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.

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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.

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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.

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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.

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

Yes, 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.)

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…

Seroquel abuse and medication weight gain

Furious Seasons has blogged about Seroquel (quetiapine) in the past and he recently posted on Seroquel abuse in an Ohio prison. Apparently, inmates have been snorting the atypical antipsychotic, also known in slang terms as “quell” or “Susie-Q.” Excerpt from Furious Seasons:

“Second, we all know that Seroquel is regularly handed out to bipolars and depressives and people with anxiety in order to address insomnia, as opposed to the kind of underlying psychosis/mania issues you’d expect it to be used for. PCPs hand it out this way and so do psychiatrists. What I have noticed among friends who’ve been given Seroquel for sleep issues is that they end up, over a few months time, needing more and more of the drug in order to get an effect. Or, put another way, people keep complaining of problems with sleep despite taking, say, 300 mgs. of Seroquel and their doctor will keep upping the dose to get the desired effect. As a result, I have seen people with very mild bipolar disorder wind up taking 800 mgs. of Seroquel a day–that’s roughly the same that a schizophrenic in a state hospital would get–and still they get no results, aside from putting on tons of weight. I have heard this from other readers of this blog as well.”

My aunt, who works in the psych wing of a hospital, warned me that she’s seen patients on Seroquel gain weight. A man I met at my Bipolar and Depression Alliance Group last night gained 60 lbs since taking Seroquel. I can’t image that everyone who takes Seroquel overeats to a point of obesity and leads a sedentary lifestyle. I have a random theory that Seroquel signficantly slows a person’s metabolism down to the point where it is difficult for a person to lose weight.

Loose Screws Mental Health News

According to the NIH, mothers can ward off postpartum depression by taking a prenatal vitamin to boost low iron levels. Mothers with iron deficiency were twice as likely to be at risk for PPD. Also, in case you didn’t know, counseling can help or stave off PPD as well.

Another NIH study has suggested that people who don’t respond to antidepressants could be aided by an injection of ketamine. Ketamine is primarily used for anesthesia. According to researchers, a dose of ketamine helped improve more than half of the participants’ mood in 2 hours (all 7 of them) while 71 percent felt better after 24 hours (all 13 of them). Supposedly, the effects lasted for a week for a third of the participants (all 4 of them). That’s very nice and all, but I’m looking forward to the follow-up study that analyzes ketamine’s long-term effects and safety.

A departure from news — are you bipolar? Take this quiz to figure it out! (P.S. Don’t take the quiz seriously.)

Dawdy over at Furious Seasons writes about a recent study that ties smoking with a “heightened risk of suicide in patients with bipolar disorder.” And an excerpt of his conversation with a DEA agent at the end of his post is awesome.

I’m also behind on reading many of the blogs on my blogroll so I’m doing my best to catch up – sorry for the delay…

Zyprexa Documents Hearing

Looks like Weinstein might redeem himself:

"The judge is asking Eli Lilly’s lawyers to now justify why the court documents that slipped out into the world last month should continue to come under the court’s seal. Good call by the judge."

Ooh, this should be interesting. (Furious Seasons)

"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. 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.

Fluoxetine helps offset Effexor withdrawal

Great news: I upped my dosage took 20 mg of fluoxetine last night and the Effexor brain shivers have completely worn off. My cognitive functioning has completely returned and I’m no longer afraid of passing out when walking or turning to talk to someone. I’ll probably take another 20 mg tonight and call it a day for fluoxetine. (Thank you Dr. Ivan!)

So it’s true: If you’re experiencing Effexor withdrawal, ask your doctor or psychiatrist (whomever you’re seeing for mental illness) for 20 mg of fluoxetine and take it for about 2-3 days.  This may not work for everyone (especially those who may be treatment-resistant) but I’m confident it can work for the vast majority of sufferers. I’ll tell you later if I have a suicidal relapse; I’ll be on the alert for the next two weeks. That’s how long it took me to have a relapse when I quit Lexapro cold turkey.

Many thanks to Furious Seasons for the shout-out.

UPDATE: An old post from a blog detailing an Effexor withdrawal experience. I was on Effexor for about 3 months and the withdrawal effects were essentially the same.

Loose Screws Mental Health News

Women who are binge drinkers are more likely to be clinically depressed, according to a joint U.S. and Canadian study. I find it funny that they’ve got a photo of a middle-aged (or senior) woman with the captions, “Binge drinking adversely affected women’s mental health, the study suggested.” It’s possible, but HIGHLY UNLIKELY that the woman in the picture is representative of a binge drinker. A picture of a female binge drinker would look more like this:

That’s better. (source: The Trouble With Spikol)

On a Spikol trip, she writes that she questions a bipolar diagnosis in children and young adolescents (as in 14 or 15). I wholeheartedly disagree. Once I received a bipolar diagnosis, I realized that it wasn’t something that I’d developed out of nowhere. I often thought that I began suffering from manic depressive episodes when I was 14. Looking into my childhood, I realized that there was so much more to it: the temper tantrums, the sudden happiness and instant withdrawal. Constant paranoia that no one liked me (which no one did because I was super smart as a child). My parents described me as a “happy” kid, but I remember my tumultous childhood from 6 years old and on. I was raised in Brooklyn until I was 5 and then moved to Long Island. Even though I attended kindergarten in Brooklyn, the LI school district insisted that I was too young for first grade and made me repeat kindergarten. This apparently angered me because my parents claim that the second time around, I didn’t do any of the work because I’d done it before. After an encounter with my teacher (and seeing my father cry for the first time in my life), I shaped up my act in time to move on to first grade.

So I disagree that a bipolar diagnosis in children would erroneous or inaccurate. However, it’s possible they may be misdiagnosed and find out later on in life that they really had ADHD or some other kind of mental illness. But that doesn’t mean they weren’t mentally ill at all; it simply means they weren’t diagnosed properly.