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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Identification

I identify with Dawdy’s article on a variety of grounds and many of his words have me thinking.

“Mostly, the suicidal show no clues that they are on dangerous ground.”

This is true for me only with people I don’t know. When people at work, friends, or family see me, they think that all is right in my world. I’m the type of person who keeps a pleasant expression fixed on her face and in general, has a bubbly, cheery attitude. (Co-workers, acquaintances, and casual friends would never know how negative and pessimistic I am.) If people found out that I struggled with depression to the extent of attempting suicide on 10 different occasions, they’d all be shocked because it doesn’t seem to jive with my “personality.”

People who really know me — those closest to me — know that when I’m suicidal, it’s extremely hard for me to not show. I withdraw from social contact, refuse to make eye contact, become extremely quiet or reply with a succession of short, one-word answers to questions, or corner myself in a seat or in bed with my head hanging down, eyes spacing off into somewhere. Those who know me should and can know when I’m suicidal. It becomes so obvious that I don’t need to say anything. I usually don’t tell anyone, but my body language speaks volumes.

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The Suicide Matrix

"There are three kinds of people in the suicide matrix: those who succeed, those who try it and live, and those who are hounded by suicidal thoughts—ideators, as they are known in the literature." — Philip Dawdy, "One Suicide Too Many," the Seattle Weekly

I'm both a suicide survivor and an ideator. I've tried overdosing on pills many times to no avail. I've also tried jumping out of cars. Each time, the driver has caught me before I could roll out into the street. Most of my other "attempts" have been strong ideations: drinking Windex, stabbing myself, shooting myself in the head, driving my car into a wall, jumping in front of a train, jumping off a high building — TO NAME A FEW.

I'm not proud of it; the list could go on and on. I identify with Dawdy's words in his SW article:

"In each case, there was little warning. One minute I'd be muddling through a weeks-long depression—wound up, angry, and lethargic all at once—and the next I'd be on the lethal precipice."

I can't really remember planning any suicides. I don't plan suicide attempts; the ideations hit me as an impulse. I become obsessed with the thought and I can't distract my mind. It's like a train headed full speed into a wall with no reverse gear.


This is me when I am suicidal.


My Latest Obsession
My latest obsession has been shooting myself in the head with a gun despite Dawdy's stat that "It is uncommon for women to kill themselves with a gun." I've never had access to a gun but if I did, I'd be dead by now. The act of pulling a trigger is final. So much more so than any act of suicide. A person can survive a stabbing, a jump, overdosing, or self-designed accidents. But once a person sticks a gun inside the mouth and pulls the trigger… it's difficult to miss. Survival isn’t impossible but not likely.

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Suicide

I’d like to say, “Been there, done that,” but it’s not something I’m proud to dismiss. February 14, 1997 was the first time I attempted suicide: I tried to jump off a fourth-story balcony. But I’m a drama queen and like standard drama queen fare, I called my pals and left them goodbye messages. People call it a cry for help; I just can’t leave this world without saying goodbye. (I liken it to leaving home for a long trip in another continent You’d say goodbye to those you love and would miss.) It’s become a bad (or perhaps, good) pattern that has kept me alive. I’ve tried jumping out of cars, swallowing pills, slashing, stabbing, drowning, suffocating — and barely stopped short of hanging. I got as far as a chair and a noose until I couldn’t bear to imagine my father walk in the door from work to see his only child hanging from the ceiling fan in the hallway.
I’m not happy to admit all this, but people can learn a lesson from a life as varied as mine. I’ve been to the depths of desolation and desperation and I know the feeling of not being able to “go on” or even wanting to “go on.”

Who I Am

I am a 26-year-old black female who suffers from bipolar disorder. I was diagnosed with the illness in November 2006. I’d been diagnosed as suffering from major depressive disorder (MDD) beginning at the age of 14. I still consider myself to suffer primarily from depression although I do have occasional manic episodes.

This blog has helped me to recognize many of the things that I am. That
I truly am more than my diagnosis and that my diagnosis does not define
me. I am not just a person with manic and depressive episodes. I am a person with a personality. I’m smart, witty, drop-dead gorgeous—okay, I wish, but I’m not ugly—musically inclined, and ambitious. And that’s just scratching the surface.

I can be happy, sad, angry, and joyful. I have so many emotions that could classify me as anything. I have a short attention span, for instance. The docs missed the attention-deficit hyperactivity disorder (ADHD) diagnosis (although I lack the hyperactivity).  I suffer from anxiety as well but not a single medical record lists me as suffering from generalized anxiety disorder (GAD). So I self-diagnose. It helps me to realize that all of my flaws can pigeonhole me into any diagnosis I choose. I accept my flaws – “diagnosable” or not – and my strengths. This is my journey to learn more about myself, my diagnosis, my medical treatment, and anything relating to my personal life and general mental health.

I’m skeptical of pharmaceutical companies. I don’t hate them; however, many of their practices are shady and I—along with some of my favorite medical blogs —hope to shed light on the “unfavorable” news they choose to keep hidden from the public.

I highlight celebrities who admit to mental illnesses. Many of them suffer from depression, which is the fashionable mental illness of the moment, but others truly suffer from problems that are worth talking about.

I also write about my personal life relating to mental illness. I struggle with constant thoughts of suicide. Readers of this blog will note a pronounced emphasis on suicidal thoughts and behaviors.

Feel free to read on to the next entry about my Perfectionistic Tendencies. Chronicling my journey to managing and treating my illness can hopefully aid me. And eventually, someone else.