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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Mental illness trend on the rise among troops

soldierThe AP is reporting that nearly one in every five soldiers who have been part of the war in Iraq and Afghanistan now suffer from clinical depression and/or post-traumatic stress disorder (PTSD).
The researchers said 18.5 percent of current and former service members contacted in a recent survey reported symptoms of depression or post-traumatic stress. Based on Pentagon data that more than 1.6 million have deployed to the two wars, the researchers calculated that about 300,000 are suffering mental health problems.

“There is a major health crisis facing those men and women who have served our nation in Iraq and Afghanistan,” said Terri Tanielian, the project’s co-leader and a researcher at Rand. “Unless they receive appropriate and effective care for these mental health conditions, there will be long-term consequences for them and for the nation.”

The trend of mental illness on the rise among soldiers isn’t a new story. I’ve written about the problem several times here, here, and here. The real question now is how the problem is being addressed.

Veterans Affairs is responsible for care of service members after they have leave the military. The Defense Department covers active duty and reservist needs.

Col. Loree Sutton, who heads a new Pentagon center on brain injury, said the Rand study will add to the work defense officials are doing. That includes researching best practices used inside the military and out, improving and expanding training and prevention programs, adding mental health staff and trying to change a military culture in which many troops are afraid or embarrassed to get mental health treatment.
“We’ve got to get the word out that seeking help is a sign of strength,” Sutton said.

She said officials have been working to add thousands more mental health professionals to help the uniformed psychiatrists, psychologists and others struggling to meet the wartime demands of troops and their families. Across the services, officials are trying to hire over 1,000 additional staff. Also, companies providing health care by contract to the Pentagon have added over 3,000 in the past year, and the U.S. Public Health Service has provided some 200, she said. Veterans Affairs has added some 3,800 professionals in the past couple of years, officials there said.

It sounds like the VA is doing all they can with what they’ve got at the moment to address this problem. According to the article, the hesitation among troops to seek help is slowly and steadily on the decline. That’s a good sign. However, a few impediments that can block this progress:

  • they worried about the side effects of medication,
  • they believed family and friends could help them with the problem, or
  • they feared seeking care might damage their careers.

Again, I think many of these problems stem from psychological issues and should be heavily addressed by psychologists who are specifically trained help them work through these problems. This is one instance where I would downplay the use of psych drugs and focus primarily on talk (CBT/DBT/counseling) therapy.

What do you know?

I received a $150 check today. Joe made good on his promise and sent me a copy of my piece and a check for one that’s been published and one that’s been accepted for publication. Who’s the jerk now?

"Quetiapine comes from the root word 'quiet'"

[UPDATE: I had some funky issues with my table. It should be fixed now. Sorry about that.]

The first time I visited my psychiatrist for my initial evaluation, he gave me the option of choosing one of three medications: Seroquel, Lithium, or Lamictal. He handed me information about Seroquel and Lamictal. I did some research on both meds (lithium was out of the question because I don’t have time to get my blood checked constantly) and Lamictal sounded like a way better deal than Seroquel. I found mental health blog Furious Seasons (probably via The Trouble With Spikol) and read numerous posts on Seroquel’s adverse effects and all the good stuff AstraZeneca doesn’t tell anyone. From Philip Dawdy’s “Seroquel, The Bipolar Pill?” post, here’s what stood out to me:

“He told her that he didn’t think Seroquel worked benignly for patients and that the increased blood-sugar levels and cholesterol levels associated with its use were unacceptable to him. She broke out a recent paper which claimed that there were no metabolic syndrome problems with Seroquel.”

The post got me thinking. One of the materials I received from my psychiatrist was an article on how Seroquel seems to help the depressive part of bipolar disorder. He had a stack of these articles. My guess is not that he’s an overzealous reader of various newspapers but received the glowing article from – you got it! – a pharma rep. The article was taken from the August 2005 issue of Clinical Psychiatry News. (NOTE: I received the article in November 2006.)

Clinical Psychiatry News’ publication goals:

“Clinical Psychiatry News is an independent newspaper that provides the practicing psychiatrist with timely and relevant news and commentary about clinical developments in the field and about the impact of health care policy on the specialty and the physician’s practice.”

Good thing they didn’t say objectively.

I don’t know much about ClinPsych’s reputation and whether they are generally a good paper that reports things objectively. However, the article, “Atypical Quetiapine Appears Effective for Bipolar Depression,” reads like a press release. I’m not happy about receiving (practically) PR material from my doctor when trying to make an unbiased decision.

The article’s lede:

“The atypical antipsychotic quetiapine led to significantly greater reductions in bipolar depression than did placebo within the first week of treatment and throughout an 8-week randomized, controlled study of 511 patients, Andrew J. Cutler, M.D., said.”

Dr. Andrew CutlerDr. Cutler? Who IS Dr. Cutler? No research necessary; look no further than the article itself:

“The differences between the placebo group and each quetiapine group were significant at each weekly assessment, said Dr. Cutler of the University of South Florida, Tampa. He is a speaker and consultant for, and has received research grants from, the company that makes quetiapine: AstraZeneca.”

At least they disclosed his financial affiliations.

It is also worth noting that Dr. Cutler also founded a clinical research company, CORE Research, which runs many of the clinical trials that he’s involved in. CORE Research’s background details:

“CORE Research, Inc. is a private research company with three offices in the Central Florida area. CORE specializes in pharmaceutical research and psychopharmacology for mental illnesses such as Bipolar Disorder, Depression, Anxiety, Schizophrenia, Attention Deficit Disorder, and Insomnia.”

Private + Pharmaceutical research + Psychopharmacology = Funding from Big Pharma Companies

I sound like I’m touting some grand conspiracy theory. (OK, maybe I am.) CORE’s background bio makes the company sound objective and unaffiliated, which isn’t the case. If Dr. Cutler has “received research grants from” not only AstraZeneca, but other companies, it’s in his best interest to make sure that their pharmaceutical products turn out OK. Namely in the interest of AZ – remember: he’s a consultant for them.

How can I expect to make a decision about which medication to take (remember it’s between Lamictal and Seroquel now) based on promotional materials from pharm companies and – oh – an article touting the benefits of Seroquel with quotes only from the study’s lead author who is paid to say good things about the company’s products?

I didn’t.

Then how did I decide on Lamictal over Seroquel? Wikipedia‘s outline of each medication’s side effects, of course, in addition to other materials. (Don’t EVER overlook the Patient Safety Information of any medication. Unless you’re reading about the molecular structure – ignore that.)

Lamictal (lamotrigine) side effects Seroquel (quetiapine) side effects
Headaches Sedation
Insomnia Agitation
Insomnia Constipation
Major weight loss Memory problems (i.e. anterograde amnesia)
Blurred/double vision Headaches
Muscle aches Abnormal liver tests
Lack of coordination Dizziness
Sleepiness Upset stomach
Nausea Substantial weight gain
Vomiting Stuffy nose feeling
Rash (Stevens-Johnson syndrome) [uncommon in adults] Neuroleptic malignant syndrome [rare]
Binds to melanin-containing tissues (i.e. iris of the eye) Tardive dyskinesia [rare]
Diabetes [unclear]
Cataracts [possible]

Not that Lamictal’s side effects looked like a walk in the park, but considering that I’d already had awful trouble with weight gain on Paxil and Lexapro – nearly 50 lbs. – Seroquel was a serious no-go on my part. That and I don’t mind major weight loss from Lamictal. (Although I have been told Lamictal has no effect on weight.) Below is a copy of the article I received from my psychiatrist or you can just go and read the archived full text at Clinical Psychiatry News.

Quetiapine article

Docs don't prescribe enough antid's: Part II

I finally watched the MSN video that I talked about here.

MSNBC

As I predicted, it was extremely lame. It was a pitch to get on depressed people on antidepressants. The 1 minute 18 second video from Today stated the following:

  • doctors prescribe smaller doses of antidepressants than they should
  • depression is the most common cause of disability America
  • the “groundbreaking new study” says antid’s aren’t prescribed enough to be effective
  • medication and therapy can help 70 percent of patients recover IF they find the right combination
  • Casey Thompson – the lady above featured in the video taking pills (hooray!) – feels amazingly better after getting antid’s

The accompanying article also states that 13 percent of the 123 study participants who did not get better on the first three drugs they tried were helped by a fourth. If I’m correct, essentially 16 people were helped after trying four different antid’s. The article says 37 percent went into remission after starting Celexa (citalopram), made by Forest Laboratories. That would mean about 46 people saw immediate remission of symptoms. The rest – 77 people now – “switched to another antidepressant or continued with Celexa and added a second treatment.” The second round on the merry-go-round helped 31 percent of the remaining group: 24 people. Ok, so we’re now down to 53 people who haven’t been helped. The third attempt – whatever that was, the article doesn’t say – had a 14 percent success rate: 7 people. And the fourth attempt had a success rate of 13 percent of the leftovers: 6 people. That means 40 people were NOT helped by antidepressants are these combination of treatments. Therefore, “67 percent of the total group had been helped by one or more drugs.” Nice pitch.

Here’s where the Today video fails to educate its viewers:

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Docs don't prescribe enough antid's

MSNBC antidepressants

What? Doctors don’t prescribe enough drugs? You have GOT to be kidding me. [I didn’t watch the report (work blocks access to this kind of stuff), but it’s probably way off regardless.] On a semi-rant, though, if 22 million Americans are suffering from clinical depression at any given day, do all 22 million REALLY need to be on antid’s? Seriously. It’s like pharma companies are in the poor house and need this NBC report to boost sales. (Ugh, who paid Today for this “free” ad spot?) (article source: Uncomfortably Numb)

Drugging of the Bipolar Mind

From Philip Dawdy's article, "The Drugging of the American Mind," originally published in the Seattle Weekly:

"Classically, the disorder is treated with a mood stabilizer. Lithium was long the gold standard. In recent years, there has been a shift to anticonvulsants like Depakote or Lamictal. Often, bipolars are also given an antidepressant like Paxil or Effexor to deal with bouts of depression. Until 2000, the mood stabilizer plus antidepressant approach was essentially the state-of-the-art treatment. It just doesn't knock down symptoms forever.

Bipolars can "break through" these meds and wind up having acute episodes of rage or suicidal depression."

Wow. The article was published just over a year ago and it describes me to a T today. Well done, Mr. Dawdy, for seeing my future.

"This is an awkward time for mental- health experts, researchers, and advocates. This month, a peer-reviewed academic paper was published on the Public Library of Science Web site pointing out that researchers still have not proved the serotonin-imbalance-in-the-brain hypothesis of depression. What proof there is, the authors claim, is mostly circumstantial. Two weeks ago, The Wall Street Journal ran an article covering the same points in relation to antidepressants."

That was in November 2005. It's good to know that I'm not the only one that sees the neurotransmitter link to mental illness as merely a hypothesis and NOT fact. Many people don't know that at the bottom of each psych med Web site and in the important safety information sheet that comes with a psych med basically says, "We're not exactly sure how this works." Well, gee, thanks for allowing me to take a risk about something you're not even sure about!

Praise to Dawdy, amazing blogger for Furious Seaons,  for uncovering much of this information that most people in America don't want to cover or are too lazy to educate themselves about.