Loose Screws Mental Health News

In the wake of the Newtown, CT shooting, NRA chief executive Wayne LaPierre called for a national registry of those who are mentally ill. According to the Washington Post, the federal government does not possess the constitutional authority “to require state agencies to report data.” All the federal government can do is either offer or withhold funding, as it did in the wake of the 2007 Virginia Tech Shooting when it provided additional funding for state governments that shared 90 percent of their mental health records. But it seems that 38 states already maintain an active database that “require or authorize the use of” mental health records during gun background checks. And the Gun Control Act of 1968 does not allow sales of firearms to people who have been institutionalized or considered to be mentally “defective.”

For the purpose of firearms sales, I support the idea of maintaining a database of people who have been institutionalized. This could prevent a person from being a harm to himself or to others. I speak as a person who has been institutionalized for being a harm to herself more than once. If I’d had access to a firearm, I wouldn’t be here right now. There may be many others who are in the same boat.


The New York Times reported on mental health coverage through insurance. In any given year, 26 percent of adults have a mental disorder, and 6 percent of adults have a mental illness that prevents them from functioning, according to the NIMH. In addition, 21 percent of teenagers between the ages of 13 and 18 undergo a “severe emotional disturbance.” But it seems as though 85 percent of employers offer some kind of mental health coverage through insurance, and 84 percent of employers with more than 500 employees allowed access to in-network and out-of-network mental health treatment. Beginning in 2014, insurance plans will be required to cover mental health disorders as part of President Obama’s Affordable Care Act.

The New York Times notes that many psychiatrists, however, don’t accept insurance:

Plenty of psychiatrists in private practice accept no insurance at all, though it is not clear how many; their professional organizations claim to have no recent or decent data on the percentage of people in private practice who take cash on the barrelhead, write people a receipt and send them off to their insurance company to request out-of-network reimbursement if they have any at all.

My psychiatrist does not accept insurance. He writes me a receipt, and I am to seek out-of-network reimbursement, a claim that has been repeatedly rejected by my insurance. The NYT is right on the money in this instance. But I am happy with my psychiatrist and would rather pay out of pocket for him without reimbursement than to find another psychiatrist who is in network.


According to the San Francisco Chronicle, California is ahead of every other state in covering mental health services with public money. But as always, there are critics who say California does not go far enough, even though in 2004, California voters approved Proposition 63 that funnels $1 billion annually for mental health services by taxing the state’s highest earners. But funding is being cut, not just in California but also nationally, according to NAMI.

Overall, California cut $768 million from its state mental health services outlay during the past three fiscal years, according to a November 2011 report from the National Alliance on Mental Illness. California’s 21 percent reduction in mental health funding over that period is the seventh-highest among all states.

Nationally, states cut more than $1.6 billion in general funds from their state mental health agency budgets for mental health services since 2009, according to the 2011 report by the National Alliance on Mental Illness.

I’m not sure what can be done to stop funding cuts of mental health services when state budgets are slashing services across the board.


And finally, according to NY1 News, New York City Mayor Bloomberg has announced an initiative to get mentally ill people out of jail and into treatment facilities. The mayor’s office estimates that 36 percent of inmates suffer from some kind of mental disorder. The city initiative will attempt to “reduce incarceration rates, improve jail safety, and lower crime.”

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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)

Thoughts on Bipolar Overawareness Week: Part III

In all seriousness, I have wondered about the BPD diagnosis but in my mind, have somewhat fallen short. I don’t think my symptoms are strong enough to be plastered with a BPD label.

To conclude my several-post rambling, I should answer the question that I initially posed. Do I think bipolar disorder is overdiagnosed?

No.

Many of my fellow bloggers will likely disagree with me. Zimmerman’s study at Rhode Island Hospital took into account whether those “diagnosed” with bipolar disorder had a family history of the diagnosis in the family. Maybe I’ve turned to the dark side. Just because I don’t have a family history of bipolar doesn’t mean that I can’t suffer
from the disorder. However, I have a family history of schizophrenia: one father and two aunts. Does this put me at a higher risk for schizophrenia? Definitely. Does this mean I could suffer from bp and have the schizo gene pass me by? You bet. I don’t think that I need a first-degree relative to suffer from bp to make me a classic diagnosis for bp.

For instance, when it comes to my physical appearance, I’m the only one on both sides of the family who suffers from severe eczema to the point where my dermatologist suggested a punch biopsy. Does that mean that I need to have a family history of eczema to obtain the malady? Not necessarily. Why is bipolar disorder any different?

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Loose Screws Mental Health News

The London Free Press reports that more than 80 percent of employees admitted to taking a “mental health” day. Most people took the day (or days) off because of work-related stress. Others called out because they were tired, bored, or lacked motivation to go to work that day.

The Royal College of Psychiatrists published a report about a month ago that concluded abortions can lead to mental illness. This is significant considering that many psychiatrists in the mental health industry deemed carrying out an unwanted pregnancy to term far more of a mental health risk than getting an abortion. However, the report seems to be echoing old information: in 2006, the Journal of Child Psychology and Psychiatry arrived at the same conclusion in young women who had abortions.

At last, New York victims of the 9/11 attack are getting assistance with their mental health benefits. Newsday reports that the benefit program “will reimburse out-of-pocket costs for mental health or substance-use treatment through a claims process similar to any insurance benefit.” These costs include outpatient services, medication related to treatment, lab work, and psych evaluations.

Unfortunately, the benefit only applies to those living in the New York City boroughs or are workers of the city. Anyone from NYC who’s curious to find out about whether they’re eligible can dial 311 or go to www.nyc.gov/9-11mentalhealth.

Finally, in more sad military news, the Veterans Health Administration admitted that about 18 vets a day—126 per week—commit suicide. This news comes on the heels of the study that found mental illness is increasing (or is being identified better) in U.S. troops.

Younger generation of psychiatrists skeptical of pharma companies

From intueri:

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

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

Loose Screws Mental Health News

"Can an antipsychotic drug from the 1950s be paired with a 1980s antibiotic to shrink 21st-century tumors?"

That's the first line from the NYT's recent article on biotech companies mixing two unrelated generic drugs to treat medical problems. Alexis Borisy, the executive of CombinatoRx, is spearheading the movement to mix and match two different generic drugs in the hopes that the combo will cure or effectively treat a disease that may be unrelated to the drugs' initial purposes.

"Orexigen, in creating its obesity drug Contrave, took a treatment used for drug and alcohol addiction and combined it with an antidepressant sometimes used to help people quit smoking." (My guess is that the antid was Zyban.)

It's a nice concept, but I'd hate to see risk of side effects doubled. One med can be a doozy; coupled with another could turn out to be problematic.


More from the NYT: Pharmaceutical companies pay psychiatrists (to push their products) more than doctors in any other specialty.

"For instance, the more psychiatrists have earned from drug makers, the more they have prescribed a new class of powerful medicines known as atypical antipsychotics to children, for whom the drugs are especially risky and mostly unapproved."

The bipolar child paradigm.

Vermont officials disclosed Tuesday that drug company payments to psychiatrists in the state more than doubled last year, to an average of $45,692 each from $20,835 in 2005. Antipsychotic medicines are among the largest expenses for the state’s Medicaid program.

Over all last year, drug makers spent $2.25 million on marketing payments, fees and travel expenses to Vermont doctors, hospitals and universities, a 2.3 percent increase over the prior year, the state said.

The number most likely represents a small fraction of drug makers’ total marketing expenditures to doctors since it does not include the costs of free drug samples or the salaries of sales representatives and their staff members. According to their income statements, drug makers generally spend twice as much to market drugs as they do to research them.

Doesn't the last sentence make you feel all warm and fuzzy inside? It's great to know that getting people to use drugs are more important to these companies than making sure these drugs are safe to use. Yeah, yeah, I know, it's a company and companies are only out to make profits. Whatever kind of optimist is in me wants to believe that maybe there's one doctor out there who is more motivated by helping others than by pharma-backing money. But I'm only a slight optimist.

PCPs Don't Know Jack From Zyprexa

Eli Lilly’s actions continue to be appalling.

LillyApart from trying to hide the fact that Zyprexa induces weight gain, diabetes, and hyperglycemia, they also had sales reps encourage primary care physicians to prescribe Zyprexa for patients who did not have schizophrenia or bipolar disorder (basically off-label usage).

It seems that Lilly told marketing reps to suggest Zyprexa for dementia in the elderly. Lilly denies this, of course, since olanzapine (Zyprexa’s generic name) is not approved for that kind of use since it increases the risk of death in seniors with psychosis associated with dementia. Lilly also attempted to market olanzapine to patients with mild bipolar disorder who suffer mainly from depression. (In actuality, Zyprexa is approved to treat those who suffer from mania.)

This issue with Eli Lilly delves into precisely why I am against PCPs prescribing psychiatric medicines. Primary care physicians don’t know enough about the various psychiatric conditions to prescribe the appropriate kind of medication. This type of prescription should be left to specialists like psychiatrists. PCPs should focus on the things they deal with on a daily basis that no one else can take care of: the common cold, the flu, annual physical, etc. It should be the job of the PCP to refer a patient to a psychiatrist should they present symptoms of mental illness (depression, schizophrenia, etc.). I have been burned by having a PCP prescribe antidepressants for me and as a result, attributed my horrible experience with drugs to that.

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What a Not-So Novel Idea!

Jotting down a few ideas:

Brain scanHow about a psychiatrist does a blood test on, oh say, 10 different people who seem to have depression… chart symptoms of the same kind, check to see if blood levels are the same or similar, low or high blood pressure, regular pulse, etc? Maybe perform an MRI of the brain and monitor brain activity as the brain is triggered by happy thoughts and then sad thoughts…? What would be the difference (if any)? How about a thyroid check? Why isn’t there a way to measure dopamine and serotonin levels? How can we accurately treat these different neurotransmitters in people if there isn’t a current way to test for those transmitter levels?

Really, I’m not thinking anything new. Hasn’t anyone already thought of/done this?

It also strikes me that when it comes to treating mental illness, neurologists and psychiatrists need to function as one unit.