November 15, 2010 at 7:18 pm (Bipolar Disorder)
Tags: ADA, Americans with Disabilities Act, bipolar, Bipolar Disorder, disabilities, insomnia, sleep
This is old news but I’ve been wanting to write about this for a while.
In 2008, bipolar disorder became a list of covered psychiatric conditions under the American Disabilities Act (ADA). While I support the move, I’m somewhat guarded about it since there are a variety of symptoms within bipolar disorder that can make it difficult for a person to perform his or her job. From PsychCentral’s post about it in September 2010:
For ADA purposes, major life activities that may be limited by a mental health disorder could include learning, thinking, concentrating, interacting with others, caring for oneself, speaking, or performing manual tasks. Sleep also may be limited in such a way that daily activities are impaired.
Someone with bipolar disorder may temporarily experience “limits” to handling life activities. A deep bout of depression or insomnia may create a need for time off or for flexible hours. An individual may need time off for doctor appointments. In the daily work environment he or she may need a quieter work area to decrease stress and enhance concentration or more frequent breaks to take a walk or do a relaxation exercise. He or she may need office supplies to help them organize and focus more effectively.
I’ve experienced all of these issues at one point or another (sleep issues have been the most frequent and debilitating) in the past and I completely understand how it can affect someone’s ability to work. However I worry that someone might use this to their advantage to cover bad behavior rather than someone who legitimately needs this protection. But alas, abuses to systems exist everywhere.
This coverage prompts me to ask the question: is bipolar disorder (and depression as well) a legitimate disability?
April 30, 2007 at 2:17 pm (Antidepressants, Bipolar Disorder, Depression, Medicine/Meds, Mental Health/Illness, Pharma)
Tags: Anafranil, Antidepressants, anxiety, April 30, big pharma, bipolar, Bipolar Disorder, bupropion, chronic pain, clinical studies, clomipramine, Depression, Effexor, fatigue, FDA, FDA approval, Fluoxetine, high blood pressure, hot flashes, IBS, insomnia, irritable bowel syndrome, Journal of Women's Health, magazine, magic pill, medications, meds, Melissa McNeil, menopause, migraines, off-label, off-label prescriptions, patient, patient education, patient responsibility, Pharma, pharmaceutical companies, pharmaceutical industry, Pink, pink magazine, PMS, premenstrual syndrome, Progressive Medical Centers of America, Progressive Medical Group, Prozac, psych meds, quetiapine, quit smoking, Sarafem, Scott Haltzman, Seroquel, smoking, somnolence, symptoms, tricyclic antidepressants, venlafaxine, Vikor Bouquette, weight loss, Wellbutrin, women, Zyban
Pink, a magazine for business women, has an article in its April/May 2007 issue titled, “The Magic Pill.” (The only way to read this article is to get a hard-copy of the mag.) No, this isn’t about birth control. The subhead: “Antidepressants are now used for everything from migraines to menopause. But are women getting an overdose?”
Good question. The article, well-written by Mary Anne Dunkin, does a nice job of trying to present both sides of the coin. One subject, Pam Gilchrist, takes tricyclic antidepressants to relieve her fibromyalgia symptoms. “One of the [antidepressants] that allows her to keep going” is Effexor (venlafaxine). God forbid the woman should ever have to come off of that one. (It works well when you’re on it, but withdrawal is sheer hell.)
The other subject mentioned in the article, Billie Wickstrom, suffers from bipolar disorder, but had a therapist who diagnosed her with obsessive-compulsive disorder. The psychiatrist she was referred to promptly put her on Anafranil (clomipramine). We all know what antidepressants tend to do for those with bipolar disorder. Wickstrom blanked out at an interview that she says she normally would have aced. In another incident, she veered off-course after leaving town and spent the night on the side of the road with her daughter. “Search parties in three states” were out looking for them.
“Three years and three hospitalizations later, Wickstrom is finally free of clomipramine and has a job she loves as PR director for a $300 million family of companies. She says she’s happy, she’s focused and she feels great – consistently.”
Dunkin’s article uncovers a large, problematic use – by my standards, anyway – of off-label usage by doctors.
“Gilchrist… is one of the estimated one in 10 American women taking some type of antidepressant medication. And a considerable percentage of these prescriptions, particularly those for tricyclic antidepressants, are not used to treat depression at all.
A growing number of doctors today prescribe antidepressants for a wide range of problems, including anxiety, chronic pain, insomnia, migraines, high blood pressure, irritable bowel syndrome, premenstrual syndrome, menopausal hot flashes and smoking cessation.”
I’m sure the list goes on, but magazines have but oh so much space.
Dr. Melissa McNeil at the University of Pittsburgh points out three things:
- Since depression is a prevalent (see common) condition, doctors are better detecting it.
- Since antidepressants have proven their safety and efficacy, primary care physicians have no reservations prescribing them.
- Clinical studies are finding that antidepressants can aid a number of medical issues apart from depression.
My take on McNeil’s points (I’ll try to keep them brief):
- Depression is way too common to be abnormal. If a woman has a rough patch in life for 2 weeks or more, she’s got depression. As for doctors being better at detecting depression? Studies consistently show that doctors are great at overlooking depression in men.
- Antidepressants haven’t proven jack squat. Placebos have proven more safety and efficacy than antidepressants. PCPs have no reservations prescribing them because they only know about the positive facts that pharma reps tell them instead of researching the potential side effects.
- Clinical studies aren’t finding all those things out. Seroquel has FDA-approval to treat psychiatric symptoms (psychosis, for one). As far as I know, Seroquel is not FDA-approved to treat insomnia or crappy sleeping patterns. There are no specific clinical studies to see if Seroquel can treat insomnia. Seroquel is prescribed to treat insomnia/restless sleep because doctors have found that a major side effect of the drug is somnolence. If this is the case, Effexor should be prescribed for weight loss. It’d be the new Fen-Phen.
Dunkin cites two widely used antidepressants for nonpsychiatric uses: Wellbutrin (bupropion) and Prozac (fluoxetine). Zyban, used for smoking cessation is, well, bupropion. Sarafem, used to treat PMS symptoms is – you guessed it – fluoxetine.
Dr. Viktor Bouquette of Progressive Medical Group thankfully takes a more cautious approach:
“The widespread use – mostly misuse – by physicians of antidepressants to treat women for far-ranging symptoms from insomnia, chronic fatigue and irritability to PMS and menopause is merely another unfortunate example of the pharmaceutical industry’s tremendous influence on the practice of modern medicine. Take enough antidepressants and you may likely still have the symptoms, but you won’t care.”
Kudos to Dunkin for landing that quote. Since Bouquette is part of an alternative medicine group, he’s got a good motive for slamming pharma companies.
McNeil goes on to sound anti-d happy in the article. Not that it matters, but she is also a section editor for the Journal of Women’s Health, which has several corporate associates representing pharmaceutical companies. (She is also the only source in the article who sings anti-d’s praises.) Dunkin tracked down Dr. Scott Haltzman, a clinical professor at the Brown University Department of Psychiatry, who advocated patient responsibility.
“Just because antidepressants work for depression does not mean they should always be used. People need to learn skills to manage their depressive symptoms instead of depending on medication. When you take medicine for every complaint, you lose the opportunity to learn how to regulate your mood on your own.”
Oh, for more doctors like Haltzman and Bouquette.
UPDATE: Uh, alleged fraud suit pending against Progressive Medical Group. Bouquette is now part of Progressive Medical Centers of America.