Concerta ADHD Ad

Of all the examples to use for an ADHD medication ad, I thought the “before” symptoms were terrible. I’m not ashamed to admit I did all of those things at one time or another (not in the same sequence). But then again, teachers tried to tell my mother I had (what used to be known as) ADD. Whatever. People these days call it ADHD. I call it being a normal kid. (Side rant: Teachers these days don’t want to deal with disciplining children in school when they misbehave or act out of turn so they recommend medicating them as a way to keep them docile and under control. And parents go along with it since they feel it will make their lives easier at home too. Not to say that some children don’t legitimately suffer from ADHD, but based on casual conversations I’ve had with a few people, it seems as though the number is rising.)

Below is a photo that I snapped of a Concerta ad which recently appeared in Shape magazine followed by 2 pages of side effects and indications. (Click on the picture to view its full size.) Feel free to post your thoughts in the comments.

Concerta ad

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The Bipolar Child, Part I: Reactions

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

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

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

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

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

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

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

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

(Image from Newsweek)

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

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

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

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

Ouch.

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

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

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

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

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

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

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

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

It’s something that I’ve questioned myself.

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

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

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

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

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

(Invega logo from Janssen.com)

Thoughts on Bipolar Overawareness Week: Part II

Here are some things that have occurred in my life:

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

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

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Babies and toddlers are mentally ill

The new fad? Diagnosing young children with mental illness.

Oh and I mean young.

Originally, I’d written about how psychiatrists are diagnosing mental illness in infants. Mental health blogs now are all over the Rebecca Riley case and rightly so.  She was a 2½-­year-old toddler diagnosed with ADHD and bipolar disorder. How a psychiatrist can diagnose a child that young is beyond me.

intueri has written a brilliant post about the case and diagnosing children that young:

“We need to stop labeling behavior as pathological just because it causes us inconvenience. We also need to stop using diagnoses as means of absolving us of our responsibilities (”it was the bipolar that made me say those mean things to you; it wasn’t me”). We, as providers, need to stop colluding in these goals: We need to stop the belief that a pill will always cure everything.”

(linkage attribution: Furious Seasons)

Catching up: Furious Seasons

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

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

The judge ruled in favor of Lilly.

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

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

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

Classic quote:

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

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

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

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

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

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

Astute observation from Furious Seasons:

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

More to come on other blogs…

Diagnosing Myself

I've been away from this journal for a while for a number of reasons. I'll be candid:

1. Work has become busy. The yearly schedule at work is in line with tax season (even though I don't work in anything related to accounting) so I'm usually busy from January through May. Expect tons of blogging in June and July — there is NOTHING to do.

2. My personal life has become quite busy too. I don't really have a free night except for Sundays and I'm left exhausted from doing something every single night of the week. Free Friday nights tend to be a rare commodity.

3. I feel awful that I can't keep up on anyone's blog at the moment. There are so many wonderful blogs that I'm addicted to reading and it's much too time-consuming at the moment. (I have this tendency to read the first post and then read back entries all the way to January. Before I know it, I've spent 2 hours at work wasting time.)

4. I'm a perfectionist who meticulously reads over most of my previously written posts and corrects grammar, spelling, etc.

There's probably more that I can't remember at the moment, but you get the picture. Now, on to diagnosing myself…

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'Dr. Titrate's little helpers'

Even if it’s the last thing you do, please go read this. I can relate to this girl in many ways (unfortunately). It’s a long read, but well worth it. Choice quote:

"Stoked by Dr. Titrate’s little helpers [Adderall and Dextrostat], I hosted my own college radio show and called it “The ADD Hour.” Naturally, “The ADD Hour” lasted just nine minutes, and I played only the first eighteen seconds of every song."

Which brings me to another thought: no one calls ADHD ADD anymore. A Google search for "ADD" produced meager results. What gives?

Loose Screws Mental Health News

A new Canadian study has found that most workers who struggled with depression had job performances were affected. (Nothing new here, right?)

“On average, the study says, depressed workers reported 32 days in the past year during which symptoms had resulted in ‘their being totally unable to work or carry out normal activities.’”

Seems like people really are taking ‘mental health’ days these days.


Bahrain is having a problem with Indians committing suicide in the country. In January, so far, three Indians have killed themselves. Triggers leading up to the suicides are theorized to be “mental or economic depression, stressful working conditions, low wages and poor housing.”


According to Dr. Brian Doyle, people with ADHD are at a higher risk for mood disorders such as major depressive disorder.

“In a recent study, 38.3% of individuals with a primary diagnosis of ADHD during the previous 12 months also had a mood disorder, compared with 5% of subjects who didn’t have ADHD.   The reverse is also true; individuals who have major depression are likelier to have ADHD than other persons.   In a Massachusetts General Hospital survey, 16% of adults with a primary diagnosis of major depressive disorder had a lifetime history of ADHD.”

Maybe I’m tired right now, but I couldn’t wrap my head around those statistics. Basically, if you’ve got a primary diagnosis of ADHD, you’re likely to have a mood disorder; if you’ve got MDD, you’re likely to also have ADHD; and if you’ve got a primary diagnosis of MDD, you probably have had ADHD for pretty much your whole life. That’s a lot to swallow.

“I am trying to screen more of my depressed patients for ADHD — especially if the patient’s depression is not responding well to treatment. The standard ADHD rating scales are a good place to start.”

I’ve heard it’s hard to screen adults for ADHD; on the flip side, I’ve also been told that it’s more difficult to find ADHD in women than in men. Dr. Doyle’s definitely on the right track here in keeping his eyes open for better ADHD screening. Perhaps I really do have ADHD.


While many celebrities are “outing” themselves on their depressive episodes, Dr. Deborah Serani’s got a list of other well-known people who have either admitted to or speculated to have experienced depression.


I’m late on the bandwagon with this but a study released in December shows that displaced women in Darfur suffer from severe depression. According to an article in Ms. Magazine:

“The International Medical Corps (IMC) posits that women’s multiple roles in society, along with constant stressors like low socioeconomic status, domestic violence, and the threat of rape when venturing outside, may account for the poor mental health of these displaced women. Women’s restricted access to education may also affect their ability to access proper care and make informed decisions about their own physical and mental health.”

And to think those of us in developed countries have problems.

“Almost one-third (31 percent) of women surveyed met the criteria for major depressive disorder while 63 percent reported suffering the emotional symptoms of depression. Five percent reported suicidal thoughts, 2 percent had attempted suicide, and another 2 percent of households had a member commit suicide in the past year. Nearly all of the respondents (98 percent) felt that counseling provided by humanitarian agencies would be the most helpful way of dealing with these feelings.”

It’s good to see that an overwhelming majority of women feel that counseling would help them. Sometimes, people in Western/developed countries take therapy for granted.

“Though depression rates are comparable to, or even lower than, those of other populations displaced by similar conflicts, the rates of suicide and suicidal ideation are ‘alarmingly high in contrast to general rates worldwide,’ according to the report.”

This, unfortunately, makes sense. Suicide is a reaction to ending constant pain. I admire women in Darfur who choose to live despite never-ending pain.  This article puts me to shame somewhat. I am incredibly blessed to have all the amenities of this country and encouragement and love from family and friends. However, I feel pretty stupid when I fall apart over minor things compared to the women in Darfur. It’s an awful cliché, but “I really do have a lot going for me; why am I depressed?”


ViagraFor men: Are you depressed and can’t get an erection? Don’t worry – Viagra can kill two birds with one stone!

A Canadian study (yes, another one) says that Viagra (sildenafil) can help improve mild depression and, of course, aid impotence in men.

“Dr. Sidney Kennedy and his team studied 184 men who had had erection problems for about four years and also met the criteria for minor, but not major, depression.

[After six weeks of treatment], the 98 men who received sildenafil had a 47 per cent reduction in their depression scores, indicating a change from mild to minimal depression. In comparison, men taking placebos had only a 26 per cent decrease in their scores, which remained in the range of mild depression.”

Pfizer’s getting their sales reps started on this one. Expect to see reps carrying Viagra brochures and info to psychiatrists eventually.

Parenting instead of Ritalin

My husband's nephew is an overly active kid. I'm sure that if he went to public school teachers would classify him as suffering from ADHD and recommend that he take Ritalin. This article from the New York Times (the last in their series of covering mental illness in children) gives me hope that most children with ADD/ADHD can be helped without the assistance of a drug.

Who I Am

I am a 26-year-old black female who suffers from bipolar disorder. I was diagnosed with the illness in November 2006. I’d been diagnosed as suffering from major depressive disorder (MDD) beginning at the age of 14. I still consider myself to suffer primarily from depression although I do have occasional manic episodes.

This blog has helped me to recognize many of the things that I am. That
I truly am more than my diagnosis and that my diagnosis does not define
me. I am not just a person with manic and depressive episodes. I am a person with a personality. I’m smart, witty, drop-dead gorgeous—okay, I wish, but I’m not ugly—musically inclined, and ambitious. And that’s just scratching the surface.

I can be happy, sad, angry, and joyful. I have so many emotions that could classify me as anything. I have a short attention span, for instance. The docs missed the attention-deficit hyperactivity disorder (ADHD) diagnosis (although I lack the hyperactivity).  I suffer from anxiety as well but not a single medical record lists me as suffering from generalized anxiety disorder (GAD). So I self-diagnose. It helps me to realize that all of my flaws can pigeonhole me into any diagnosis I choose. I accept my flaws – “diagnosable” or not – and my strengths. This is my journey to learn more about myself, my diagnosis, my medical treatment, and anything relating to my personal life and general mental health.

I’m skeptical of pharmaceutical companies. I don’t hate them; however, many of their practices are shady and I—along with some of my favorite medical blogs —hope to shed light on the “unfavorable” news they choose to keep hidden from the public.

I highlight celebrities who admit to mental illnesses. Many of them suffer from depression, which is the fashionable mental illness of the moment, but others truly suffer from problems that are worth talking about.

I also write about my personal life relating to mental illness. I struggle with constant thoughts of suicide. Readers of this blog will note a pronounced emphasis on suicidal thoughts and behaviors.

Feel free to read on to the next entry about my Perfectionistic Tendencies. Chronicling my journey to managing and treating my illness can hopefully aid me. And eventually, someone else.