I’m aware that my blog has taken a significantly dark turn. This may alienate some of my readers who seek happier, brighter topics. I don’t think my posts have been negative; on the contrary, I think they’ve been positive. Positive and educational.
This post kicks off Depression Overawareness and Overmedication Week.
Two weeks ago, CLPsych and Gianna, among others, celebrated Bipolar Overawareness Week. To cap off Mental Health Awareness Month, I’ve declared this last week of May Depression Overawareness and Overmedication Week. Use this checklist to identify whether you may possibly be “overaware” and “overmedicated” for depression:
- If you’re on Zoloft because you’ve never been sad or anxious.
- If you get a prescription for Lexapro on Thursday because you had a bad day on Tuesday.
- If you take Paxil because you’re never restless or irritable.
- If you are on Pristiq as a result of sadness and guilt over your Wii-related injury (eg, throwing your shoulder out or tripping over the coffee table).
- If you are on Celexa because you hate the job that you disliked anyway before you began the medication.
- If you are on Cymbalta because you are tired after normal long, exhausting days at your job(s).
- If you are on Effexor only because you overate during the holidays.
- If you take Prozac because you’ve never had passing thoughts of suicide.
If you meet any of the criteria above, this is a medical emergency. You are overaware and overmedicated. Go see your doctor immediately and discuss treatment options that involve non-medication and/or talk therapy.
Now, the disclaimer.
The checklist above is satire. It is not intended to poke fun at those who suffer with real clinical depression (of which I am one). It is intended to mock the extremely high number of people in the U.S. who are diagnosed with depression and medicated with antidepressants. This is not a medically based checklist for anything. It is not a professional recommendation or intended for professional use. It is not intended to be serious. In fact, it is not intended to be seriously serious. If you take this to your doctor, he or she will probably diagnose you with something other than depression. If you have been offended by this post, don’t be; you shouldn’t come close to meeting the criteria above. And if you do, then you really should go to a doctor. While I meet the criterion for sadness over my Wii-related injury, I don’t take Pristiq for it. If you have something nice to say, click on the Comments link below. If you don’t have something nice to say, click on the Comments link below.
(comic from problogs.com)
The show is essentially Depression 101 – for those new to learning
about the illness. As someone who struggles with depression (within
bipolar disorder), I found a lot of the two hours pretty boring (90
minutes on personal stories and about 22 minutes for "candid
conversation"). The "a lot" comes from the stuff that I've either heard before or flies over my head, eg, how depression affects the brain, prefrontal cortex, neurotransmitters, synapses, etc. The personal stories were powerful: depressingly heartwarming. (Yes, I mean that.)
My heart sank as I heard the stories of Emma and Hart, teenagers who were diagnosed with depression and bipolar disorder, respectively. Both were such extreme cases that they needed to be sent away for special psychiatric care. They are on medications for their disorders; the specific drugs are never mentioned.
While watching Deana's story of treatment-resistant depression, I instantly thought of Herb of VNSDepression.com whose wife suffers from the same malady.
I tried to listen attentively for the antidepressant that Ellie, who suffered from PPD after the birth of her first child, would be taking during her next pregnancy. It was never mentioned.
My jaw nearly dropped to the carpet as Andrew Solomon, carefully plucked brightly colored pills from his pillbox that he takes every morning for his unipolar depression: Remeron, Zoloft, Zyprexa, Wellbutrin, Namenda, Ranitidine, and two kinds of fish oil. He might have even mentioned Prozac. He takes Namenda, an Alzheimer's drug to combat the effects of an adverse interaction between Wellbutrin and one of the other drugs that I can't remember. Solomon says he's happy. I'm happy for him and I'm happy that his drug cocktail works for him but I couldn't help but sit there and wonder, "Isn't there a better way?"
While I thought the stories covered the gamut, in retrospect, I'm surprised they didn't interview a veteran or U.S. soldier to discuss PTSD. If the producers were able to fit in dysthymia, I'm sure they might have been able to throw in a story about a soldier who struggles with depression and suicidal thoughts stemming out of PTSD. Considering all the stories coming out of the VA, it's rather relevant. It would have been more interesting than the Jane Pauley segment. But I'll get to that in a minute.
As I listened to the narrator, I couldn't help but wonder what alternate perspectives could have popped up. For what it was, I fear none. This was a Depression 101 show — a program designed to either get people to fight against fear and stigma and get help or to open the eyes of loved ones to this debilitating disorder. I'm not sure how to slip in an opposing view on medication from a doctor without confusing or scaring people away. What would Healy or Breggin say that would encourage people to seek appropriate care?
Holistic or natural treatment was not mentioned. It's not mainstream and it's not recommended by most doctors as first-line therapy. I would have been surprised had something been said about it.
The depression portion of bipolar disorder was briefly discussed in Hart's story then Pauley added commentary about her personal experience in the remaining 22 minutes of the program.
Pauley appears at the end of the show promising a "candid conversation" on the topic. The three experts: Drs. Charney, Duckworth, and Primm sit and smile politely as Pauley rattles on occasionally about herself. Some people might find her exchange endearing and personal. After the first 3 minutes, I found it annoying. As a journalist, I wish she would have taken the impartial observer approach rather than the "intimate discussion" approach. In my opinion, she seemed to have dominated the "discussion."
It ended up being a Q&A with each doctor. Her questions were focused and direct. I expected a little bit of an exchange between doctors, talking not only about the pros of medication and treatment like ECT and VNS but also the cons. (Should I apologize for being optimistic?) Charney interjected into the conversation maybe once or twice but was only to offer an assenting opinion. Primm spoke least of everyone on the panel. I think she was placed on the show solely to represent diversity.
There were no "a recent study said…" or "critics say such-and-such, how do you address that?" It was a straightforward emphasis on encouraging people to get help or for those suffering to get treatment. Pauley's segment didn't discuss any negatives (not with the medical director of NAMI there!). The closest the entire 2 hours gets to any cons is with ECT shock treatment and giving medication to growing children. The childhood medication thing isn't dwelt on. The basic gist is: Doctors don't understand how medication works in children but are working on trying to understand it and improve its efficacy.
Forgive me for being negative. The point of the program was designed to give hope to those suffering. Instead, it just made me feel even worse. Thoughts raced through my head: "Well, if this doesn't work, then it's on to that. And if that medication doesn't work then I'll probably be prescribed this therapy, and if that doesn't work, then I'm treatment-resistant at which point, I'll have to do…"
I hope the program does what it's designed to do and that's to get those suffering with depression to seek appropriate care. The one upside is that talk therapy was stressed. I'm a huge proponent of talk therapy myself. Let me know what you thought of the show if you were able to catch it.
In the meantime, this depressed girl is going to cure herself for the night by going to bed.
P.S. Is it really fact that depression is a disease?
I’m on EST so I’m watching the Depression PBS show. I’ll be live blogging about it because I have nothing better to do with my life. Probably no interesting observations but, like I said, I have nothing better to do right now.
UPDATE: Jane Pauley doesn’t appear until 10.25.
9.07 pm – Andrew Solomon, author of The Noonday Demon is sharing his story about his bout of depression. It doesn’t help that his mother, who suffered from a terminal illness, chose to end her life.
9.09 – Dr. Myrna Weissman says that depression "is a biological disorder. It’s not all in your head."
9.12 – The show highlights an adolescent named Emma who’s been struggling with depression since 5th grade. She began "acting out" as a form of self-medication. She ended up going to to an out-of-state psychiatric hospital.
9.15 – Cut to an adolescent male, Hart, who has been suffering from depression since 6th grade. After going to a hospital, he was diagnosed with bipolar disorder.
9.19 – Jed, a 20-year-old college student killed himself supposedly from undiagnosed depression. Dr. Thomas Insel says that suicide is almost twice as common as homicide in the United States.
9.21 – Drs. Geed(?) and Casey at NAMI are using MRI to further research in adolescent depression. An explanation on the neurochemical brain functions in adolescent depression follows.
9.25 – A narrative on postpartum depression begins. Ellie’s husband videotaped Ellie with the baby, Graham, shortly after his birth, and you could see the unhappiness of postpartum of depression on her face. In the homemade video, she holds her child while saying that she had suicidal thoughts the day before and wanted to die because she "couldn’t do this" anymore.
9.29 – Cut to Shep Nuland, author of Lost In America, and explains the circumstances that led to his depression.
9.32 – Dashaun, a member of the Bloods gang, suffered from early life trauma that led to his bouts of depression.
This probably goes without saying but so far, the program is replete with different doctors, none of which appear in segments other than the first one they were featured in.
9.37 – "When you gang bang, it’s just a form of suicide."
9.38 – Segue to Terrie Williams who not only helped Dashaun write his story and helped him recover from his depression, but also suffers from a mild form of depression, dysthymia. Dysthymia is estimated to affect 10-15 million Americans. One of the symptoms is overeating.
9.40 – Williams mentions that stigma of mental illness in the African American community prevents African Americans from seeking treatment.
9.41 – Philip Burguieres(?), a former CEO, suffers from depression and discusses the stigma of mental illness in corporate America.
They’re really covering the whole gamut.
The hubby is getting frustrated because the segments are really just that – segments and they never fully finish anyone’s story but jump back and forth.
9.45 – Back to Andrew Solomon from the beginning of the show. He’s currently taking Remeron, Zoloft, ZYprexa, Wellbutrin, Nemenda(? an alzheimer’s drug), Ranantadine(?), two kinds of fish oil. HOLY CRAP. (I think he’s also on Prozac but don’t hold me to that.)
9.47 – We’re being walked through the neurotransmitter explanation.
9.48 – Poor Andrew thinks he wouldn’t be on as many medications today if he had been on medication a long time ago.
9.48 – Ooh, look! It’s Richard Friedman, the psychologist/psychiatrist from the NYTimes.
9.52 – Back to adolescent Hart Lipton, who is in a special
school that gives him specialized attention. He has bipolar II. He is
on an antidepressant and a mood stabilizer.
9.52 – Emma takes one antidepressant and engages in talk therapy. She tried several different ones before she found one that worked.
9.53 – The Narrator admits that meds in young people isn’t
fully researched and may be a problem. He mentions the black box
warning on antid’s.
9.55 – NIMH docs are working on faster-acting meds for depression – as in 1 to 2-hour relief. Guinea pig patients were administered intravenous ketamine for depression. (WTF???) One of the patients, Carl, says he felt instantly better.
9.58 – Back to Shep. Doctors suggested performing a lobotomy but a resident intervened and suggested ECT. They cut to a scene from One Bird Flew Over the Cuckoo’s Nest in which Jack Nicholson got ECT. Shep says it was worth it and that he began to feel better by the 11th treatment.
10.00 – ECT especially works well on the elderly. A woman, Sue, who developed late onset depression at age 65 comes back for her 9th treatment of ECT. It helps her. Her husband says, "She’s back to her old self."
The next hour of the show under the cut…
In all seriousness, I have wondered about the BPD diagnosis but in my mind, have somewhat fallen short. I don’t think my symptoms are strong enough to be plastered with a BPD label.
To conclude my several-post rambling, I should answer the question that I initially posed. Do I think bipolar disorder is overdiagnosed?
Many of my fellow bloggers will likely disagree with me. Zimmerman’s study at Rhode Island Hospital took into account whether those “diagnosed” with bipolar disorder had a family history of the diagnosis in the family. Maybe I’ve turned to the dark side. Just because I don’t have a family history of bipolar doesn’t mean that I can’t suffer
from the disorder. However, I have a family history of schizophrenia: one father and two aunts. Does this put me at a higher risk for schizophrenia? Definitely. Does this mean I could suffer from bp and have the schizo gene pass me by? You bet. I don’t think that I need a first-degree relative to suffer from bp to make me a classic diagnosis for bp.
For instance, when it comes to my physical appearance, I’m the only one on both sides of the family who suffers from severe eczema to the point where my dermatologist suggested a punch biopsy. Does that mean that I need to have a family history of eczema to obtain the malady? Not necessarily. Why is bipolar disorder any different?
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
- 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
- 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
- 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.
BJ Harroun left this comment for me on one of my posts Pristiq's FDA Chances: Depression – Yea; Menopause – Nay:
I have just completed my first two weeks on Pristiq. I have suffered from MDD for 35 years. I cannot take Effexor because it increases my appetite. Pristiq has really helped me. I have taken everything and I think I have finally found something that works for me. Don't dismiss this drug because it is an Effexor metabolite.
I didn't expect to see much of a difference between Pristiq and Effexor in terms of side effects since I figure since they're from the same class (SNRI). But I'm glad that Pristiq seems to be helping BJ. It would behoove me to take a look at the PIs for Effexor and Pristiq and check out the clinical trial data and see how they shaped out differently. But there's only so much time for me during the day.