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.

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Younger generation of psychiatrists skeptical of pharma companies

From intueri:

>> Psychiatrists Top List in Drug Maker Gifts. This kind of thing makes me embarrassed to be a psychiatrist. I’m glad that the Times is publishing this information—transparency is good and should be encouraged—and it’s painful to read. Many of us in the younger crew view Big Pharma with a disdain that borders on disgust, but how are other people supposed to know this? Average newspaper readers may now believe that I’m a skanky whore for Big Pharma upon learning my profession. I could prattle on, but I won’t.

It's good to know that the new breed of psychiatrists aren't as loyal to Big Pharma as the old ones are.

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)

intueri hits the spot

Oh. My. Goodness.

Abilify phone booth (side view)Intueri originally wrote the post about seeing Abilify on the side of a phone booth. I thought it was pretty funny and pretty stupid.

I still find it stupid, but even more so now.

I was on the bus heading to work today (I don’t normally take it) . When it reached a red light near the subway, I saw a telephone booth – akin to the one that you see on the right – draped in an Abilify ad. The ad is exactly what you see here. (If you can’t see it, go to Abilify.com and click on the “see our print adverisement!”)

I work near two major colleges with students who all have cell phones. Adults in the area are too busy thinking about their own problems while heading into the subway. (They, too, are likely to own cell phones.) Public telephones are rarely used anymore. So who’s going to read an ad on Abilify, let alone on a public telephone booth?

Some marketing person at Bristol-Myers Squibb probably thought it would be awesome to have an ad for Abilify near two major colleges. “All the college kids that walk by will see it!”

The readable text – from the bus, anyway – was “Treating bipolar disorder takes understanding.”

Understanding of what? Who’ll actually stand there and go, “Yeah, I need understanding” and walk right up to it to read more.

    • “where you’ve been
    • where you want to go
    • how you want to get there”

I’m ready to understand my history, my future, and the plans I should make. Uh-huh, Abilify will help me do that.

“Ask your doctor or health care professional if ABILIFY is right for you.” [emphasis mine]

The bus didn’t stay there long enough for me to see if they included the safety information, but here’s the gist of what they provide:

    • “Acute manic and mixed episodes associated with Bipolar I Disorder
    • Maintaining efficacy in patients with Bipolar I Disorder with a recent manic or mixed episode who had been stabilized and then maintained for at least 6 weeks “

Someone can explain the last part to me a little better? I’m a mixed-episode case, do I qualify for Abilify?

I was under the impression that Abilify (aripiprazole) is an atypical antipsychotic. Antipsychotics should be prescribed for those who have psychosis. (I may be wrong here; I’m still trying to figure out the difference between typical and atypicals.) I don’t have psychosis. I don’t need Abilify. But the few bipolar people who will read that ad – they’re likely to be homeless – will be misled into thinking that they need Abilify to help them. They’ll go their doctors, saying, “I’ve heard Abilify helps people with bipolar disorder, could I perhaps try it?” PCPs will immediately churn out prescriptions and uneducated psychiatrists (yes, they are out there despite their degrees) will say, “Sure, Abilify works for bipolar disorder. Let’s see if it works for you.” The smart psych would say, “I’m not sure if it would be right for you. It’s an atypical antipsychotic that targets Bipolar I patients who have symptoms of psychosis. Let’s try something else instead.”

So I went on my soapbox. Again. But it angers me to see:

    • An Abilify ad on a phone booth. Period.
    • A misleading advertisement geared to all people with bipolar disorder (it doesn’t specify until you get to the fine print) that says, “Try this; it may work for you.”
    • An advertisement for medication. At all.

What’s next? A marketing blitz by Eli Lilly? “Zyprexa doesn’t cause diabetes! Check out zyprexafacts.com for more information!”

Big Pharma never fails to surprise me.

Pharmaceutical roundup

AbilifyNearly every mental health blog I know is talking about this post from intueri.org. It’s definitely worth the read. I don’t know much about Abilify, but I don’t think most uneducated bipolars know that it is prescribed specifically for those with psychosis. On the flip side, I don’t think uneducated PCPs know that tidbit either. A person with bipolar without symptoms of psychosis who asks for Abilify may be in for a rude awakening. [UPDATE: Who paid this chick? I only skimmed the post but I don’t see any negative side effects listed.]

I’m not deep into the pharmaceutical industry like all of these heavyweights: CL Psych, PharmaGossip, and Furious Seasons, among many others whom I may have failed to mention. However, there’s a wealth of information to be found. My newest discovery:

“The approach is called ‘ethical pharmaceuticals,’ and it was unveiled on January 2 by Sunil Shaunak, professor of infectious diseases at Imperial College, and Steve Brocchini of the London School of Pharmacy, the Guardian reports. Their team of scientists in India and the UK, financed by the prestigious Wellcome with technical assistance from the UK government, have developed a method of making small but significant changes to the molecular structure of existing drugs, thereby transforming them into new products, circumventing the long-term patents used by the corporate giants of Big Pharma to keep prices – and profits – high. [emphasis mine] This will give the world’s poorest and most vulnerable people access to life-saving medicines – now priced out of reach – for mere pennies.”

I read the above on CLPsych’s blog (originally from Chris Floyd at truthout) and couldn’t believe what I was reading. It somewhat ties into what I’ve been researching about Neurontin (which will probably be posted later in the day):

“Pfizer has developed a successor to gabapentin [Neurontin’s generic name], called pregabalin (being marketed as Lyrica®). Structurally related to gabapentin [emphasis mine], pregabalin is effective for neuropathic pain associated with diabetes and shingles, and for the treatment of epilepsy and seizures.”

Pfizer, in an attempt to distance itself from the trouble surrounding Neurontin, developed another medicine – pregabalin, which is similarly structured to gabapentin. Pfizer can now claim, “Don’t like Neurontin? You can have Lyrica instead!” Pfizer also tried to pass off the (illegal) off-label marketing practices with Neurontin off to their acquired division Parke-Davis. So now we’ve got two options: Pfizer either has learned from Parke-Davis’ issues with Neurontin or is pretty stupid and pushing Lyrica for off-label usage similar to that of Neurontin’s. No evidence to support either option… yet. But CLPsych delves into an interesting practice that Pharma companies use to circumvent a drug patent running out:

“News Flash — PhRMA does NOT believe in the free market: While PhRMA likes when the market works in their favor, they also believe in circumventing that same market when it comes to competition. When drugs are slated to come off-patent, which would allow generic version of the drug to be made, PhRMA members have increasingly turned to buying off the competition. That’s right; they simply pay the generic manufacturer to not make a generic version of the patented drug, so that the consumer can continue to pay a hefty price for the drug which is still under patent. [emphasis sorta mine]

Wow. That bit of information has left me speechless. Screw the consumer that can’t afford psych meds without health insurance; we as Big Pharma need our DAMN money!!! [end rant]

This practice, called “reverse payments,” is not something new and, at the current moment, is relatively legal. Supposedly, the FTC and the Department of Justice are keeping their eyes on reverse payments and patients can only imagine what might occur in the future. PharmaGossip has more, but slips this bit of info before linking to the Star-Ledger:

“And with the patents on 70 blockbuster drugs — with a total of $48 billion in annual sales — set to expire by 2011, the industry expects reverse-payment deals to proliferate further.”

The FTC and Justice Department better hurry up and step in so we can finally have a generic version of Lipitor!

In all honesty, my mind can’t simply fathom the depths to which Pharma will stoop to make money. (Perhaps because I don’t work directly within the medical industry.) It has me wondering if Pharma is worse than gas companies. Is OPEC more trustworthy than Eli Lilly? I’ll leave it up to you to decide.

Patient Relationships

This is an old post from Maria at intueri, but I found it really insightful. The following is a gem:

"Patients—people!—are incredibly resilient and, in the past, I had not given enough credit where credit is due.

As a result, I learned more about the role of hospitalization and when and how it is appropriate."

Oh, if only more doctors were more like Maria…

Loose Screws Mental Health News

Surprise, surprise — the likelihood of suicide attempts increases with antidepressants.

     “Suicidal patients taking antidepressants have a ‘markedly increased’ risk of additional suicide attempts but a "markedly decreased" risk of dying from suicide, a large Finnish study has found.
     “The research into nearly 15,400 patients hospitalized for suicide attempts between 1997 and 2003 showed that ‘current antidepressant use was associated with a 39 percent increase in risk of attempted suicide, but a 32 percent decrease in risk of completed suicide and a 49 percent reduced risk of death from any cause,’ the authors wrote in a report published in the Dec. 4 issue of Archives of General Psychiatry.
      “The Finnish study analyzed 15,390 suicidal patients of all ages for an average of 3.4 years. The authors said they did this ‘because previous suicide attempts are the most important risk factor for predicting suicide.’”

I think 15,390 patients is a sizeable, significant study that could probably yield semi-accurate statistics.

      “Among the 7,466 males and 7,924 females examined, there were 602 suicides, 7,136 suicide attempts requiring hospitalization and 1,583 deaths recorded during follow-up. The risk of completed suicide was 9 percent lower among those taking any antidepressants than among those not taking antidepressants.
     “But the picture was not so bright for all those who took SSRIs. It was for those taking fluoxetine (Prozac), who had a 48 percent lower risk of suicide than those not taking medication. But the study found that those taking another SSRI, venlafaxine hydrochloride (Effexor XR), had a 61 percent increased risk.”

So Prozac is better than Effexor XR in terms of suicidal risk. Nice, considering that I've had a 10-year history of suicidal attempts and this study seems to show that venlafaxine increases the risk of suicide attempts. Perhaps Effexor should be prescribed to those who aren't/have never been suicidal?

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