Loose Screws Mental Health News: Suicide slide

congregationA new study from the University of Manitoba shows people who regularly attend some kind of religious service are less likely to attempt suicide. The study, published in the Journal of Affective Disorders, surveyed 37,000 Canadians and their connection with spirituality, religious worship, and suicidal behavior. Those who simply said they were spiritual but didn’t attend religious services did not show a reduced risk of suicide attempts. However, I was dismayed to read that researchers didn’t investigate why regular church attendance decreases the risk of suicide attempts. (Note to self: Go to church each Sunday!) (pic via www.assumpta.fr)

Alison Go of U.S. News & World Report cites a study from Academic Medicine (originally reported by Inside Higher Ed) which suggests depression affects 21.2 percent of medical students. The rates is 11.2 percent higher than that of the general population. And unfortunately, 13 percent of black medical student reported suicidal ideation in the survey, suggesting that the demographic is more likely to suffer from suicidal thoughts.

And yet another study about suicide… The University of Gothenberg in Sweden performed a study on people who had nightmares following a suicide attempt and found out that they were five times more likely to try committing suicide again. The conclusion is based on a meager sample size of 165 patients but I suppose it’s a start.

While it appears that other sleeping obstacles do not raise the risk of multiple suicide attempts, patients who have attempted suicide seem to battle sleeping problems on a regular basis.

It is normal for patients that have attempted suicide to suffer from sleeping difficulties. Some 89 percent of the patients examined reported some kind of sleep disturbance. The most common problems were difficulty initiating sleep, followed by difficulty maintaining sleep, nightmares and early morning awakening.

Interesting observation considering that I have pretty much all of the common problems with the exception of early morning awakening.

Finally in a semi-cool story, a 22-year-old New Jersey guy who was friends with an 18-year-old Californian over the Internet called California police when he found out the 18-year-old said he would attempt suicide. Although it sounds like the teen (his name was not disclosed) is pretty upset about being saved (I know the feeling), it’s a (somewhat) happy ending compared to what happened in November when a Florida teenager streamed a webcast of him committing suicide by dying of a drug overdose. The Florida teen died before police arrived.

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FDA: No link between Singulair and suicidal behavior

On Tuesday, the FDA announced that an investigation into Merck’s clinical trial data did not discover a link between Singulair (montelukast) and suicidal behavior. The investigation, which began 9 months ago, was prompted by a number of reported suicides, especially that of 15-year-old Cody Miller who took the drug and appeared to have no history of mood or behavioral problems. (It is worth noting here that Singulair “is the top-selling drug for people under 17 years old” and Merck’s biggest seller with annual sales of close to $4.5 billion.)

In attempt to assess Merck’s data better, the FDA also investigated AstraZeneca’s Accolate (zafirlukast) and Cornerstone Therapeutics’s Zyflo (zileuton). Although the FDA did imply that “the data were inadequate to draw a firm conclusion” and said that the clinical trials were not set up to observe any psychiatric behavior. Here are the data the FDA discovered during their review of these trials:

SingulairSingulair: 41 placebo-controlled trials that included 9,929 patients

  • Reports of suicidal thoughts: 1 (treated with Singulair)
  • Attempted suicides: None reported
  • Completed suicides: None reported

AccolateAccolate: 45 placebo-controlled trials that included 7,540 patients

  • Reports of suicidal thoughts: 1 (placebo group)
  • Attempted suicides: 1 (placebo group)
  • Completed suicides: None reported

ZyfloZyflo: 11 placebo-controlled trials (number of patients unknown)

  • Reports of suicidal thoughts: None reported
  • Attempted suicides: None reported
  • Completed suicides: None reported

Forgive me for being cynical but the data sounds fishy. I can’t pinpoint why but it does. The suicide numbers and patient involvement data seem to deviate some from the numbers listed in Merck’s PR issued last March. (I’m seeing 11,000+ patients vs. 9,929 patients.) Regardless of the clinical trial data, it appears that the FDA as of yet have not reviewed post-marketing data.

Scott Korn, a senior safety surveillance executive for Merck said in an article for Reuters:

“‘At the time we did not believe, and we still don’t think a link has been established’ between Singulair and the suicides.”

In the same article, Sanford Berstein analyst Tim Anderson had this to say about the possibility of the FDA finding a link:

“If the… safety review leads to a stern warning about behavioral changes in the Singulair label, this could frighten users of the drug or their parents and give Merck’s competitors ammunition to attack the brand.”

The Washington Post has Dr. David Weldon, director of the Allergy and Pulmonary Lab Services at Scott & White in College Station, Texas, on record saying that he had not “seen any increase in psychiatric problems with the drug but that some patients had complained of nightmares after starting on Singulair.” (Note: It appears that the closest conflict of interest Weldon would have here is that he served as a consultant and is honoraria for AstraZeneca.)

Dr. Rauno Joks, head of the SUNY Downstate division of allergy and immunology, made an interesting point in the Washington Post article:

“The physician really needs to review whether there are symptoms that have developed since patients started taking the medication, if there’s an underlying depression that was there before medication started.

Also, seasonal allergies in and of themselves can cause fatigue and lethargy, which makes it harder to assess, because those are some of the symptoms you have with depression.”

The FDA says they’ve completed analyses of submitted clinical trial data but their “safety review will continue” for several more months before they come to a concrete conclusion. For customer testimonials, check out medications.com that has over 2,300 people reporting side effects and askapatient.com that has an average 2.3 rating from 524 reviewers. The most commonly reported mood-related side effect on both of the sites is irritability.

Loose Screws Mental Health News

I need a new subject header for “Mental health news.” It’s so blah. I need something snazzy. Perhaps “Loose Screws News”? Okay, nevermind… That’s what I get for being a former copy editor. Renamed as of 2/16/2009.

A new study, published in the scientific journal of the American Academy of Neurology has found that women who experience chronic headaches, namely migraines, are four times as likely to report symptoms of major depressive disorder. Of the 1,000 women surveyed, “593 reported episodic headache (fewer than 15 headaches per month) and 439 had chronic headache (more than 15 headaches per month).” Migraines were diagnosed in 90 percent of the women. Author of the study Dr. Gretchen Tietjen said that more studies are being done to discover whether the a serotonin imbalance in the central nervous system is the cause of chronic headaches, severe physical problems, and major depressive disorder. (source: The Trouble With Spikol)

According to businesswire.com, the non-profit organization Stanley Medical Research Institute (SMRI) will provide up to $9 million to fund Omeros Corporation’s schizophrenia program, which will help the completion of
Phase 1 clinical trials. Business Wire basically listed SMRI’s press release so I’m curious to do some research on SMRI and how this non-profit was able to obtain $9 million. I don’t know much about this organization but a non-profit organization funding a biopharmaceutical company’s program seems out of the ordinary to me. (This may be something normal, but I’m not aware of this.) According to SMRI’s “about us” blurb at the bottom of the PR, they state:

“The Stanley Medical Research Institute (SMRI) is a nonprofit organization that supports research on the causes and treatment of schizophrenia and bipolar disorder (manic-depressive illness), both through work carried out in its own laboratories and through support of researchers worldwide who are working on these diseases. SMRI has provided over $200 million in funding since 1989.”

Whoa. $200 million since 1989 is not a whole lot. Where in the world did this $9 million come from? Do non-profit organizations actually save up money to blow on a worthy future project? (The cynical patient in me wonders if there’s a drug company like GSK or Wyeth slipping money through SMRI’s back door.)

Liz Spikol usually blogs headlines before I can even get to ‘em so I credit her with discovering the following three links:

According to the Delhi Newsline, yoga can help with cases of severe depression and schizophrenia. (Hm, interesting.) Patients who took yoga classes in addition to meds improved more rapidly than patients only on meds. The connection with yoga seems to be the relaxation component — outdoing counseling and “talk therapy,” which can aid treatment in a mentally ill individual.

Oy. UPI has reported that Swedish researchers have discovered that those who struggle with suicidal ideation have problems with nightmares and sleep problems. Of the 165 patients surveyed, 89 percent of them reported a sleep problem. Nightmares proved to be the highest indicators of those with a high suicide risk. However, lead author Nisse Sjostrom is quick to note,

“Our finding of an association between nightmares and suicidality does not imply causality.”

But

“Our findings should inspire clinicians to include questions concerning sleep disturbance and especially nightmares in the clinical assessment of suicidal patients.”

CPAPMy husband thinks I suffer from sleep apnea – he claims I stop breathing sometimes in the middle of the night. I’m going for a sleep assessment sometime in February so I’ll let you know if I come back with a CPAP (continuous positive airway pressure) machine.

I’ve had increased dreams (or nightmares, what have you) on these psych meds. I haven’t been excessively suicidal and I hope it’s no indication of more suicide attempts on the way. *sigh* Were any of the surveyed patients on meds like Effexor and Lamictal?

(ASIDE: Dang working in a medical industry! I’m becoming more familiar with unfamiliar medical acronyms.)

And finally, News 24 reports that children who suffered from neglect and abuse are more likely to develop severe depression as adults. The study, published in the Archives of General Psychiatry, says the data specifically shows that “depression is a consequence of… abuse.” Um, who wouldn’t be depressed after such a traumatic experience? How do physicians differentiate between major depressive disorder (DSM-IV term for clinical depression) and post-traumatic stress disorder? Ah, once we get the answer, we can use it as a Jeopardy! question.

Patient Responsibility

“An article on brain shocks from about.com linked to a statement at socialaudit.org.uk on venlafaxine withdrawal. It seems that when coming off of venlafaxine, it is best to use fluoxetine (Prozac) in conjunction with it. Somehow, Prozac’s effects can minimize or negate the side effects of Effexor allowing for an uneventful withdrawal. I’m seeing my psychiatrist later today and I might bring up the idea with him. He might think one of two things: a) I’m crazy (pun not intended) or b) I don’t know what I’m talking about. My guess is he’ll choose the latter of the two.

Unlike most patients, I know more about meds than ‘the average bear.’”

UPDATE: I asked my doctor about going on fluoxetine to offset the effect of venlafaxine withdrawal. He looked up, somewhat shocked, and said, “Yeah.” So then I pushed and said, “Well, I’d like 10 mg then.” lol. He wrote out a prescription for 10 mg of Prozac in addition to bumping me up from 150 mg to 200 mg of Lamictal. I took the fluoxetine (Prozac is now a generic drug) last night and it has offset the intensity of the brain shocks. I experience them but they are much more mild compared to yesterday when they were moderate to severe. Yesterday, I was barely able to drive; today, I drove nearly an hour to work on a somewhat urban road with good reflexes and almost normal cognitive functioning. I can only hope that the Prozac continues to aid my withdrawal issues. And I was happy to wake up this morning without wondering why I dreamt that I was in a department store with parrots singing Gwen Stefani’s “Wind It Up” and swinging like moneys instead of flying.

You get the idea: Effexor causes some strange dreams.

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