Loose Screws Mental Health News

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


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


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

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

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

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

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


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

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


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

Loose Screws Mental Health News

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

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

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

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


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

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

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


Depression is increasing among Japan’s public school teachers.

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

The Japan Daily Press article also notes:

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

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

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

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


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


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

Loose Screws Mental Health News

According to an article in USA Today, researchers have found that siblings who argue could have negative effects on their mental health.

Researchers report that conflicts about personal space and property, such as borrowing items without asking and hanging around when older siblings have friends over, are associated with increased anxiety and lower self-esteem in teens a year later. And fights over issues of fairness and equality, such as whose turn it is to do chores, are associated with later depression in teens.

I’d like to tell these siblings to get over it, but I don’t have any siblings of my own to relate my experience to.


PBS’s Frontline reports that most soldiers who commit suicide have never seen combat or even been deployed. According to the Defense Department, the Army has the sharpest rate of suicides of all the military branches. About 53 percent of military personnel who took their lives in 2011 had no history of deployment to active combat zones such as Iraq or Afghanistan. Even more troubling is that 85 percent of those who committed suicide may have been deployed but not involved in direct combat. Even though the military has invested $50 million to study mental health and suicide, a stigma of getting help still remains. It seems as though military personnel would rather take their own lives than seek help.


An antidepressant called GLYX-13, currently under study, appears to work within hours and last for up to a week. The lead researcher reports little to no side effects on the drug, which is injected intravenously. The drug is in phase 2, which means that its effectiveness and safety are still being tested. I have my doubts about an intravenous drug. If doctors are not currently testing patients’ serotonin levels, how would they be able to prescribe an intravenous antidepressant?


Depression has passed asthma as the top disability among North American (U.S. and Canadian) teens.

Asthma had been the largest contributor to YLDs (years lived with disabilities) for youths in that age range in the US and Canada in 1990, but the study published in The Lancet on Thursday led by researchers at the Institute of Health Metrics and Evaluation (IHME) at the University of Washington, Seattle showed that in this group depression surpassed asthma to claim the number one spot in 2010.

Back in the 1990s, depression was not widely regarded or evaluated among teens. It was still “suck it up” and “pull yourself up by your bootstraps.” My depression was viewed as laziness or “senioritis” among my teachers. I had no sympathy and very little leeway. Now, mental health is being taken more seriously for teens, and I think that’s a good thing.


See you if you can keep an elder person in mind during this holiday season. Senior depression is always on the rise during the holiday season due to problems with health, loneliness, or finances.

Lamictal and Abilify: Back on Medication

Images from rxlist.com & drugs.com

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

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

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

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

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

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

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

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

Notes:

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

Anxiety

I’ve experienced anxiety for the past two days unlike anything I’ve experienced before. I’m afraid to do anything significant which includes leaving my home. I’m afraid to drive, travel, and interact with people other than my husband and impersonal Internet communication. I’ve cried every day and every night since Sunday. As part of anxiety issues, I’m battling depression as well. I’m simply paralyzed by fear and afraid to venture beyond my home. I’m somewhat paranoid about being watched as well. And no, I’m not on medication.

I don’t know what to do. Anyone have any advice to offer?

Quote of the Week

“The statistics on sanity are that one out of every four Americans is
suffering from some form of mental illness. Think of your three best
friends. If they're okay, then it's you.” — Rita Mae Brown

The local church fails in assisting those with mental illness

Baylor University performed a study on how the churches help those who suffer from mental illness and found that they are not the most helpful places. PsychCentral notes:

churchBaylor University researchers built upon a 2008 study that found nearly a third of those who approached their local church in response to a personal or family member’s previously-diagnosed mental illness were told they really did not have mental illness.

In the new study, investigators discovered individuals experiencing depression and anxiety were dismissed the most often.

It seems that the local church has a long way to go in assisting those who suffer from mental illness. I am very thankful for CCEF that intends to “restore Christ to counseling and counseling to the church.” Here’s a blog post from Tim Lane, executive director of CCEF, in which he provides “four reasons to incorporate counseling into the local church.” And here’s another post by Mr. Lane on guidance for churches seeking outside help for counseling.

Quote of the Week

You should pray for a sound mind in a sound body.— Juvena

World Suicide Prevention Day

Commemorating World Suicide Prevention Day by living yet another day. There was a time when I didn’t want to live so this is a big accomplishment for me. Now, the script:

Learn more about suicide prevention and the warning signs of suicide through the “It’s On My Mind” page: http://www.facebook.com/itsonmymind.

Check out other World Suicide Prevention Day activities at http://www.iasp.info.

To learn more about mental health conditions and suicide, visit one of The Jed Foundation’s sites at http://www.jedfoundation.org, http://www.ulifeline.org or http://www.halfofus.com. You’ll find links to many other resources through these sites. If you or someone you know needs help immediately, please call the National Suicide Prevention Lifeline at 1-800-273-TALK.

Quote of the Week

“Mental illness is nothing to be ashamed of, but stigma and bias shame us all.” — Bill Clinton

Should psych drugs be avoided at ALL costs?

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


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

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

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

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

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

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

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

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

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

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

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

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

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

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

Loose Screws Mental Health News

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

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

Gianna at Beyond Meds provides here take here.


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


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


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

20% of American children suffer from mental illness

The new SCHIP (State Children’s Health Insurance Program) law that President Obama signed significantly increases health coverage for children, which also includes mental health parity. According to Nancy Shute of U.S. News & World Report, health coverage is expanded to:

“4 million more children beyond the 6 million already covered but also brings mental-health parity to the state programs that provide insurance for children in low-income families, requiring that they get the same access to treatment for bipolar disorder, depression, anxiety, and other serious disorders as they do for physical ailments.”

Then I stumble across this:

Depressed child“Mental-health needs are nowhere near being met,” says Jay E. Berkelhamer, past president of the American Academy of Pediatrics and chief academic officer at Children’s Healthcare of Atlanta. “At least 20 percent of all visits to pediatricians’ offices are related to mental-health problems.

Normally, though, overworked pediatricians may not ask if a child has a mental-health problem—and may not know where to refer him or her if they do. About 20 percent of children and teenagers have a mental-health problem at any given time, or about 8 million to 13 million people. Two thirds of them are not getting the help they need.

That means out of roughly 40-65 million kids, we have 8-13 million who are “mentally ill.” And then about 5-8 million who aren’t getting proper mental help.

Color me cynical but I think 20 percent is a disproportionately high number to classify children as mentally ill. I think the percentage of adults being classified as mentally ill is exorbitant enough, let alone children who are going through stages in their lives where they’re simply developing, encountering mood swings, being disobedient, and perhaps, being — perish the thought! — normal children.

But let’s address something else here: I don’t think it’s impossible for children to suffer from mental illness but the incidence should be significantly lower.

According to Dr. Louis Kraus, the chief of child and adolescent psychiatry at Rush University Medical Center in Chicago, suicide ranks as the sixth-leading cause of death among ages 5-14 — “although rare.” From ages 15-24, it jumps to number three.

The key word in that last paragraph is suicide is “rare.” The rate of mental illness in children should reflect that somehow. While I’m very happy SCHIP includes widespread mental health parity for low-income families, I’m also concerned children will be overdiagnosed with a “mental illness” when they may simply be dealing with the normal challenges of a difficult life.

“I used to care, but now I take a pill for that.” — Author unknown

Philip Dawdy at Furious Seasons has some great posts on the bipolar child paradigm that further explore the murky world of psychiatry pushing psychiatric illnesses and psychotropic drugs on kids. I’d also recommend reading Soulful Sepulcher as Stephany recounts her and her daughter’s experiences in and out of the mental health system.

(pic from save.org)

Loose Screws Mental Health News

I could’ve been a statistic right here in this area.

suicides in PhiladelphiaPhiladelphia now boasts the sharpest increase in suicides in the country. Despite all the homicides in Philadelphia making the news, the 196 people who killed themselves in 2008 were quietly buried in the obit pages (if they made it there at all).

In light of this news, I’ve decided to place a suicide hotline web banner in the upper right-hand corner of my right sidebar. Susan of If You’re Going Through Hell Keep Going has one in her sidebar and I think it’s a wonderful idea. I’ve had a couple of people comment or send me emails about how they feel they’re on the brink of losing it so hopefully the banner — one of the first things to be seen on this page — will draw some attention and prompt someone to call for help. When I was a teen, I called 1.800.SUICIDE. I can’t remember what happened exactly but I called the hotline and someone talked me into why life was still worth living. People who are suicidal don’t really want to die; they want an escape from the pain they’re feeling and they feel the only way to alleviate that pain is through inflicting death upon themselves. I hope someone who is suicidal would be willing to pick up the phone and come to the same realization that I did at the time.


Speaking of suicide, researchers from the World Health Organization and the University of Verona, Italy have discovered that SSRIs (a class of antidepressants) may significantly reduce the risk for suicide in adults. SSRIs — which include such medications as Prozac, Paxil, and Zoloft — are not be confused with SNRIs such as Effexor, Pristiq, and Cymbalta. PsychCentral notes:

SSRIPrevious studies, including a 2007 study by the U.S. Food and Drug Administration (FDA), found the risk of suicide in adults was neutral, elevated in those under 25 and reduced in people older than 65. A subsequent black box warning was added to all antidepressants regarding increased risk of suicidal symptoms in people under 25 years of age.

Basically, this study just means antidepressants help those who are 25 years and older and hurt those 24 years and younger. I’m sure a new study will come out within the next year or so that contradicts this one. Especially since numerous previous studies on SSRIs found the risk of suicide to be neutral in ages 25-65.


Young adultAccording to the Boston Globe, a (really pathetic) new study shows that nearly half of young adults between the ages of 19 to 25 “meet the criteria for at least one psychiatric disorder.”

Whether in college or not, almost half of this country’s 19-to-25-year-olds meet standard criteria for at least one psychiatric disorder, although some of the disorders, such as phobias, are relatively mild, according to a government-funded survey of more than 5,000 young adults, published in December in the Archives of General Psychiatry.

The study, done at Columbia University and called the National Epidemiologic Study on Alcohol and Related Conditions, found more alcohol use disorders among college students, while their noncollege peers were more likely to have a drug use disorder.

But, beyond that, misery is largely an equal-opportunity affliction: Across the social spectrum, young people in America are depressed. They’re anxious. They regularly break one another’s hearts. And, all too often, they don’t get the help they need as they face life’s questions…

According to the 2005-2007 American Community Survey, the population for adults ages 18-24 is gauged to be around 30 million. Therefore if we’re going to take the study at its word, let’s chop the number by half (even though the number is just under half). That will put us at about 15 million young adults. The NIMH, however, estimates 57.7 million adults in the U.S. “suffer from a diagnosable mental disorder.” If this is the case, those 15 million young adults make up nearly 26 percent of the NIMH’s “diagnosable mental disorder” statistic. The inclusion of alcohol and drug addictions might explain why this figure might be a little high.

Antidepressant rankings: Zoloft and Lexapro considered best overall

A number of antidepressants were recently ranked in different surveys:

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

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

Efficacy:

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

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

Acceptability:

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

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

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

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

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

Loose Screws Mental Health News (the ODD version)

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

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

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


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

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

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


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

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

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

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

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

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

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


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

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

–snip–

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

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

Coming off of Lamictal (lamotrigine)

Medication

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

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

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

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

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

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

My pdoc was trying to scare me into staying medicated.

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

WHAT?! My eyes flew open.

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

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

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

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

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

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

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

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

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

We’ll see what happens.

Bipolar Awareness Month

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

United States of Tara

United States of Tara

I don’t have much familiarity with DID (Dissociative Identity Disorder) but Showtime has a new show called United States of Tara in which the main character (Tara) has three alter egos: Buck (thinks she’s a guy), T (think she’s a 15-year-old), and Alice (turns Betty Crocker when she feels like she’s a bad mother). Then Tara is… Tara trying to be a normal wife and mother. I watched a truncated episode of the pilot and the show seems interesting. I just hope that the husband of 17 years doesn’t suddenly ditch Tara for her cuter, younger, and non-DID sister Charmaine. (I sigh because I see it coming anyway.)

I don’t personally know anyone with DID. Does anyone want to check out the pilot and tell me what they think? It’s 30 minutes. I’m curious to see if someone gets the impression that it’s a mixture of poking fun at DID and showing a realistic aspect of what life must be like with the disorder.

Update: Apparently, Showtime takes DID pretty seriously.

Do I have bipolar disorder because my father had schizophrenia?

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

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

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

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

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

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

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

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

Mood rating: 6

Emotional depression along with economic recession?

suicide rates compared to employment ratesCNN has a story looking into whether suicides increase as the economy falls into a recession and investors begin to lose thousands of dollars in the stock market. According to a chart by the NIH & Bureau of Labor Statistics, there seems to be a correlation. Here are the latest high-profile suicides that seem to have been prompted by the economic downturn:

  • Steven Good, a chairman and CEO of Sheldon Good & Co., a major U.S. real estate auction company, may have shot himself, according to police.
  • Adolf Merckle, a 74-year-old German billionaire who was ranked the 94th richest person in the world by Forbes magazine, killed himself by walking in front of a train. According to the CNN article, “in recent months his empire had been near collapse.”
  • Rene-Thierry Magon de la Villehuchet, a 65-year-old French investor, killed himself after losing $1.4 billion in the Ponzi scheme that Bernard Madoff ran.
  • Kirk Stephenson, 47-year-old English financier  and COO of Olivant Ltd., jumped in front of a train in September (the real climax in the economic collapse).

The Centers for Disease Control and Prevention (CDC) estimates more than 32,000 people commit suicide each year but public health experts expect an increase upwards to an additional 1200 suicides because of the economic climate. Here are a few more stats that are worth reading:

  • Calls to the National Suicide Prevention Hotline went from 412,768 in 2007 up to 540,041 in 2008.
  • Unemployed people are two to four times more likely to kill themselves than those who are employed.

I have to admit, I found that following paragraph interesting:

So what about these wealthy and powerful men who have recently killed themselves? Mental health experts say it’s impossible to say why they did it, but they say that people who kill themselves have an underlying psychological issue, such as depression or bipolar disorder, so it’s not only about the money.

So I pose a question: Do all those who commit suicide have a mental illness? Or is it possible to kill oneself without being mentally ill?

Study shows atypical antipsychotics pose a higher risk for cardiac arrest

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

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

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

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

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

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

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

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

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

This Girl’s Biblical View: Introduction

During my conversation with Natalie two nights ago, she emphasized infusing her brain with Bible verses and Scriptural passages and encouraged me to do the same. Finally, a thought came to me that a good way of constantly keeping myself in step with the Bible would be to meditate on God’s word. I know all about creating 3 x 5 index cards to help memorize Bible verses but I think a great way for me to really absorb some of the principles that I read would be to post a Bible verse and reflect on:

    1. What I think it means
    2. What it means to me
    3. How it has impacted or can impact my life

      Open BibleWhile the Bible is no cure-all (nothing currently in this world is!), I believe God’s word “is living and active, sharper than any two-edged sword, piercing to the division of soul and of spirit, of joints and of marrow, and discerning the thoughts and intentions of the heart.” (Hebrews 4:12)

      I plan on trying to make this a weekly thing, hopefully for publication each Wednesday. I don’t promise to be perfect but I think doing this over the coming weeks (maybe even months!) will deepen and strengthen my relationship with God and others and will help me to overcome some associated behavioral issues (ie, fear, anxiety, etc.).

      Christian counseling: Nouthetic vs. Biblical

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

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

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

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

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

      But NC has its Christian critics.

      Read the rest of this entry »

      Lamictal in consideration of pregnancy

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

      Lamictal.

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

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

      Read the rest of this entry »

      Goal for 2009: Staying Alive

      I’m being hit by suicidal thoughts again. Hard.

      I’m not going to the hospital but if these thoughts keep pummeling me, it’ll become a consideration again. I’m walking a fine line here because my husband’s family has had a suicide hit close to home earlier this year and they don’t need to experience another loss. I try to keep in mind how important I am to many people that I know: my husband, my in-laws, my mom (I’m her only child). I try to visualize the grief my mother would experience losing her only kid. It’s worked so far. I can only pray that it lasts.

      In the meantime, I’ve had my husband hide my belts. I ended up in the hospital in October 2006 after my husband woke up just in time to find me kicking a chair away in an attempt to hang myself from an air vent.

      After what now seems like a short reprieve, I constantly glance up at the ceiling air vent in our bedroom thinking about trying the hanging thing again. I’m sure I could find something else to use if I really wanted to but I’m trying not to dwell on the idea too much.

      The lies that used to convince me to try killing myself, oh say, three years ago, don’t work as well anymore. I can fight off most of them:

      Lie #1: Nobody cares about you.
      Answer: I have a husband, a big family, and wonderful friends who love and care for me. I’d be missed.

      Lie #2: You don’t make a difference in this world.
      Answer: I have a 98-year-old grandmother who loves me to pieces, I have a mother who I bring so much joy to, I have a husband who tells me I’m the best thing that’s happened to him, and I have a mother-in-law who thinks that I’m so cool, she wants to spend time with me. I do make a difference.

      Lie #3: You’re worthless.
      Answer: My husband tells me all the time that I’m worth something to him and that he’d be lost without me. If only for him, I’m worthwhile.

      So the “lies,” or challenges if you will, have changed. Here’s the new one:

      “You’re such a liar. You’re just looking for attention. You want people to pity and feel bad for you while you sit there and cry wolf. So, if you’re so serious about committing suicide, why don’t you show them that you’re not kidding and prove ’em all wrong?”

      Hmm. Good question.

      Mood rating: 3

      Beware XYZAL — allergy drug

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

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

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

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

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

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

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

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

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


      Mood Rating: 4

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

      So much for Miss Up-on-Pharmaceuticals.

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

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

      In the pockets, of course.

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

      WHAT?

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

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

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

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

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

      Mood rating:
      5

      Golden Gate Bridge Barrier Update

      The San Francisco Chronicle’s site has an update on the GGB barrier debate. Unfortunately, most people don’t want any kind of barrier at all. However, of the design options, the net is proving to be the most popular. Likely because it doesn’t affect the aesthetics of the bridge by much and it is still considered a suicide prevention mechanism.

      Golden Gate Bridge net barrierI’d initially cited concerns about how jumpers would be pulled out of the net. Rachael Gordon, the Chronicle’s staff writer, got chief engineer Denis Mulligan to provide an answer:

      For starters, he said, once someone jumps over the Art Deco span’s 4-foot railing, it could take rescuers several hours to get to the scene to retrieve the person from the net, which essentially would envelop the person and make it difficult but still possible to clamber out.

      “It wouldn’t be like a trampoline, that once you jump onto, it would be easy to jump off,” Mulligan said. But, he added, “If you’re very agile, very strong and focused, you may be able to climb out.”

      I hope it’s as hard to climb out of as Mulligan cites. Just the wait to be rescued alone might get jumpers to think twice about trying again. But here’s the process in more detail:

      During a rescue operation from the net, authorities would shut down a lane of traffic. A specialized vehicle, called a “snooper” truck, would be brought in. Outfitted with a mechanical arm similar to a cherry picker used by utility crews, two specially trained rescue workers would be lowered down to the net in a bucket to pull the person out.

      Authorities said they would have to convince pranksters and daredevils that jumping into the net would not be a pleasant experience.

      “It would hurt,” Mulligan said of the 20-foot drop into a net made out of marine-grade stainless steel coated in plastic.

      This article also uses another bridge — a former suicide hotspot — as an example to show that suicides can be prevented.

      In Switzerland, researchers found that just the presence of the net stopped people from even trying to jump off the Munster Terrace, a medieval cathedral located in the old section of Bern, from which two or three people had been leaping to their deaths every year. They also found that the net did not shift suicides to other locations.

      And that the implementation of barriers in other places have also proven successful:

      Other well-known jump spots, among them the Eiffel Tower in Paris and the Empire State Building in New York City, were long ago outfitted with suicide barriers. Like the net attached to the Gothic cathedral in Bern, studies have shown them effective in thwarting impulsive suicide attempts.

      I’m not so idealistic to think barriers will keep suicidal people from committing suicide. Rather, I think they’re worth erecting for “thwarting impulsive suicide attempts.” Who knows how many people are still alive as a result?


      The general public is welcome to vote for a barrier on the Golden Gate Bridge and provide additional comments (ie, you don’t need to be from California or San Francisco). Visit the Golden Gate Bridge Suicide Deterrent Barrier site to make your opinion known on this issue.

      Loose Screws Mental Health News

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

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

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

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

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

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

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

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

      Chemical imbalances do not exist; dying brain cells do

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

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

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

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

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

      Read the rest of this entry »

      A thought on Mad Pride

      Maybe I’ve got the whole Mad Pride thing all wrong but I’m not proud of anything I’m dealing with. I just hope I can share my experience and knowledge to help others. Perhaps Mad Pride means being proud to be an activist on this issue?

      More Famous People With Mental Illness

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

      Read the rest of this entry »

      The Era of Quick Fixes

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

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

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

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

      Crazy Psychiatric Treatments

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

      (Hat Tip: Bob Thompson)

      Gun Ownership = Suicide?

      Liz Spikol on The Trouble With Spikol linked to an article in the Chicago Tribune in which author Steve Chapman discusses whether buying a gun is a suicidal act.  Chapman argues "not really." Is it?

      The Act and Follow-through of Suicide: Wrap-Up

      I’ve always found it annoying when people say a suicide attempt is
      "a cry for help." And the best one — "She’s just looking for
      attention." I ran into that quite a bit in high school.

      While a suicidal person may not realize it (I certainly didn’t), a suicide attempt is a cry for help. It’s  an action that says "I’ve come to my breaking point. I’ve run out of options
      and I don’t know what else to do. My problems are too much for me to
      handle and the only way out of them is to die." Suicide is the action
      which stem from thoughts that likely were never verbalized.

      The majority of people who commit or attempt suicide aren’t just
      seeking to die "just because."

      …[T]wo doctors who are among the most often-cited experts on suicide…readily acknowledged the high degree of impulsivity associated with [jumping], but also considered that impulsivity as simply another symptom of mental illness. “Of all the hundreds of jumping suicides I’ve looked at,” one told me, “I’ve yet to come across a case where a mentally healthy person was walking across a bridge one day and just went over the side. It just doesn’t happen. There’s almost always the presence of mental illness somewhere.”

      They feel as though they truly have "run
      out of options" and ending their life is the least favorite backup
      plan. The common thread that runs through all suicides is hopelessness.

      So to wrap this series up, is it possible to prevent someone  from committing or attempting suicide?

      Read the rest of this entry »

      The Act and Follow-through of Suicide: Part IV

      Compilation of Statistics Regarding Suicide

      Scott Anderson in his NYT article weaves the grim statistics of suicide in and out of his story. Here’s the morbid list:

      General

      • mental illnessThe nation’s suicide rate (11 victims per 100,000 inhabitants) is almost precisely what it was in 1965.
      • In 2005, approximately 32,000 Americans committed suicide, or nearly twice the number of those killed by homicide.
      • The National Institute of Mental Health says that 90 percent of all suicide “completers” display some form of diagnosable mental disorder.

      Demographics

      • Both elderly men living in Western states and white male adolescents from divorced families are at elevated risk.

      Premeditation vs. Passion

      • [T]he person who best fits the classic definition of “being suicidal” might actually be safer than one acting in the heat of the moment — at least 40 times safer in the case of someone opting for an overdose of pills over shooting himself.
      • In a 2001 University of Houston study of 153 survivors of nearly lethal attempts between the ages of 13 and 34, only 13 percent reported having contemplated their act for eight hours or longer. To the contrary, 70 percent set the interval between deciding to kill themselves and acting at less than an hour, including an astonishing 24 percent who pegged the interval at less than five minutes.
      • “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total. By the early 1970s, the amount of carbon monoxide
        running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

      Read the rest of this entry »

      The Act and Follow-through of Suicide: Part III

      Premeditation vs. Passion

      Author Scott Anderson in his NYT magazine article, "The Urge to End It All," notes:

      Just as with homicide, researchers have long recognized a premeditation-versus-passion dichotomy in suicide.

      Read the rest of this entry »

      The Act and Follow-through of Suicide: Part II

      The British Coal-Gas Story

      According to Scott Anderson’s NYT article, the little-known British coal-gas story — even among mental health professionals — is a good example of how suicides can be prevented if one takes away the means:

      Coal-gas ovenFor generations, the people of Britain heated their homes and fueled their stoves with coal gas. While plentiful and cheap, coal-derived gas could also be deadly; in its unburned form, it released very high levels of carbon monoxide, and an open valve or a leak in a closed space could induce asphyxiation in a matter of minutes. This extreme toxicity also made it a preferred method of suicide. “Sticking one’s head in the oven” became so common in Britain that by the late 1950s it accounted for some 2,500 suicides a year, almost half the nation’s total.

      Those numbers began dropping over the next decade as the British government embarked on a program to phase out coal gas in favor of the much cleaner natural gas. By the early 1970s, the amount of carbon monoxide running through domestic gas lines had been reduced to nearly zero. During those same years, Britain’s national suicide rate dropped by nearly a third, and it has remained close to that reduced level ever since.

      Experts seems to insist that committing suicide is proof of an underlying mental illness. Suicide that stems from impulsivity, among these experts, is also considered part of a mental illness. Anderson subtly argues against this, and I find myself agreeing with him:

      How can this be? After all, if the impulse to suicide is primarily rooted in mental illness and that illness goes untreated, how does merely closing off one means of self-destruction have any lasting effect? At least a partial answer is that many of those Britons who asphyxiated themselves did so impulsively. In a moment of deep despair or rage or sadness, they turned to what was easy and quick and deadly — “the execution chamber in everyone’s kitchen,” as one psychologist described it — and that instrument allowed little time for second thoughts. Remove it, and the process slowed down; it allowed time for the dark passion to pass.

      Would this mean that if people had less access to suicidal means that promoted “ease, speed, and certainty of death” (ESCOD), a number of suicides could be averted? It appears so. Anderson continues to make a case using the Ellington Bridge in Northwest Washington as an example:

      Read the rest of this entry »

      Celebrity Sensitivity: 135 Famous Celebrities and Their Mental Health

      The Pop-Crunch Show has a list of 135 Famous People Who Struggled with Depression. I sit on the fence and think that it should probably be retitled "135 Famous People Who Struggled with Mental Health Issues."

      But then again, we could throw nearly every celebrity in there, huh? I’m bummed that Tom Cruise isn’t on the list.

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

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

      Read the rest of this entry »

      The Act and Follow-through of Suicide: Part I

      “What was immediately apparent was that none of them had truly wanted to die. They had wanted their inner pain to stop; they wanted some measure of relief; and this was the only answer they could find. They were in spiritual agony, and they sought a physical solution.”Dr. David Rosen, psychiatrist and Jungian psychoanalyst

      A recent article in New York Times magazine suggests that those who exhibit suicidal behavior or have had unsuccessful attempts are least likely to die by way of suicide.

      The author, Scott Anderson, delves into the psyche of what drives a person to commit suicide. And he attempts to answer the "what" question by evaluating the "how."

      Read the rest of this entry »

      Staffers at a Brooklyn mental hospital allow a woman to die

      I’m quite surprised there’s video footage of a woman in a mental hospital (of all places) dying on the facility’s floor. Let alone, the outrage of the fact that none of the staffers did anything about it even when alerted by a patient. I really hope this incident sheds light on the treatment of patients in mental health facilities and effects change in these facilities. Read the story and watch the video here. (Hat tip: PsychCentral)

      Light posting again

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

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

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

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

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

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

      Lexapro maintains status as first-line antidepressant therapy

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

      • cost
      • efficacy
      • familiarity

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

      As a result, SNRIs are likely pricier.

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

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

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

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

      (logos from Forest Pharmaceuticals, Inc. and Wyeth)

      The Bipolar Child, Part II: Childhood bipolar disorder criteria

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

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

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

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

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

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

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

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

      But I will now.

      Read the rest of this entry »

      The Bipolar Child, Part I: Reactions

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

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

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

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

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

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

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

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

      (Image from Newsweek)

      Read the rest of this entry »

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