzles (especially the hard ones!), but now, I’m lucky if I can solve medium. Easy takes me quite a while to finish now. If it is the Lamictal, my husband and I have discussed a trade-off: mixed episodes or the return of cognitive functioning? It’s like choosing between psychotic episodes or obesity. What would your choice be?

I apologize in advance for misspellings or sentences that don’t make sense. In some ways, I miss my pre-200 mg Lamictal self.

Get prescription medication without a prescription

I went to retrieve a printed document at the main office copier/printer/fax yesterday and noticed two unsolicited faxes sitting on the upper tray. The first one was the generic tropical vacation deal; the second was from myfirstpharma.com encouraging whomever to order “prescription medication without a prescription.”

You can go on the site and order the prescription medication they offer:

“Just fill out our online questioner [sic] and one of our doctors will write your prescription. Our pharmacy will then fill your order and ship it overnight to your Door.”

First, let’s address the online “questioner.” It doesn’t ask for your symptoms or why you want the drug. The only exception is purchasing a weight-loss drug. You fill in your height, weight, and BMI to verify obesity. So of course, you can’t lie and say you’re 5′ 4″ and 210 lbs when you’re really 5′ 4″ and 110 lbs. [sarcasm] Click the “Buy now” button and all of the shipping and billing information pops up with the “questionnaire” at the end. You must agree or disagree with the questionnaire that consists of the following:

  1. I agree not to take any over-the-counter medicines without approval from my pharmacist. If you disagree, please explain why.
  2. I agree not to take medication if I am pregnant, breast-feeding, or trying to get pregnant. If you disagree, please explain why.
  3. Please list all current medical conditions.
  4. Is there anything in your medical history that you consider to be relevant?
  5. Please list all over-the-counter and prescription medications that you are currently taking and the length of time for each.
  6. Please list all medication that you plan to take while on this program.
  7. Please list all past or present allergies including allergies to any medications.
  8. Please list all past surgeries and provide details including the condition that was treated with each surgery.
  9. Please explain the specific medical reason for ordering this medication. The physician must know the exact nature of your medical problem in order to prescribe this medication. This cannot be left blank.
  10. Are you currently taking this medication? If yes. How frequent do you take the medication in one day?

If you disagree with any of the above, you need to specify why. (Not sure if you get denied, but it’s what the site requires.) Need an anxiety medication? You can buy Buspar. Want to try different antidepressants without having to go through the hassle of seeing your doctor and dealing with insurance? You can choose from Bupropion, Fluoxetine, Wellbutrin, Paxil, Effexor, and Lexapro.

I highly getting recommend Effexor on your own. [sarcasm]

Pharma AdNeedless to say – but I’ll say it anyway – this is ridiculously dangerous. It’s cheaper to go through your doctor ($15 copay, most likely) and insurance (probably a $20 copay), but if you can’t afford that and can somehow afford prescription medication on your own, you’d better cough up some serious dough. Here’s the going rate for effexor on the site:

30 pills at 37.5 mg – $191.00
30 pills at 75 mg – $209.00
30 pills at 150 mg – $217.00
90 pills at 37.5 mg – $361.00
90 pills at 75 mg – $447.00
90 pills at 150 mg – $427.00

In KBTX.com’s article about the subject, Dr. Garth Morgan of University Family Medicine makes a few good points:

“It’s actually very scary for this type of website to actually exist. You have no way of knowing the physician that is prescribing this to you, or if they’re actually a physician,” [Morgan] said. “Looking at the website there is nothing on there that tells you who the doctors are that are prescribing it.”

“Medicines on the site are addictive, medicines on there have a black market value, and people could sell them on the black market,” said Morgan. “If people get on these sites and start ordering these medications and taking them incorrectly they’re going to be coming to the emergency rooms or my office and I won’t have an idea what they’re taking.”

“The medicines that are meant for prescriptions mean you have to have someone follow over you, look over your shoulder, work with you,” said Morgan. “It doesn’t mean it’s just an inconvenience that you have to have a piece of paper to get the medication.”

I found some more information on panicdisorder.about.com (of all places) about the risks involving the purchase of non-prescribed medications:

What is dangerous about buying medications online?
You may find yourself facing the following dangers if you purchase drugs online without a prescription:

  • Web sites offering medications without prescriptions are illegal and are not regulated in any way. The medication you purchase may be contaminated. It may not be the correct product or it may not even be a medication. You may be given the wrong dose.
  • Wrong medications and dosages put you at risk for drug interactions and other health consequences.
  • Both the FDA and the American Medical Association agree that it is unsafe to take prescription medication without seeing a doctor for a prescription. These illegal Web sites often will provide you with medication after you have filled out a questionnaire. A questionnaire cannot determine if a treatment is appropriate for you nor can it figure out if you have any underlying medical conditions that may be complicated by the medication.
  • If you purchase medications without a prescription from a foreign Web site, you are at risk for being ripped off financially and there will be little you can do about it. It is generally illegal to import most drugs purchased from these kinds of sites.

I’d like some illegal Percocet, but I’d be too much of a scaredy-cat to give any of my credit card info online.

Here’s the lesson, kiddies: Don’t purchase meds online, even if your PCP is clueless to the risks of psych drugs. It’s worth adding that you shouldn’t even purchase psych meds if your PCP is prescribing them.

(photo from The Red State)

Mentally ill? Expect to die sooner

In the midst of the Virginia Tech shootings and the Rebecca Riley case, the media have finally shone a spotlight on mental illness. Some good, some bad (see TAC’s lock ’em and throw away the key).

Marilyn Elias’ article in USAToday, "Mental illness linked to short life," points to obesity and antipsychotics as two of the main factors. (They’re inextricably linked.)

"Obesity is a serious problem. These patients often get little exercise, and many take a newer type of anti-psychotic, on the market for 18 years, that can cause drastic weight gains, promoting diabetes and heart disease, Parks says. He thinks these drugs are contributing to deaths from cardiovascular disease.

Recent studies question the advantage of the newer drugs. "Many could be switched to safer medicines," Parks says. Schizophrenics are thought to have a higher risk for diabetes already, he says."

The article specifically mentions that people with mental illness tend to die at the age of 51 as opposed to the national average of 76. The odds of dying are as follows:

  • 3.4 for heart disease and diabetes, respectively
  • 3.8 for accidents
  • 5.0 for respiratory disease
  • 6.6 for pneumonia and the flu

The staggering fact here is "three out of five" people die from diseases that can either be prevented or easily treated. This combats the widespread myth that the mentally ill die mostly by accidents and suicide.

My hope here is that as the NY Times and USAT pick up on the issues of mental illness, the public can become less callous to those who are – ahem – "crazy" and try to reach out to them. Despite the TAC’s point of view, most of us are NOT violence and benefit from the help of a caring few.

What a shame that 32 lives had to be taken to spark this discussion.

USAToday has a great list of related articles. I recommend "New antipsychotic drugs carry risks for children."

PERSPECTIVES: One family’s success story
PERSPECTIVES: Mom feels betrayed by doctors, FDA
Adult antipsychotics can worsen troubles
For foster kids, oversight of prescriptions is scarce
A rush to overprescribe?
Opinion: An outraged journalist and father discovers the mental health system is in ‘shambles’
Welcome to the club.

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