It’s Official: I’m on Abilify and Prozac

A cursory search on Google for Abilify + Prozac didn’t yield too many helpful results. I suppose it’s not a common drug combination. So far, I haven’t had any real side effects. I take Prozac in the morning and Abilify at night. I’ve also started taking my vitamins again after shirking them for quite a while: Fish Oil with Omega-3s, Iron (for slight anemia), Vitamin B-Complex with Vitamin C, and a women’s multivitamin.

I am a little nervous about taking an SSRI again because the last SSRI I was on (Effexor/venlafaxine) produced some nasty side effects (mania, night sweats, vivid dreams, brain shivers) along with the one I liked (significant weight loss). When I last blogged about Prozac, my only side effect was somnolence—a side effect I don’t appear to be experiencing this time around.

Are you on a drug combination? If so, what and is it working for you? If you used to be on a drug combination, what was it and did it help?

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Lamictal and Abilify: Back on Medication

Images from rxlist.com & drugs.com

After 2 years of not being on medication, I am back to a daily regimen of lamotrigine (Lamictal) and aripiprazole (Abilify) with lorazepam (Ativan) as needed.

Many of you may know, or may not know, what I decided to taper off of medication so that I could get pregnant. Well, that hasn’t happened. And my thoughts got to a point where it became life and death again. I didn’t want to go back to the psych hospital so I asked my psychiatrist for help.

My psychiatrist (God bless him) is a very conservative psychiatrist. He was the one who helped me off of medication 2 years ago, and he’s the one titrating my dosages up now. Lamotrigine is for long-term maintenance of the bipolar disorder, aripiprazole is for short-term maintenance of bipolar disorder and SAD (seasonal affective disorder), and lorazepam assists with severe anxiety as needed. I started taking the medication four weeks ago, and I’m only on 50 mg of lamotrigine and 5 mg of Abilify. There will be no increase on Abilify and I titrate up on lamotrigine every 2 weeks. My next big jump is 100 mg.

My psychiatrist expects me to come off of aripiprazole within the next few months (hopefully by December). If not, I will have to get regular blood sugar and cholesterol tests performed. He will adjust all medications as necessary in the event that I am pregnant. He’s a great psychiatrist; he’s willing to work with me based on my situation rather than him throwing drugs at me. He allows me to have complete control over my treatment regimen, which is something I like and respect.

In the past, I may have come off as anti-medication, but really, I’m not. I advocate for use of medication in a necessary, responsible manner. In 2010, 253 million prescriptions were written for antidepressants.¹ (Keep in mind that the U.S. is estimated to have 307 million people in the country.² That’s about 82.4% of the population taking antidepressants.) This is not responsible; this is too much. In the comments, people have rightly corrected me in the assumption that 1 person can get multiple prescriptions in a year; I failed to remember that.

Let’s assume a person is on 1 antidepressant (the majority of people take 1). Beginning in January, that person gets 5 refills for 30 days. By May, the person will need another 5 refills. Then another prescription is dispensed in October. That’s 3 prescriptions per person. Of course, this can vary depending on how often the doctor will see a patient so let’s generalize and say 5 prescriptions per person per year. My calculations for prescriptions per American mean that nearly 20 percent (about 17%) of the population is on antidepressants. Sure, it’s not my original ridiculous number of 82.4%, but I still think this is pretty high. (By the way, feel free to correct my stats in the comments if necessary; I don’t claim to be a math wizard.)

While I am not on an antidepressant, I am one of the millions of Americans who is on medication for mental illness. For 2 years, honestly, I’d forgotten I had anything relating to mental illness. It was nice to wake up and be myself without thinking about me plus bipolar disorder. Every morning and every evening, it’s now me plus bipolar disorder plus SAD plus anxiety. These are all real symptoms that need to be managed. I don’t want to be dependent on this medication forever, but I may have to. If it helps me manage my suicidal thoughts and function with people in life, then it’s worth it.

Your turn: What do you think about taking psychotropic medication? Do the symptoms outweigh the risks for you? What’s been your experience in taking (or not taking) psych meds?

Notes:

1. Shirley S. Wang, “Antidepressants Given More Widely,” The Wall Street Journal. Published on August 4, 2011. Available at: http://online.wsj.com/article/SB10001424053111903885604576486294087849246.html. Accessed October 20, 2011.
2. Google Public Data Explorer. Population in the U.S. Last updated: July 28, 2011. Available at: http://www.google.com/publicdata/explore?ds=kf7tgg1uo9ude_&met_y=population&tdim=true&dl=en&hl=en&q=us+population. Accessed October 20, 2011.

Should psych drugs be avoided at ALL costs?

My brain isn’t functioning today quite honestly so my apologies if the following makes no sense whatsoever. It’s long and I ended up rambling.


Lately, I’ve been thinking about whether there are any benefits to using pharmaceutical drugs. I have blogger friends who are very much anti-pharmaceuticals anything, try to avoid drugs as much as possible but take them if necessary, or think pharmaceutical drugs are a Godsend.

I’m still trying to figure out where I stand.

Pharmaceutical companies are in the business of making money. It is not to their advantage to put out completely shoddy products that do not work. I’m sure many of them bury negative data and findings that do not shed a positive light on their drugs but if something works overall, they’ll put it out there. I don’t believe the doctors who are involved in these trials are all dirty, rotten sell-outs. Some of them are very well-meaning and honest who work to make these drugs as effective as possible. Call me naïve if you like but I just can’t bring myself to believe there are more greedy docs who skew results than there are those who are concerned with advancement.

I don’t think twice about popping Excedrin Migraine when I’ve got a painful, debilitating migraine; I have no problem taking naproxen (aka Aleve) when I’ve got menstrual cramps, and taking ibuprofen isn’t an issue if I have severe muscle pain. I don’t question the safety of these drugs. I’ve used them for so long, they’ve proven to be relatively safe for me (not everyone can tolerate those drugs) and efficacious. The safety risk of taking Excedrin Migraine sometimes outweighs the benefits of not taking it. (Note: I only speak of adults in terms of ingesting this kind of medication.I don’t believe developing bodies, such as youngsters, are able to handle medication that can significantly affect mood.)

When it comes to psych meds, I am not anti-medication. Psych meds should be taken on a case-by-case basis. There are some people who consider these meds to be a life-saver while others complain that it has made them miserable and worsened their lives. This is the gamble people take when choosing to ingest a psych med—most people don’t know that. Trouble is, most people don’t know when the stakes are high enough to take that risk.

I shouldn’t be in a position to judge anyone but when I hear people taking antidepressants based on circumstances—a job loss, failed relationship, loss of a life—I worry that it’s unnecessary. We are becoming a nation that is more reliant on “quick fixes” rather than developing coping mechanisms. It’s easier to pop a pill and dull your emotions than it is to face problems, tackle issues head on, and learn to work your way through it. Case in point: rising unemployment hasn’t slowed sales of antidepressants or sleeping pills.

  • I have an aunt who was a violent paranoid-schizophrenic. She was placed in a mental institution and drugged up the wazoo. Now, she’s basically existing; the lights are on but no one’s home. The drugs have killed her. She’s alive but not really.
  • My father was a non-violent paranoid-schizophrenic. It got to the point where we needed to medicate him to get him on track. The medication helped him to function “normally” but his thought processes and physical ability was significantly slowed. He once told me that he felt useless because my mother was busting her butt at work to pay for my college and he was basically an invalid because his mental illness had prevented him from being able to work. He died 4 months later. A few days after the funeral, my mom began to find his psych meds hidden all around the house. I often wonder if the drugs killed him.
  • Another aunt (this is all on the paternal side of the family) also became a paranoid-schizophrenic. She was a brilliant woman who was basically reduced to moving from place to place to the point where she eventually became homeless and could not hold down a job. She disappeared for a while but during one cold winter, was found and brought into a homeless shelter. She was placed on meds and her cognitive functions returned despite the fact that her speech was sometimes garbled. She traveled the world, went on cruises and various excursions. The change was remarkable. Psych meds improved her life and saved her—the benefits of the drugs outweighed the side effects.

As I withdraw from Lamictal, I am curious to see who I am without this drug. Will my creative juices flow freely once again or are they now somewhat hindered? Will my cognitive functioning correct itself or will I forever suffer from problems? Will my short-term memory loss issues smooth out or will I still suffer from intermittent forgetfulness? I have some side effects that may remain with me for a while or perhaps forever (though I hope not) but seeing others fully recover after taking drugs for 10 times longer than I have gives me hope.

I feel the majority of my progress has come from intensive counseling and being infused with the truths as laid out in the Bible. I’d say 90% of my progress has been due to counseling. I give the meds 10%. You can tell I don’t place much stock in them. But they’ve helped to cut down on the mixed episodes.

So far, I haven’t had any suicidal thoughts are behaviors that are out of the ordinary. (Thank GOD.) I’ve been dealing with a mild depression but that stems from basing my worth based off of my career rather than any biological imbalances. The last time I suffered a severe depression, I was on Lexapro (if that tells you anything).

I’ve gotten a lot of resistance and concern from family members who question my decision to come off of the medication. They’ve seen a miraculous change in me and attribute it to being on meds. Meds aren’t a cure-all. They don’t see the counseling and shifting of thought processes going on that has helped me to develop coping mechanisms. Meds may help people “cope” but they don’t develop the tools needed to cope.

I’ve decided that I’ll probably give that Christian psychiatrist a call. My counselor recommended him and she said that he’s very neutral on meds and doesn’t shove them on anyone. I mentioned that I wasn’t sure if anyone would accept me as a patient only to lose me in the end—she insisted he wouldn’t mind. The intake cost is hefty but since I was able to temp a few days for my job this week—I’m not permanently returning, I can swing it.

Which brings me back to my position on psych meds: I said it earlier but I think it’s a case-by-case basis. In my personal life, I’ve seen the benefits outweigh the side effects and I’ve seen the side effects outweigh the benefits. And I’ve seen benefits (not necessarily beneficial) as a result of side effects. Psychiatry is the biggest medical guessing game of all medical specialties. There are no certainties, and there’s no one medication that works best for everyone. Pharmaceutical companies make it a point to put the disclaimer on the patient information sheet that they’re not exactly sure HOW these drugs work. All that stuff about serotonin, dopamine, and neurotransmitters is pure speculation when it comes to depression. You’ll have me convinced about chemical imbalances once I can get a MRI and blood test done. Until then, it’s all trial-and-error.

So if I do suffer from relapses while withdrawing from this medication and it gets to the point where I may need to be hospitalized, I’m not averse to remaining on the drug. Better to be alive and on a psych drug than dead because I was determined not to use it at risk to my safety. If I end up having to stay on the drug, the future of giving birth to children will seem a bit more uncertain.

Lamictal withdrawal: fatigue & insomnia

I'm having the weirdest combo of side effects on this. I'm tired all the time, but I can't get to sleep easily no matter how hard I try. Then when I do sleep, it's craptastic and it feels like I never slept in the first place. Anyone else experienced this or heard of anyone who's experienced this? It's wearing me out and causing me to suffer from a lack of patience.

Lamictal withdrawal: 125 mg… and counting

I'm down to 125 mg… I'm feeling sluggish and wiped out. I have what I call "body zaps" — basically I feel little prickles, like someone sticking a pin in my skin — that I find highly uncomfortable. (It's similar to feeling "brain zaps" or "brain shivers" throughout your body.) They mainly occur when I'm still, especially when I'm laying down in bed at night.

My sleeping schedule is also out of whack. While my body can be tired by midnight or 1 am, my brain simply will NOT shut off. My brain decides to shut down along with my body around 3 or 4 am from sheer exhaustion.

A few people have recommended I take melatonin to get back to a normal sleeping pattern, but I'm not sure whether that would be okay as I withdraw from the medication. Melatonin seems relatively harmless but right now, I can't tell what's normal with my body and what's not.

Concerta ADHD Ad

Of all the examples to use for an ADHD medication ad, I thought the “before” symptoms were terrible. I’m not ashamed to admit I did all of those things at one time or another (not in the same sequence). But then again, teachers tried to tell my mother I had (what used to be known as) ADD. Whatever. People these days call it ADHD. I call it being a normal kid. (Side rant: Teachers these days don’t want to deal with disciplining children in school when they misbehave or act out of turn so they recommend medicating them as a way to keep them docile and under control. And parents go along with it since they feel it will make their lives easier at home too. Not to say that some children don’t legitimately suffer from ADHD, but based on casual conversations I’ve had with a few people, it seems as though the number is rising.)

Below is a photo that I snapped of a Concerta ad which recently appeared in Shape magazine followed by 2 pages of side effects and indications. (Click on the picture to view its full size.) Feel free to post your thoughts in the comments.

Concerta ad

Loose Screws Mental Health News

I could’ve been a statistic right here in this area.

suicides in PhiladelphiaPhiladelphia now boasts the sharpest increase in suicides in the country. Despite all the homicides in Philadelphia making the news, the 196 people who killed themselves in 2008 were quietly buried in the obit pages (if they made it there at all).

In light of this news, I’ve decided to place a suicide hotline web banner in the upper right-hand corner of my right sidebar. Susan of If You’re Going Through Hell Keep Going has one in her sidebar and I think it’s a wonderful idea. I’ve had a couple of people comment or send me emails about how they feel they’re on the brink of losing it so hopefully the banner — one of the first things to be seen on this page — will draw some attention and prompt someone to call for help. When I was a teen, I called 1.800.SUICIDE. I can’t remember what happened exactly but I called the hotline and someone talked me into why life was still worth living. People who are suicidal don’t really want to die; they want an escape from the pain they’re feeling and they feel the only way to alleviate that pain is through inflicting death upon themselves. I hope someone who is suicidal would be willing to pick up the phone and come to the same realization that I did at the time.


Speaking of suicide, researchers from the World Health Organization and the University of Verona, Italy have discovered that SSRIs (a class of antidepressants) may significantly reduce the risk for suicide in adults. SSRIs — which include such medications as Prozac, Paxil, and Zoloft — are not be confused with SNRIs such as Effexor, Pristiq, and Cymbalta. PsychCentral notes:

SSRIPrevious studies, including a 2007 study by the U.S. Food and Drug Administration (FDA), found the risk of suicide in adults was neutral, elevated in those under 25 and reduced in people older than 65. A subsequent black box warning was added to all antidepressants regarding increased risk of suicidal symptoms in people under 25 years of age.

Basically, this study just means antidepressants help those who are 25 years and older and hurt those 24 years and younger. I’m sure a new study will come out within the next year or so that contradicts this one. Especially since numerous previous studies on SSRIs found the risk of suicide to be neutral in ages 25-65.


Young adultAccording to the Boston Globe, a (really pathetic) new study shows that nearly half of young adults between the ages of 19 to 25 “meet the criteria for at least one psychiatric disorder.”

Whether in college or not, almost half of this country’s 19-to-25-year-olds meet standard criteria for at least one psychiatric disorder, although some of the disorders, such as phobias, are relatively mild, according to a government-funded survey of more than 5,000 young adults, published in December in the Archives of General Psychiatry.

The study, done at Columbia University and called the National Epidemiologic Study on Alcohol and Related Conditions, found more alcohol use disorders among college students, while their noncollege peers were more likely to have a drug use disorder.

But, beyond that, misery is largely an equal-opportunity affliction: Across the social spectrum, young people in America are depressed. They’re anxious. They regularly break one another’s hearts. And, all too often, they don’t get the help they need as they face life’s questions…

According to the 2005-2007 American Community Survey, the population for adults ages 18-24 is gauged to be around 30 million. Therefore if we’re going to take the study at its word, let’s chop the number by half (even though the number is just under half). That will put us at about 15 million young adults. The NIMH, however, estimates 57.7 million adults in the U.S. “suffer from a diagnosable mental disorder.” If this is the case, those 15 million young adults make up nearly 26 percent of the NIMH’s “diagnosable mental disorder” statistic. The inclusion of alcohol and drug addictions might explain why this figure might be a little high.

The Zoloft-rage connection

ZoloftI’ve received a lot of hits from people looking to find a connection between Zoloft and rage/violence/irritability. Here’s what I have so far:

Pristiq (desvenlafaxine) information

…and on to AstraZeneca's problems with Seroquel

Eli Lilly seems to be passing along its misfortune off to AstraZeneca, which now appears to be having issues with masking evidence of Seroquel side effects. From Furious Seasons:

A great article appeared in the St. Petersburg Times over the weekend, revealing that lawyers for AstraZeneca will argue in court later this month that the company wants documents introduced into a federal court hearing in a case over various allegations around Seroquel sealed and hidden from public view. They want an upcoming hearing in the federal class action lawsuit against AZ closed to the public as well. Lawyers argue that they are protecting patients and, oddly, the public at-large.

Read the rest of Philip's post.

Antidepressant rankings: Zoloft and Lexapro considered best overall

A number of antidepressants were recently ranked in different surveys:

Zoloft and Lexapro came in first for a combination of effectiveness and fewer side effects, followed by Prozac (fluoxetine), Paxil (paroxetine), Cymbalta, and Luvox among others.

The first was efficacy — or how likely patients were to experience the desired effects of the drug.

Efficacy:

1. Remeron (Mirtazapine)
2. Lexapro (Escitalopram)
3. Effexor (Venlafaxine)
4. Zoloft (Sertraline)
5. Celexa (Citalopram)
6. Wellbutrin (Buproprion)
7. Paxil (Paroxetine)
8. Savella (Milnacipran)
9. Prozac (Fluoxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

The second was acceptability — the likelihood that a patient would continue using a drug for the duration of the study (it is generally assumed that a high ratio of patients dropping out indicates the presence of undesirable side effects for a drug).

Acceptability:

1. Zoloft (Sertraline)
2. Lexapro (Escitalopram)
3. Wellbutrin (Buproprion)
4. Celexa (Citalopram)
5. Prozac (Fluoxetine)
6. Savella (Milnacipran)
7.
Remeron (Mirtazapine)
8. Effexor (Venlafaxine)
9. Paxil (Paroxetine)
10. Cymbalta (Duloxetine)
11. Luvox (Fluvoxamine)
12. Vestra (Reboxetine)

antidepressantsMy experience with Lexapro was a disaster and I’ve written about Zoloft’s connection with irritability and rage. Paxil’s side effects are especially rough (see Bob Fiddaman’s Seroxat page) while Effexor’s withdrawal effects proved to be significantly challgenging. Although Prozac offset Effexor’s withdrawal symptoms, it causes severe somnolence that can impair cognitive functioning. And last but not least, Cymbalta contributed to the unfortunate death of Traci Johnson who had no history of depression.

These drugs may be effective for many people but it’s still a guessing game. Dr. Mark I. Levy, quoted in ABC News’s article on the rankings, mentioned that while psychiatrists may not have much use for the rankings, he sees them as beneficial for primary care physicians. And Dr. Harold G. Koenig, a professor at Duke University Medical Center, adds:

“I would be likely to start patients on either Zoloft [because it’s cheaper] or Lexapro … Unfortunately, that is almost none of my patients. By the time they get to me [a psychiatrist], the primary-care doctors have tried Zoloft and other antidepressants, so my patient are not the “new to medication” kind of patients,” he said.

I won’t rehash my thoughts on PCPs prescribing antidepressants and other psych meds. You can read about them here.

Coming off of Lamictal (lamotrigine)

Medication

I am officially joining the ranks of those who are facing the challenge of Lamictal withdrawal.

On Wednesday, I went to see my psychiatrist with a plan to come off of Lamictal:

  • 150 mg for 3 months
  • 100 mg for 3 months
  • 75 mg for 3 months
  • 50 mg for 3 months
  • 25 mg for 3 months
  • 12.5 mg (depending on whether my side effects on the 25 mg are bad)

I told him that my husband and I were looking to have a child sometime next year and that I’d like to taper off of Lamictal but was open to the possibility of getting back on it should I encounter severe suicidal ideation and mixed episodes. He warned me against it and thought it was a bad idea.

He proceeded to say that it’s a maintenance medication, I have a lifelong disorder, it won’t just go away, my symptoms would probably return, I have a higher risk of attempting suicide, blah blah blah — am I aware of all these risks?

He explained people with bipolar depression after coming off of meds can actually be worse, undergo severe depressive episodes, have more suicide attempts, and yadda yadda yadda. To sum it all up, I was risking my life just to get off of Lamictal.

My pdoc was trying to scare me into staying medicated.

He then added if I really wanted to come off of my meds, I could “just stop.”

WHAT?! My eyes flew open.

He stated he’d had patients who had stopped cold turkey without a problem. According to him, anticonvulsants don’t have severe withdrawal effects.

WHAT?! His advice just flies in the face of what most doctors recommend. In fact, quitting Lamictal immediately increases the risk of seizures, which is exactly what I’m afraid of.

Philip’s experience and Gianna’s experience along with the comments on each blog are proof that many people have experienced tremendous withdrawal effects from decreasing Lamictal’s dosage. In the past, I’ve quit Paxil and Lexapro cold turkey — both with not-so-good results to put it mildly.

I insisted that I wanted to come off of it slowly so he said I could just cut my 200 mg pills in half and jump down to 100 mg and stop after 2 weeks.

For real? Two weeks, doc? I had a plan that would take me over a year and you’re reducing it to a mere two weeks? On 100 mg dosage?

Again, I insisted that I wanted to take more time. He reluctantly wrote me a 30-day prescription for 100 mg and said since I was off the medication, I had no need to see him anymore. “Good luck,” he flatly told me.

When I came home after the appointment (and a bitching session to my husband), I remembered that I’d stashed a few 150 mg pills away sometime ago after I jumped back up to 200. So as of Wednesday, my arsenal included:

  • A bottle of six 150 mg pills
  • A bottle twenty-five 200 mg pills
  • A prescription for thirty 100 mg pills

I dropped down to the 150 mg on Wednesday and have been doing all right so far. I intend to keep myself at 150 mg (cutting the 200 mg and the 100 mg in half) for at least 2 weeks, then drop down to 75 mg for 2 weeks and then 50 mg for 2 weeks. I’m most worried about coming off of the 25 mg. This is a way more accelerated plan that I hoped for but I’ve got to work with the cards that I’m dealt.

We’ll see what happens.

Done deal: Pfizer buys Wyeth for $68 billion

Pfizer-Wyeth merger

The New York Times puts it this way:

The deal, if completed, would not only create a pharmaceutical behemoth but would be a rarity in the current financial tumult: a big acquisition that is not a desperate merger of two banks orchestrated by the government. [emphasis mine]

Funny the writers decided to add that. A year ago, that clause would have never been considered yet alone thought of.

Pfizer isn’t doing badly; in fact, despite the credit crunch, they’ve been able to snag $22.5 billion in loans since they also have $26 billion cash on hand. The NYTimes also reports that this merger would be the biggest since AT&T and BellSouth merged back in March 2006. But of course, with mergers always come layoffs. And what a time to have layoffs. Pfizer today announced that they’ll be cutting 8,000 jobs.

But as I said in a previous post, Pfizer’s biggest challenge is get some pipeline products out to market soon since some of the patents on their big names (ie, Lipitor) are expiring soon. Don’t hold me to this but I think Wyeth has a bit more sitting in their pipeline, hence why the merger would make sense. But I hope Wyeth can produce a new blockbuster drug for Pfizer otherwise Pfizer’s really going to be hurting for money. Especially since Wyeth’s best-selling drug, Effexor, is now generic and Pristiq isn’t completely cutting it.

Study shows atypical antipsychotics pose a higher risk for cardiac arrest

The New York Times has reported that a recent study found atypical antipsychotics, which include the friendly family of Clozaril, Abilify, Risperdal, Zyprexa, and Seroquel (maybe Saphris soon), can increase a patient’s risk of dying from cardiac arrest twofold.

The study published in The New England Journal of Medicine also concluded that the risk of death from the psychotropic medications isn’t high. However, an editorial also published in the same issue “urged doctors to limit their prescribing of antipsychotic drugs, especially to children and elderly patients, who can be highly susceptible to the drugs’ side effects.”

A U.S. News & World Report article linked to the FDA’s atypical antipsychotics page for further patient information. If you’re on an atypical, I’d recommend reading each word in the patient safety info that applies to you. Proofreaders like me shouldn’t be the only ones tortured with reading all the fine print. *winks*

Christian counseling: Nouthetic vs. Biblical

Last night, I spent some time on the phone with my husband’s friend’s sister (aka my former pastor’s sister). We’ll call her Natalie.

Natalie was very sweet and kind, really encouraging and strengthening me by sharing her testimony of faith in God. She suffers from anxiety and panic attacks, which has led her to take Paxil (on and off) for the past 7 years. She says the drug has helped her tremendously and who am I to knock the drug (knowing what I know about Paxil/Seroxat) when she has seen the wonders that it has worked in her life?

I briefly explained my story of depression, history of suicide, and diagnosis of bipolar disorder. Although she couldn’t fully relate, she was very sympathetic and understanding. In fact, our conversation was so fruitful, I ended up taking notes!

Jay AdamsWe briefly touched on the issue of Nouthetic counseling (NC). She has undergone the course and simply needs to be certified. The counselor I currently see is associated with the Christian Counseling Education Foundation (CCEF), which has roots in NC and was founded by the man—Jay Adams—who developed the method. However, CCEF is now known for what is called biblical counseling. The organization has since moved away from pure Nouthetic methods and become more a bit more varied, taking bits and pieces of psychology (and perhaps psychiatry) that line up with the Bible. Adams, disagreeing with the organization’s approach, founded the Institute for Nouthetic Studies and uses the Bible as the sole counseling textbook. According to the wiki entry on Nouthetic counseling, Adams developed the word Nouthetic based on the “New Testament Greek word noutheteō (νουθετέω), which can be variously translated as ‘admonish,’ ‘warn,’ ‘correct,’ ‘exhort,’ or ‘instruct.'”

NC was developed back in the ’70s as a response to the popularity of psychology/psychiatry. Many Christians reject some of the teachings of such popular psychologists as Freud, Jung, Adler, Maslow, etc. Adams’ highly successful book, Competent to Counsel, criticizes the psychology industry and counters its teaching with a Nouthetic approach.

But NC has its Christian critics.

Read the rest of this entry »

Lamictal in consideration of pregnancy

My husband and I are talking about expanding our family. While that sounds all well and good, I just have one issue:

Lamictal.

For most women, they think, “Well, I want a kid” and the most they have to do is probably get off birth control. Just finish off their contraceptives, maybe feel a little nauseous, and move forward with their plans.

(sigh) Not me. If I want to do this right, it might be a good 6 months or so before I can consider trying.

Read the rest of this entry »

Lamictal's generic equivalent, lamotrigine, has now hit the market

So much for Miss Up-on-Pharmaceuticals.

I’ve been paying so much attention to Pristiq that the very medication I take slipped out from right under my nose.

How did I find this out? It hit me where it hurt.

In the pockets, of course.

I went to CVS yesterday night for my Lamictal refill. Since I’ve been under my husband’s plan, we’ve been paying about $40 for the medication. So I nearly doubled over when the pharmacy cashier said $54.

WHAT?

I was in a bit of a foul mood about money anyway so the last thing I wanted to do was argue about the cost of my prescription that had jumped up by $14. (Which, in retrospect, I probably should have done because I could have saved $49 right there.)

I came home and made my husband’s day go from bad to worse. He flipped out and got on the phone with his insurance immediately. He said that the max he should pay on any medication is $50 so why was he paying $54 and why the cost rose so sharply.

“Well, sir, it’s because Lamictal has now gone generic and you’re paying the difference between the cost of the medication and the cost of the generic.”

Bob gets off the phone and goes straight to Google News to find out when Lamictal went generic.

Money & drugsAccording to MarketWatch.com, Teva Pharmaceuticals commenced shipment of lamotrigine tablets on July 22nd
. So instead of either the pharmacist asking me if I wanted a generic version or the insurance company letting us know a generic version would be available (it would have saved them money), we ended up paying $49 more than necessary. It appears that Teva’s generic is AB-rated, which means that it has similar strength, bioequivalence, and efficacy. Overall, it likely shouldn’t be a problem if I go from Lamictal to lamotrigine. At least I hope not. We’ll see.

Mood rating:
5

Loose Screws Mental Health News

The mastermind behind Stavzor is Noven Pharmaceuticals (in conjunction with Banner Pharmacaps Inc.). The new “small, easy-to-swallow soft gel capsule” is available in three strengths: 125, 250, and 500 mgs. The pills are are “up to 40% smaller than han Depakote® and Depakote ER® tablets at the 500 mg dosage strength.” From Noven’s PR:

Stavzor is approved for the treatment of manic episodes associated with bipolar disorder, as monotherapy and adjunctive therapy in the treatment of patients with complex partial seizures that occur either in isolation or in association with other types of seizures, and for prophylaxis of migraine headaches.

The drug will hit the market in mid to late August.

The hotline receives an average 250 calls each day from veterans that have fought in Iraq, Vietnam, and Afghanistan.

The issue of soldiers with mental illness has recently come to light with studies showing that 1 in 5 soldiers returning from Iraq and Afghanistan have shown symptoms of post-traumatic stress disorder. The issue of the high suicides rate has been a high priority of the VA since mental health director Ira Katz tried to hide the significant number of suicides committed by veterans.

The National Suicide Prevention Lifeline is available 24 hours a day by calling 800-273-TALK (8255); veterans should press “1” after being connected.

“We have seen a 60 per cent increase in demand for our child anxiety classes in the past six months,” said [Dr. Kimberley O’Brien, of the Quirky Kids Clinic at Woollahra in Sydney].

It sounds more like the article is speaking of children who are exposed to constant physical and emotional abuse. If that’s the case, shouldn’t there rather be an increase in parenting properly classes?

Chemical imbalances do not exist; dying brain cells do

Researchers have never been fully confident in the chemical imbalance theory, yet the media continue to purport it as fact. Dr. John Grohol over at PsychCentral recently wrote:

We’ve all heard the theory — a chemical imbalance in your brain causes depression.

Although researchers have known for years this not to be the case, some drug companies continue to repeat this simplistic and misleading claim in their marketing and advertising materials. Why the FTC or some other federal agency doesn’t crack down on this intentional misleading information is beyond me. Most researchers now believe depression is not caused by a chemical imbalance in the brain.

How did we come to this conclusion? Through years of additional research. But now some are jumping on the next brain bandwagon of belief — that depression is caused by a problem in the brain neuronal network.

Grohol cites Jonah Lehrer's article in the Boston Globe in which he posits that researchers now think depression comes from "brain cells shrinking and dying." Lehrer writes:

Read the rest of this entry »

An inhalation drug for schizophrenia and bipolar disorder???

Oh no they didn’t. From Alexza Pharmaceuticals’ recent PR:

Staccato system-inhalationAlexza Pharmaceuticals, Inc. announced today that it has initiated its second Phase 3 clinical trial with AZ-004 (Staccato(R) loxapine). AZ-004 is an inhalation product candidate being developed for the treatment of acute agitation in patients with schizophrenia or bipolar disorder. Alexza believes the novel, non-invasive nature and rapid pharmacokinetic (PK) properties resulting from inhaled loxapine administration via the Staccato system (click on the photo to the right to see an enlargelarement) have the potential to make AZ-004 a viable product to treat acute agitation.

The supposed benefits:

  1. Rapid onset
  2. Ease of use
  3. Consistent dose and particle size
  4. Broad applicability

Is this pharmaceutical company really developing a product to treat schizophrenic and bipolar disorder symptoms by inhaling? I thought the injectable Risperdal was bad. Check out how the Staccato system works. It blows my mind that psych drugs are being developed for injection and inhalation.

Pristiq's side effects: Too close to Premarin and Prempro for comfort?

Back in January 2007, I’d mentioned that Wyeth was not only seeking to market Pristiq (desvenlafaxine) for depression but also for the use of vasomotor symptoms in menopausal women.

I just learned that Wyeth produces two major menopause drugs, Premarin and Prempro, that allegedly has produced hormones causing cancer in more than 5,000 women. This added up to a loss of 40 million users and $1 billion annually.

With Effexor going generic in 2 years and the introduction of Pristiq to the market, Wyeth hopes to lure some of those customers back and net an annual $2 billion. However, serious questions linger about Pristiq’s side effects in menopausal women.

Why did two women in the study group taking Pristiq have heart attacks
and three need procedures to repair clogged arteries compared with none
taking placebo? How can Wyeth assure long term safety when 604 of the
2,158 test subjects took Pristiq for only six months and 318 for a year
or more? And what about serious liver complications seen in the studies?

Martha Rosenberg, reporting on Pristiq’s use as a menopausal drug, culled comments from CafePharma’s message boards and found one thread rife with mixed comments on the new drug. From an Anonymous commenter:

Read the rest of this entry »

2-Year Anniversary: The Long and Winding Road

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.

I’ve been exploring the topic of suicide recently because it’s a subject that’s quite near and dear to me, now more than ever before.

Read the rest of this entry »

The Era of Quick Fixes

Pink Magazine: Out of DarknessPink magazine has an article called “Out of Darkness” on high-powered, successful women (likely in corporate America) who suffer from depression and try to hide it. There’s an online exclusive but the actual article can only be read in the print version of the magazine.

Apart from the three resourceful sidebars accompanying the article, the one thing that I felt was missing from the article more of an emphasis on psychotherapy. The article seemed to focus heavily on women whose condition improved as a result of medication. There appears to be only one mention of a women whose condition improved with psychotherapy and medication.

While I understand that medication can be an important factor in assisting those with mental illness to recovery, it should not be the sole form of treatment. Mental illness does not only involve the chemical/biological activity of the brain, but it also involves the psyche — the part of us that comprises of our personalities and behaviors. This is why cognitive behavioral therapy (CBT) and dialetical behavioral therapy (DBT), among other forms of treatment, can be so beneficial. I’m not a fan of being on medication but I feel that 80 percent of my recovery comes from my weekly Christian counseling sessions. Therapy, medication, or other forms of treatment are not cure-alls, and I’m concerned when I read that people rely solely on medication for treatment. These are the people who are most likely to suffer relapses because after a while, their medication just “stops working.”

Most people today are looking for a “quick fix.” We do this with weight loss (alli), food (McDonald’s), exercise (Fast Abs), and so much more. Then, it should be no surprise that people desire a quick fix to control their emotions. Some people use illegal drugs to dull the emotional pain in their life. Is it possible that psychotropics are the “legal” drugs that accomplish the same purpose?

Crazy Psychiatric Treatments

As if some psychotropic meds out on the market aren’t bad enough, out from the archives of Neatorama is a post on 10 Mind-Boggling Psychiatric Treatments. Somehow Insulin-Coma Therapy made it to #1 and lobotomy was listed as #10. I don’t know if they were placed in order of craziness. I didn’t even read the text of most of the treatments. The graphics and headlines were enough to make me cringe.

(Hat Tip: Bob Thompson)

John Grohol interviews Wyeth's VP of Medical Affairs on Pristiq

Dr. Grohol interviewed Dr. Phil Ninan, Wyeth’s VP of Medical Affairs on Pristiq, its efficacy, and surrounding issues. It was quite an interesting interview (and long) but here are some highlights that I chose to comment on. I’ll be making some comments in between Dr. Ninan’s answers due to the extensive length. Some parts of the answers have been truncated.

Read the rest of this entry »

Light posting again

POSTING
Posting may be light through Friday as I’m proofing an ENTIRE website — medication-related, actually — and making all the web copy is correct, the links work, and that the design/layout isn’t funky. Since it’s a website, it’s a huge job and it may take me until Friday. Here’s an example (not the real site I’m working on) of the monstrosity of the kind of work I’m doing.  I’m proofing every single piece of text on every page.  Funny thing is, I don’t mind. I love what I do.

PSYCHIATRIST APPOINTMENT
I have my psychiatrist appointment at 3:30 pm so I might be able to get a quick post in to let you know what happens. He’ll probably be concerned that I didn’t take my Abilify, but I just stopped taking fexofenadine (Allegra’s generic equivalent) and have begun to drop weight. I don’t need Abilify to help me pack it back on it again. I can do it quite easily with the help of the amazing bakery across the street.

COUNSELING
I had counseling last night but will be going again next week. I usually go once every two weeks, but my counselor is concerned since I’m having a consistent reoccurrence of suicidal thoughts. Even when I’m in a good mood, I still think of finding a way to kill myself. That’s not depression so much as it is my negative way of thinking. However, it’s still cause for concern considering that dwelling on the idea could actually lead to another attempt.

RISPERDAL WITHDRAWAL
I’ve read a few blogs in which people are enduring Risperdal withdrawal. I have a friend who’s currently coming off of Risperdal because her blood sugar is so high. She’s been on it for years. That’s one of the reasons why I don’t want to take an antipsychotic. Doctors put patients on it for long-term maintenance when most of the clinical trials have only studied short-term effects.

LAYOUT
I’ve become dissatisfied with how narrow the layout is on my blog so it’s possible that if you visit the site, it’ll look funky every now and then as I play around with it and decide on one I like. I’m not an expert with CSS so I tinker with it until I’m satisfied. I’d like my text area wide enough to post YouTube videos and pictures without them getting cut off. Just letting you know so you don’t wonder what happened to your browser.

FURIOUS SEASONS
Last but not least, if you like this blog, then please go to this one and donate $1, $2, or $5. If you know me in person, please donate as well. (I made a plea about this last week.) That blog provides me with inspiration to keep on going.  You can donate to Philip Dawdy via PayPal, check, or money order. (I guess you could send cash too but that’s never recommended.) Philip’s blog, Furious Seasons, has helped many people in the mental health community including myself.

Lexapro maintains status as first-line antidepressant therapy

Lexapro vs. Pristiq According to a Decision Resources (DR) press release, Lexapro (escitalopram), a SSRI, “retains leadership among first-line therapies in the treatment of major depression” despite the fact that physicians have increasingly moved toward the use of SNRIs, eg, Effexor (venlafaxine). However, the reason why SSRIs still retain their first-line status is due to

  • cost
  • efficacy
  • familiarity

SSRIs have been out on the market for much longer than SNRIs so it’s what physicians are more comfortable with. As far as I know, there currently aren’t any generic SNRIs in the U.S.

As a result, SNRIs are likely pricier.

DR’s survey of psychiatrists found that the majority believe SNRIs work better in treating clinical depression than SSRIs and about 44 percent believe they have fewer sexual side effects. PCPs were also included in this survey and it seems that the majority of them believed the opposite despite DR’s spin that a lot of PCPs are on board with psychiatrists. From personal experience, four SSRIs were prescribed to me before I was shifted to a SNRI.

In the up-and-coming SNRI department, DR forecasts a bright future for Pristiq (desvenlafaxine).

Physicians are expected to move patients from Effexor to Pristiq-a newly approved SNRI- over the next two years. … Pristiq will begin to replace Wyeth’s Effexor XR and Lilly’s Cymbalta, especially in
psychiatrists’ practices.

This is an interesting analysis from DR considering that psychiatrists, health insurers, and even some investors seem less than impressed with the slight advantages the “me-too” drug has over Effexor.

(logos from Forest Pharmaceuticals, Inc. and Wyeth)

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.

Read the rest of this entry »

Breggin takes on Newsweek's "Growing Up Bipolar" article

Breggin’s post on Newsweek‘s "Growing Up Bipolar" article makes good points but steers clear into wackiness throughout. My only wish is that instead of pointing out the problems of the psychiatric industry, he would have offered some suggested solutions.

Oh, and he flat-out gets some things wrong:

Newsweek makes clear that Max’s parents have serious conflicts over how to raise their son, but they have not pursued therapy, marriage counseling or, apparently, not even parenting classes.

The article DID mention that they tried to pursue marriage counseling but dropped out.

He says he has never been to therapy. But late last year, Amy demanded that the two of them see a marriage counselor. Richie agreed. They went a few times, but there were "scheduling issues," says Richie, and they haven’t gone back. For the moment, they are getting help from the same people who help Max. Anything that makes his life easier makes theirs easier, too.

Then he applies a broad brush from the cases of "out-of-control" children that he’s seen:

In every case of an out-of-control child I have seen in my psychiatric practice, either the parents were unable to reach agreement on a consistent approach to disciplining their child, or a single working mom was trying to raise a young boy without the aid of a male adult in the child’s life.

I like Peter Breggin’s approach to psychotropic drugs for the most part, but sometimes he just gets a little off-base for me.

Pharma's "me-too" drugs face skeptical docs and health insurers

As patents expire on a variety of drugmakers’ moneymakers, pharma companies have gone to great lengths to structurally reinvent the successful drugs then tout the benefits that differ from their predecessors.

InvegaCase in point — Johnson & Johnson’s Invega. Invega is the successor to the popular antipsychotic drug, Risperdal, and competitor to AstraZeneca’s widely used antipsychotic Seroquel. Scott Hensley at The Wall Street Journal’s Health Blog (WSJ) reports that Risperdal is going generic in June. Gianna at Beyond Meds recently said it will not. According to the Dow Jones Newswires (DJN), these “junior” drugs face skepticism from health insurers and doctors. California-based Kaiser Permanente and Minneapolis-based UnitedHealth Group Inc. (UNH) are example of companies that have somewhat discouraged use of the drug. Kaiser doesn’t cover Invega at all, and members of UNH are required to pay higher copays for the brand name. The wire reports New York-based psychiatrist Jeffrey Lieberman wasn’t “buying it” the difference between Invega and Risperdal.

Invega is “basically a me-too drug, and the company hasn’t done the studies that would be required to really distinguish it,” Lieberman, chairman of the psychiatry department at Columbia University’s medical school told Peter Loftus of Dow Jones Newswires.

Ouch.

The blog also quotes Daniel Carlat from the The Carlat Psychiatry Report.

Dan Carlat, a psychiatrist and a tough critic of Invega, wrote that J&J’s “marketing team apparently missed the fact that the word in the English language that sounds most like “Invega” is “inveigle,” meaning “to entice, lure, or ensnare by flattery or artful talk or inducements.’ ” He asked doctors: “Will you be doing your patients a favor by taking the plunge? Or will you simply be giving them the same wine in a fancier bottle?”

Even J&J’s Group Chairman of Pharmaceuticals, David Norton, admitted that Invega is a tough sell.

“We need to do a better job at drawing a differentiation in a difficult-to-treat population.

So far, Invega sales have been incredibly disappointing compared to the Risperdal blockbuster.

Wyeth (antidepressant Effexor XR cum Pristiq) and Shire (ADHD drug Adderall XR cum Vyvanse) face the same uphill battle. Wyeth’s Effexor faces generic competition from Teva Pharmaceuticals despite efforts to halt generic sales of the drug and the patent on Shire’s Adderall is set to expire next year.

Hensley, in his analysis, raises a question in which the answer remains to be seen:

Cheap generics abound to treat a broad assortment of illnesses these days. What’s the point, the critics ask, of paying more for drugs that are at best only slight improvements over tried and true medicines available at bargain prices?

It’s something that I’ve questioned myself.

In an attempt to have the “me-too” drugs compete with its derivative, both Wyeth and Shire are slashing their prices, or as the DJN reported, “emphasizing improved dosing for the newer drugs.” Although Pristiq’s efficacy comes at higher doses, it’s being priced 20 percent lower than Effexor.

[Deutsche Bank pharmaceutical analyst Barbara Ryan] thinks the odds of
Pristiq’s success are slim because it appears to offer few benefits
beyond those of Effexor.

That remains to be seen. So far, a few patients have commented on my blog that Pristiq has already begun to help them. I haven’t seen any DTC ads for Pristiq so I can only assume that drug reps are doing a fine marketing job at selling the different benefits of the drug to doctors.

Vyvanse, on the other hand, is looking promising for Shire, already having 7 percent of U.S. ADHD drug prescriptions. Chief Executive Matthew Emmens says the drug is chemically different from Adderall (aren’t they all?) and has better pricing. Shire expects to beat Adderall’s 26 percent peak market share. Seems like a lofty goal to me.

As for Invega, J&J is currently seeking FDA approval to use the drug for bipolar disorder and not just treatment for schizophrenia. It is also l0oking to get approval for an injectable Invega XR.

(Invega logo from Janssen.com)

Depression Overawareness and Overmedication Week

The Pursuit of Happiness

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)

Loose Screws Mental Health News

John Grohol at PsychCentral reports that the fate of the mental health parity bill is uncertain as its main champion, Sen. Ted Kennedy, takes a leave of absence to focus on treatment of his brain tumor. I echo John’s thoughts in hoping to see that other senators are willing to carry the torch and pass this important piece of legislation.


I came across a post from Kalea Chapman at pasadena therapist in which she linked to a WSJ article on whether veterans suffering from PTSD should be awarded the Purple Heart.

Supporters of awarding the Purple Heart to veterans with PTSD believe the move would reduce the stigma that surrounds the disorder and spur more soldiers and Marines to seek help without fear of limiting their careers.

Opponents argue that the Purple Heart should be reserved for physical injuries, as has been the case since the medal was reinstituted by Congress in 1932.

I side with the opponents. The Purple Heart should be awarded to be people who have visible evidence of bravery. With the rising number of PTSD prevalence, I’m afraid that the award would be handed out like candy. The rising number of veterans with PTSD on disability has caused enough of an issue that a Texas VA facility wanted mental health officials to stop diagnosing veterans with the condition.


Jordan Burnham, an 18-year-old student who survived a nine-story jump from a building, plans on walking at his graduation with the assistance of two canes. A family who used to attend my church knows this family and put him on my church’s prayer list. It’s a small world, after all.


Finally, it looks like expecting moms should have no fear of causing birth defects in their baby while taking antidepressants, according to a study being published in the British Journal of Psychiatry.

A research team from Montreal University studied more than 2000 pregnant women on antidepressants and discovered the drugs did not present any adverse effects. However, it sounds like they only oversaw the women while they were pregnant in their first trimester. I haven’t seen the actual study but it doesn’t seem to mention whether the women discontinued the antidepressants after the first trimester.

Analysis of "Depression: Out of the Shadows"


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?

Celebrity Sensitivity: Christina Ricci, Mel Gibson, and Britney Spears

Liz Spikol has a new post on celebrities talking about mental disorders. This time, it’s Christina Ricci and Mel Gibson. Ricci has previously admitted to suffering from anorexia but now admits to suffering from depression. Gibson, on the other hand, said in a 2002 interview that he was bipolar (manic-depressive back in the day). Then she’s got a whole list of people who have recently admitted to depression.

Then there’s Britney Spears. If you don’t know who she is, be thankful. For the rest of us who spend our time following celebrity news, there have been rumors swirling around recently that she is pregnant because she’s got a big, protruding belly (bigger than the botched VMA’s last year) even though she’s been exercising regularly.

Britney SpearsAccording to the Daily Mail, Spears isn’t pregnant but seriously bloated as a result of her medication.

A source close to the family says that Britney has been struggling with her weight ever since she had her second son Jayden James, 20 months, and the medication has not helped.

The pop star has been back in training in preparation for a comeback, spending plenty of time on the treadmill – but despite all the effort, she is failing to regain the svelte figure which made her famous.

I wonder what antipsychotics she’s on. Seroquel?

Finally, ABC News wrote about celebrities who suffer from various mental illnesses. I’d been wanting to blog on this some time ago but never had the chance. BPD in OKC beat me to it.

My official position on pharmaceutical companies and psychotropic meds

In previous posts, perhaps I’ve come off a little bit as “I hate Big Pharma.” I did. For a while.

I’m not in love with pharmaceutical companies either. I’ve quoted it before but “to whom much is given, much is required.” As a result of accumulating knowledge through reading and research, I know a whole lot more about pharmaceutical companies, the treatment options they put out there, and what lengths they go to get those treatments out there. Most of the things I read are negative. Much of what I’ve said is negative. Perhaps “ignorance is bliss.” My husband said this recently:

“The Internet is the great bitching ground. No one’s going to talk about how great medication is. Everyone’s going to go on and just bitch about side effects and bad experiences.”

I agree. “Effexor really helped me feel better today” doesn’t make for an interesting blog post. No one pays attention to medication when it’s working, however, everyone will complain if something is going wrong. The most “positive” drug comments I’ve seen are on my seemingly “negative” posts from people who are being helped by a drug.

Take, for instance, the following comment from Suffering:

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Thank you

Thank you, everyone, for your well-wishes and outpouring of support. I saw my psych today and he is adding 2-5 mg of Abilify to my medication regimen. He had me choose between Geodon and Abilify. Of course, I am hesitant to do this. Take a look at Philip’s post on Abilify and then take a look at CLPsych’s post about how Abilify performed against placebo. My psych pointed out that I did better on 200 mg of Lamictal but I distinctly remember feeling cognitive impairment on 200. The 150 seemed to work well for a while but I don’t know what’s happening. And to be quite honest, I’m always a little wary of alternative treatments even though I know they have helped so many people. I wonder if they are for me.

More thoughts soon…

Gone but I don't know where

You have been drifting for so long / I know you don’t want to come down / Somewhere below you, there’s people who love you / And they’re ready for you to come home / Please come home
~ Sarah McLachlan, “Drifting”

I have an appointment with my psychiatrist on Tuesday morning. I’m not quite sure what to do.

My “symptoms” are back. Now that I know what to look for as someone with bipolar disorder, I am aware of them. I’m having mania moments. I don’t want to sleep. I have no desire to. My husband sometimes MAKES me go to sleep. I’d rather be up doing the laundry, washing the dishes, blogging, reading other blogs, making to-do lists, and organizing the apartment–all at the same time–at 2 or 3 am. (This doesn’t mean all of this stuff gets finished.)

My husband and I have had physical fights in the past where he has had to restrain me because I wouldn’t go to bed and I wouldn’t sleep. It would be 4 in the morning and I refused to sleep and I’d fight him tooth and nail. I don’t know why. I have no problem wanting to sleep at 2 pm. Make it 2 am and there’s too much to do suddenly. I have the superhuman ability to get things accomplished between midnight and 5 am more than I can during the hours of 9 am to 11 pm. Right.

So now it’s almost 1 in the morning and I have nursery duty at church later in the morning. Then I have a hair appointment in the afternoon. Then I’m paranoid about what my hair stylist thinks of me.

She says she’s my friend but I wonder if she’s just pretending to like me because she feels sorry for me. I’m really lame you know. People at work acted nice to my face and then dissed me behind my back. She does the same thing to others, why wouldn’t she do the same to me? She just keeps me around and kisses up to me because I tip well.

Thinking like that scares me. It reminds me of the way my father used to think. Paranoid. (You can stop reading here. At this point on, it’s just a manic ramble that’s basically full of nothing but stream-of-consciousness just because i can.)

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"You can do this"

From October 10, 2006:

carI’m tempted to go crash my car.

Again, the boy cried wolf.

Except I’m a girl.


Right now, I’m going through what my old pastor used to say is a “spiritual winter.” I just fall into moments when I just cease praying and reading my Bible for whatever reason. I’m not mad at God or anything; I still struggle with believing in a God that I’ve never seen with my own two eyes. But then I think about the specific events that have taken place in my life and I know He exists.

With that being said, I sat in my car this morning with the ignition turned on, ready to drive my car over the bridge into the Schuylkill River. I was ready to run home, make the stupid “goodbye world” post on this blog, text my husband “I love you. Goodbye” and then ram my car into a divider on I-76. It’s the worst suicidal thought I’ve had since I ended up in the hospital in October 2006.

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Loose Screws Mental Health News

If the state gets its way, hundreds of children could be put in foster homes, in what could be a wrenching cultural adjustment that may require intensive counseling.

Wow. That's all I can say. How do you place 400 different children in foster homes and ensure they'll get proper care? You can't.

NYTimes

“The drugs save lives, and we often have no choice but to use them — even if we have questions about their long-term use. But the questions are big ones, and we owe it to our patients to try to answer them.”

Richard FriedmanDr. Richard Friedman, a frequent mental health columnist for the New York Times, has written a piece that questions the use of antidepressants and how dependent patients have become on them. I’ve read Friedman’s previous columns and appreciate his realistic take on the psychiatric and psychological field. His most recent piece is worth reading.

Pittman, Zoloft, and akathisia revisited

Christopher PittmanI’ve written about Christopher Pittman, now 19, who confessed to shooting and killing his grandparents when he was on psych meds at the age of 12. He appealed for a Supreme Court hearing but was denied, CNN reported today. He — and his defenders — appealed on the grounds that his 30-year sentence was “excessive for someone that age” and that the dosage of his antidepressants at the time (200 mg) “sent his mind spinning out of control.” Pittman was tried as an adult and, his lawyers argue, “no other inmate in the United States is serving so severe a sentence for a crime committed at such an early age.”

In previous posts here and here, I’ve questioned the link between Zoloft and violence/rage. Pittman, in 2001, had been switched to Zoloft a few days before the murder of his grandparents. However, it sounds like there had been some emotional problems in Pittman’s life that may have given prosecutors a solid case:

At the time of the crime, the boy had bounced around homes for years, experiencing a half dozen family splits and divorces after his mother had twice abandoned him as a child. She has not been in Pittman’s life for years.

Joe Pittman, the boy’s father, raised Christopher Pittman and his sister for much of their lives, but the relationship between father and son deteriorated. A state psychologist later testified this was a “young man who’d had difficulty with the adults in his life.”

On November 28, 2001, Pittman was sent home early for fighting in school and sent to bed by the grandparents. The boy claimed his “Pop-Pop” also beat him with a belt as punishment.

South Carolina prosecutors may easily have set Pittman up as a disturbed young man, which he very well may have been. But there are indications that this disturbance transcended his emotional state into his mental health:

After threatening to harm himself and suffering other emotional incidents, the boy was diagnosed as clinically depressed. His lawyers said Pittman was then given Paxil, a mild antidepressant no longer recommended for those under 18.

Just days before [shooting his grandparents], a doctor had begun prescribing Zoloft, another antidepressant. The family contends the abrupt substitution of drugs caused a bad chemical reaction, triggering violent outbursts.

At trial, a parade of psychiatrists offered conflicting testimony on whether the boy’s emotional problems excused his criminal behavior. Prosecutors called the Zoloft defense a “smokescreen.”

Juror Steven Platt later told CNN the crime appeared deliberate. “It always seemed like the defense was grasping at straws,” he said. “Just because you take prescription medicine doesn’t mean you can’t be held accountable for your actions.”

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Generic drugs are not exactly like brand names

Gianna at Bipolar Blast stumbled upon an article at the LA Times that outlines the FDA’s standard for generics:

In almost all cases, the FDA permits a generic drug to release 80% to
125% of an active ingredient into the bloodstream, compared to that
released in a single dose of the original medication.

Gianna makes a good point for tapering down on brand-name meds then switching to generics:

And definately too broad when I’ve been cutting down my only 10% at a
time. If the drug is 80% of what I’m taking that is a 20% cut without
intending a reduction. It of course can work the other way and make
coming off the drug a longer task and more difficult if it’s actually
125% of the brand name.

eek – that’s something to think about.

Loose Screws Mental Health News

I recently wrote about the MOTHERS Act and the unnecessary scare tactics surrounding it. A Dallas-Fort Worth TV station picked up on the story and provided a short one-sided view of the issue, continuing to purport that the bill is solely about drugging new moms. I don’t discount Ms. Philo’s terrible experience with her medication. In fact, I’d be against the act if its sole purpose was to force treatment on pregnant women – medicated or not. Again, I’d like to reiterate that the bill’s purpose is to educate moms about postpartum depression and postpartum psychosis – not to shove unnecessary pills down women’s throats.

If you have sleep apnea, your CPAP (Continuous Positive Airway Pressure) machine may alleviate depression symptoms. My husband has sleep apnea and hasn’t been able to use the CPAP machine because of sinus problems. When he doesn’t use it (he hasn’t for a while), he’s noticeably moodier and prone to depressive symptoms. But then again, anyone who doesn’t get good sleep for several days is pretty moody.

Seroquel XRAstraZeneca (AZ) is going after Teva Pharmaceutical Industries and Novartis AG’s Sandoz unit after the two companies applied to make cheaper version of Seroquel available. AZ’s patent on Seroquel expires in 2011. The trial date for patent litigation is August 11. In the meantime, according to the Bloomberg report, the FDA is considering approval of Seroquel XR for bipolar depression and bipolar mania.

What is it about the U.K. that they seem to take pharma’s power more seriously than the U.S.? The UK Medicines and Healthcare products Regulatory Agency (MHRA) charged GlaxoSmithKline (GSK), the maker of Seroxat (Paxil in the U.S.), with not fully disclosing their clinical trial data that downplayed serious side effects such as increasing suicidal tendencies among those 18 years and younger. The MHRA also asserts that Seroxat didn’t alleviate depression as much as GSK’s initial data showed. GSK, of course, denied manipulating the data to show favorable results:

GSK denies withholding data, claiming the risks did not come to light until the results of nine studies were pooled.

The UK minister of public health, Dawn Primarilo, promised to address the issue of Big Pharma hiding negative clinical trial data.

“Notwithstanding the limitations that may exist in the law, pharmaceutical companies should disclose any information they have that would have a bearing on the protection of health,” she says.

In other news, I shouldn’t be a successful writer or novelist. The correlation between creative writers and suicide is ridiculously high. More than 70 well-known writers and poets have successfully committed suicide. How much more “unknown” writers and poets have as well?

(Image from Monthly Prescribing Reference)

Loose Screws Mental Health News

An article in the NYTimes addresses the issue of diagnosing mental health in developing countries. A startling fact:

Depression and anxiety have long been seen as Western afflictions, diseases of the affluent. But new studies find that they are just as common in poor countries, with rates up to 20 percent in a given year.

emoIn India, as in much of the developing world, depression and anxiety are rarely diagnosed or treated. With a population of more than one billion, India has fewer than 4,000 psychiatrists, one-tenth the United States total. Because most psychiatrists are clustered in a few urban areas, the problem is much worse elsewhere.

Looks like depression is really more than just a whiny rich American kid who chooses to be upset because he’s got nothing better to do. That’s “emo” for those who aren’t hip-to-the-jive. 😉


On The Elite Agenda, Dr. Fred Baughman mentions Swedish writer Janne Larson who asserts that “over 80 percent of persons killing themselves were treated with psychiatric drugs.” Thank God for FOIA that provides the docs to back this up:

According to data received via a Freedom of Information Act request, more than 80 percent of the 367 suicides had been receiving psychiatric medications. More than half of these were receiving antidepressants, while more than 60 percent were receiving either antidepressants or antipsychotics. There is no mention of this either in the NBHW paper or in major Swedish media reports about the health care suicides.

I guess Sweden isn’t the only country in the world that wants to sweep unfavorable mental health coverage under the rug. By the way, Sweden also is considered to be the seventh happiest country in the world.

While the FDA has recognized that antidepressants can cause an increase in suicidal behavior (as indicated by the “black box warning”), antipsychotics seem to have fallen under the radar. In fact in 2002, Clozaril was approved to combat suicidal behavior in schizophrenic patients. Since then, research has shown that antipsychotics can increase suicidal behavior in schizophrenic patients twenty-fold.

Akathisia – a serious side effect that has occurred for nearly all psych drugs in clinical trials – has been found to be linked to suicidal behavior with not only antidepressants but also in conjunction with antipsychotics.

Finally, Baughman closes with this:

It is important to note that nearly every school shooting that has happened in the United States over the last decade has been conducted by young males who were taking antidepressant drugs. The drugs not only cause suicidal behavior, they also seem to promote extreme violence towards other individuals. In most school shooting cases, the young men committing the violence also committed suicide after killing classmates and teachers. These are classic signs of antidepressant use.

I don’t know if that’s wholly true but it’s a trend I’ve seen with Cho, Kazmierczak, and Eric Harris of Columbine. Since 1996, there have been 55 major school shootings all around the world; 43 of them occurred in the U.S. Makes you wonder how many of these gunmen were on a psychotropic drug – prescribed or not – of some kind.

(Image from Style Hair Magazine)

Today's lesson: Paxil and Lexapro are not great antidepressants

Dawdy at Furious Seasons wrote a post on an editorial in the LA Times by Summer Beretsky’s experience with Paxil. After reading her editorial, I’m reminded that my own experience with one antidepressant wasn’t all that unique. Her drug was Paxil for panic attacks; mine was Lexapro for depression following a 3-month (on-and-off) stint with Paxil. I’m struck by the similarity of our experiences; not only did the same thing happened to me but I was also a communications major in college as well.

Paxil had one pretty undesirable effect on me: I started to lose interest in just about everything. I stopped initiating social activities (who needs that sort of thing?) and was no longer motivated to perform well academically.

My emotions had flat-lined: I hadn’t cried in months, nor had I proverbially jumped for joy. I felt — nothing.

I can still remember sleeping in bed at home on a weekday when I should have been at class. It was 2 in the afternoon, around the time my copy editing class was to begin. My boyfriend at the time (now my husband) lived in Kentucky while I attended college in New York. He planned to visit me that weekend but was getting fed up with my depression and listlessness. He called from work to tell me to get up and go to class. I mumbled on the phone, half-confused, and said no. He demanded, “Why not?” I said quite plainly, “Because I don’t care.” He said, “If you don’t get up and go to class, I won’t visit you this weekend.”

I replied, “I don’t care.”

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Selective publication on antidepressant efficacy and data

After the release of the U of Hull study on Tuesday, the AFP has written an article about doctors who are urging patients on antidepressants to continue taking them.

Louis Appleby, national clinical director for Mental Health, told the Press Association: "… the message to patients and doctors remains the same — anti-depressants are an appropriate treatment for moderate or severe depression."

I agree that patients on antid's should not cease medication cold turkey. (Trust me on this one. Even with proper tapering, the side effects are not pretty.) I waver on the idea that antid's are "appropriate treatment" for moderate-to-severe depression rather than a "form of treatment." Antidepressants can help, but I'm not sure I like the term "appropriate." But I likely am arguing semantics.

Since the results of the study originate from Britain (despite the fact that it also includes data from the FDA), I can only assume that news reports on this are more widespread over there. In my Philadelphia, USA-world, it seems a little bit off the radar to me. Let me know if I'm wrong.

To Mr. Appleby's credit, he has acknowledged that the British government plans to rigorously pursue routes of alternative treatment in light of the study.

The government has plans to expand the availability of psychological therapies as an alternative to drugs, Appleby explained, with extra investment and more psychological therapists.

"The evidence shows that these therapies are effective and often preferred by patients."

WebMD also covered the recent study.  Dr. Nada Stotland of the American Psychiatric Association insists that the study is not reflective of real psychiatry.

"We know that many people who are depressed do not respond to the first antidepressant they try," she says. "It can take up to an average of three different antidepressants until we find the one that works for a particular individual. Therefore, testing any single antidepressant on a group of depressed individuals will show that many of them do not improve."

Stotland has a point. Patients usually do not respond to the first antidepressant that is prescribed to them. About 30 percent of patients do not respond to antidepressants or experience no improvement until several weeks later.  Even then, patients who are on antidepressants for long-term maintenance, experience the return of depressive symptoms. An article from The New England Journal of Medicine evaluated the selective publishing of antidepressant trials with a positive efficacy:

Among 74 FDA-registered studies, 31%, accounting for 3449 study participants, were not published. Whether and how the studies were published were associated with the study outcome. A total of 37 studies viewed by the FDA as having positive results were published; 1 study viewed as positive was not published. Studies viewed by the FDA as having negative or questionable results were, with 3 exceptions, either not published (22 studies) or published in a way that, in our opinion, conveyed a positive outcome (11 studies). According to the published literature, it appeared that 94% of the trials conducted were positive. By contrast, the FDA analysis showed that 51% were positive.

The authors' conclusion: "Selective reporting of clinical trial results may have adverse consequences for researchers, study participants, health care professionals, and patients." It's an obvious statement; so obvious, it can be easily overlooked.

While it's important to shed light on the issue of treating depression with antidepressants, it seems as though many authors are cherry-picking favorable results to publish. Considering that much of these research studies are backed by drug companies, it's no surprise. Also, I can't fault the authors only. I recently freelanced for a medical publication and learned that many of the submitted articles are heavily rewritten by the editors. Editors are hard-pressed (and probably loath) to publish a piece that criticizes antidepressants when their biggest advertisers include such big names as Wyeth, Eli Lilly, and GlaxoSmithKline. Run enough of those pieces and a publication is quickly on its way to folding.

That's why it's stunning to read the U of Hull study that has somewhat of a negative slant toward antidepressants' effectiveness. While doctors are wisely advising patients to continue any antidepressants they may be on, currently drug makers have launched into damage-control mode.

In a statement, GlaxoSmithKline (GSK) representatives express "disappointment" at how the study was being reported by the media, suggesting that news reports may have caused "unnecessary alarm and concern for patients."

Of course these news reports are "unnecessary" to GSK. Letting patients know that their antidepressants might not work better than sugar pills isn't good for business. However, GSK's reps were kind enough to balance out their statement, adding "counseling and lifestyle changes" also are important aspects of treating depression. Then, the company accuses the researchers of selectively reporting their data:

"GSK fully endorses public disclosure of clinical trial results for its medicines and is actively committed to communicating data relevant to patient care," the statement reads. "All the data related to GSK's clinical trial results of [Paxil], regardless of study outcome, are available at the company's clinical trials register at 20 www.gsk.com."

Tell that to the estimated 5,000 Americans who have filed a lawsuit against GSK regarding Paxil. Still, Kirsch, who has received consulting fees from Squibb and Pfizer, insists "the [drug companies] certainly do publish selectively."

I'm inclined to agree.

Take two pills and call me if there's a birth defect

A recent article in the NYT reported that two studies released in The New England Journal of Medicine claim that an antidepressant could potentially increase the risk of a baby being born with a birth defect, but, uh,  it's unlikely and "confined to a few rare defects."

Benedict Carey, author of the article, points out that the studies didn't have a good sampling to really prove that assertion:

"In both studies, researchers interviewed mothers of more than 9,500 infants with birth defects, including cleft palate and heart valve problems. They found that mothers who remember being on antidepressants like Zoloft, Paxil, or Prozac while pregnant were at no higher risk for most defects than a control group of women who said they had not taken antidepressants."

So what's it's sounding like for me is that researchers got a group of expecting moms together, basically said, "Hey, have you taken an antidepressant?" and the ones who said yes were placed in one control group and the ones who said no were placed in another. How reliable.

Having been part of a clinical trial for bipolar disorder, I know it's likely these women got paid for their participation in this study. (Most people do, from what I understand.) So some could essentially have lied in the hopes they could snag $100. It doesn't sound like these women agreed to have their past medical history released to researchers that could prove they've been on antidepressant medication, they could have just been like:

"Uh, yeah. I took the antidepressant with the happy little egg sad face thingy."

Doctor: "Zoloft?"

"Yeah, yeah! That one. It maketed me alllll better."

Remember – it's mothers who "remembered" being on antidepressants while pregnant, not medical histories that proved that they've at least been prescribed the medication.

One doctor, not involved in the research, had reservations about the so-called findings:

"These are important papers, but they don't close the questions of whether there are major effects" of these drugs on developing babies, said Dr. Timothy Oberlander, a developmental pediatrician at the University of British Columbia, who was not involved in the studies.

Despite the seemingly positive outcomes that "support doctors' assurances that antidepressants are not a major cause of serious physical problems in newborns," both studies uncovered some pretty serious – but considered rare – conditions.

"One of the studies, led by Carol Louik of Boston University and financed in part by the drug makers GlaxoSmithKline and Sanofi-Aventis, found that use of Paxil was associated with an increased risk of a rare heart defect, which the company had previously reported.

The other study, led by Sura Alwan of the University of British Columbia, found that use of antidepressants increased the risk of craniosynostosis, a condition in which the bones in the skull fuse prematurely. Rare gastric and neural tube defects may also be more common in babies exposed to the medication, the studies suggested."

But don't worry, pregnant moms – the risks are low, "appear remote, and confined to a few rare defects." So, hey, even if your baby DID develop a rare defect, at least it's rare! [sarcasm]

I'd take the chance of depression if it meant my baby had a better chance of being born healthy. I'm lucky – I couldn't take Lamictal if I got pregnant. I wish antidepressants would have the same instruction.

Women & Antidepressants

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.

Melissa McNeilDr. Melissa McNeil at the University of Pittsburgh points out three things:

  1. Since depression is a prevalent (see common) condition, doctors are better detecting it.
  2. Since antidepressants have proven their safety and efficacy, primary care physicians have no reservations prescribing them.
  3. 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.

Viktor BouquetteDr. 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.

Tips for proper self-withdrawal from medication(s)

Gianna, a reader of this site, has a great and informative blog, Bipolar Blast. In a recent post, she gives some tips for proper psych drug withdrawal. This is particularly helpful for those dealing with severe antidepressant withdrawal effects. For me, Effexor comes to mind. I also think about "Honey’s" experience with Zoloft. Not only does Gianna emphasize diet and nutrition as an important part of the process, but she also delves into proper titration. (Many people think that the diet and nutrition thing is obvious, but many people overlook that important piece of recovery.)

I understand that many people – especially in the psych world – think Peter Breggin’s a wack job, but he can have some good points. Gianna refers to Breggin’s 10% rule:

"Breggin suggests what has come to be known the 10% rule. Any given drug should not be reduced anymore than 10% at a time. Once a taper is complete the next taper should not exceed 10% of the new dose. Therefore, the milligram, then fraction of milligram amount decreases with each new taper. I’ve found that I have to sometimes go in even smaller amounts. As low as 5% and sometimes people go as small as 2.5%–for people on benzodiazepines it is not unusual to go in even smaller amounts. Cutting pills is not always enough. Sometimes liquid titration is necessary. This may involve dissolving the smallest dose pill in water, club soda or even alcohol, which can then be diluted with water, then using a syringe to cut down milliliters at a time. Medications also sometimes come in liquid form and can be gotten by prescription. It should be noted that some medications should not be dissolved. Especially time released medications. This would be extremely dangerous."

Gianna clearly knows what she’s talking about. Head on over to her site to read the rest of the post.

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