a personal quest to discover, analyze, and question news and personal events relating to mental illness
From Furious Seasons:
I simply don’t know what to make of the case of Christopher Pittman who was convicted of shooting his grandparents to death when he was 12-years-old–except that it argues for how risky it is to put young children on anti-depressants. Pittman, sentenced to 30 years in prison, is seeking a new trial and a hearing on that matter is underway in South Carolina.
You can read more about the Zoloft-rage/violence connection is relation to Pittman’s case.
I’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:
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:
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:
My 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.
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.
Continue reading “2-Year Anniversary: The Long and Winding Road”
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 meet any of the criteria above, this is a medical emergency. You are overaware and overmedicated. Go see your doctor immediately and discuss treatment options that involve non-medication and/or talk therapy.
Now, the disclaimer.
The checklist above is satire. It is not intended to poke fun at those who suffer with real clinical depression (of which I am one). It is intended to mock the extremely high number of people in the U.S. who are diagnosed with depression and medicated with antidepressants. This is not a medically based checklist for anything. It is not a professional recommendation or intended for professional use. It is not intended to be serious. In fact, it is not intended to be seriously serious. If you take this to your doctor, he or she will probably diagnose you with something other than depression. If you have been offended by this post, don’t be; you shouldn’t come close to meeting the criteria above. And if you do, then you really should go to a doctor. While I meet the criterion for sadness over my Wii-related injury, I don’t take Pristiq for it. If you have something nice to say, click on the Comments link below. If you don’t have something nice to say, click on the Comments link below.
(comic from problogs.com)
The show is essentially Depression 101 – for those new to learning
about the illness. As someone who struggles with depression (within
bipolar disorder), I found a lot of the two hours pretty boring (90
minutes on personal stories and about 22 minutes for "candid
conversation"). The "a lot" comes from the stuff that I've either heard before or flies over my head, eg, how depression affects the brain, prefrontal cortex, neurotransmitters, synapses, etc. The personal stories were powerful: depressingly heartwarming. (Yes, I mean that.)
My heart sank as I heard the stories of Emma and Hart, teenagers who were diagnosed with depression and bipolar disorder, respectively. Both were such extreme cases that they needed to be sent away for special psychiatric care. They are on medications for their disorders; the specific drugs are never mentioned.
While watching Deana's story of treatment-resistant depression, I instantly thought of Herb of VNSDepression.com whose wife suffers from the same malady.
I tried to listen attentively for the antidepressant that Ellie, who suffered from PPD after the birth of her first child, would be taking during her next pregnancy. It was never mentioned.
My jaw nearly dropped to the carpet as Andrew Solomon, carefully plucked brightly colored pills from his pillbox that he takes every morning for his unipolar depression: Remeron, Zoloft, Zyprexa, Wellbutrin, Namenda, Ranitidine, and two kinds of fish oil. He might have even mentioned Prozac. He takes Namenda, an Alzheimer's drug to combat the effects of an adverse interaction between Wellbutrin and one of the other drugs that I can't remember. Solomon says he's happy. I'm happy for him and I'm happy that his drug cocktail works for him but I couldn't help but sit there and wonder, "Isn't there a better way?"
While I thought the stories covered the gamut, in retrospect, I'm surprised they didn't interview a veteran or U.S. soldier to discuss PTSD. If the producers were able to fit in dysthymia, I'm sure they might have been able to throw in a story about a soldier who struggles with depression and suicidal thoughts stemming out of PTSD. Considering all the stories coming out of the VA, it's rather relevant. It would have been more interesting than the Jane Pauley segment. But I'll get to that in a minute.
As I listened to the narrator, I couldn't help but wonder what alternate perspectives could have popped up. For what it was, I fear none. This was a Depression 101 show — a program designed to either get people to fight against fear and stigma and get help or to open the eyes of loved ones to this debilitating disorder. I'm not sure how to slip in an opposing view on medication from a doctor without confusing or scaring people away. What would Healy or Breggin say that would encourage people to seek appropriate care?
Holistic or natural treatment was not mentioned. It's not mainstream and it's not recommended by most doctors as first-line therapy. I would have been surprised had something been said about it.
The depression portion of bipolar disorder was briefly discussed in Hart's story then Pauley added commentary about her personal experience in the remaining 22 minutes of the program.
Pauley appears at the end of the show promising a "candid conversation" on the topic. The three experts: Drs. Charney, Duckworth, and Primm sit and smile politely as Pauley rattles on occasionally about herself. Some people might find her exchange endearing and personal. After the first 3 minutes, I found it annoying. As a journalist, I wish she would have taken the impartial observer approach rather than the "intimate discussion" approach. In my opinion, she seemed to have dominated the "discussion."
It ended up being a Q&A with each doctor. Her questions were focused and direct. I expected a little bit of an exchange between doctors, talking not only about the pros of medication and treatment like ECT and VNS but also the cons. (Should I apologize for being optimistic?) Charney interjected into the conversation maybe once or twice but was only to offer an assenting opinion. Primm spoke least of everyone on the panel. I think she was placed on the show solely to represent diversity.
There were no "a recent study said…" or "critics say such-and-such, how do you address that?" It was a straightforward emphasis on encouraging people to get help or for those suffering to get treatment. Pauley's segment didn't discuss any negatives (not with the medical director of NAMI there!). The closest the entire 2 hours gets to any cons is with ECT shock treatment and giving medication to growing children. The childhood medication thing isn't dwelt on. The basic gist is: Doctors don't understand how medication works in children but are working on trying to understand it and improve its efficacy.
Forgive me for being negative. The point of the program was designed to give hope to those suffering. Instead, it just made me feel even worse. Thoughts raced through my head: "Well, if this doesn't work, then it's on to that. And if that medication doesn't work then I'll probably be prescribed this therapy, and if that doesn't work, then I'm treatment-resistant at which point, I'll have to do…"
I hope the program does what it's designed to do and that's to get those suffering with depression to seek appropriate care. The one upside is that talk therapy was stressed. I'm a huge proponent of talk therapy myself. Let me know what you thought of the show if you were able to catch it.
In the meantime, this depressed girl is going to cure herself for the night by going to bed.
P.S. Is it really fact that depression is a disease?
The Wall Street Journal reports that Wyeth, desperate to make money off of its Effexor XR-knockoff, Pristiq, says it will slash the antidepressant at a 20% discount compared to Effexor’s price. The price slash, CNN money reports, is a result of less-than-impressive clinical trial data on Pristiq’s “safety and effectiveness.”
Wyeth SVP Joe Mahady told analysts that Pristiq will sell for a flat $3.41 per tablet for both mid- and high-dose, Dow Jones Newswires’ Peter Loftus reports.
Wyeth, apparently, has done this in the past. Back when it was known as American Home Products, the company slashed its price on Protonix, its heartburn drug, to compete with AstraZeneca’s Prilosec. The drug generated $1.9 billion in profits for Wyeth last year. CNN Money reports that Teva Pharmaceuticals and Sun Pharmaceuticals began selling the generic version of the drug and handily cut into Wyeth’s profits: the company reported a 4.6% decline in profit and a 66% drop in sales for the drug for the first-quarter. What will happen with Pristiq remains to be seen. I’m not sure that doctors in 2010 will want to dole out prescriptions for Pristiq when they can save patients—and insurance companies—money by prescribing what will then be known as venlafaxine. WSJ also notes:
A month’s supply of sertraline (Pfizer’s old hit Zoloft) or fluoxetine (Lilly’s Prozac) goes for 50 cents a day at drugstore.com.
$3.41 or $0.50 per tablet. It wouldn’t surprise me if some insurance companies choose to exclude Pristiq from its list of covered drugs. Regardless, Wyeth expects sales of the drug to exceed $1 billion in its first year.
The drug will hit the shelves in May.
I’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.”
[This post is quite lengthy so I suggest you grab a cup of coffee or tea and sit down and read it. The following is not for the faint of heart (or those with a lack of time).]
It’s been amazing to me that I’ve received numerous comments on Zoloft inducing rage. I’m humbled by having a Pittman supporter visit my site and post some comments from the ChristopherPittman.org forums. Read the following:
In my senior year in high school I was diagnosed as being severely depressed and put on medication. The first medication that I was on I took for 5 months and it made me really aggressive. My friends and family noticed the change and I told my doctor about it and she changed my meds. After that I was fine. I am normally a very passive person and will let just about anything fly. But the medication made me really aggravated and aggressive toward my friends and family and it seemed that I wasn’t overcoming my depression. I just got done watching the 48 hours investigation on the Discovery Times Channel and felt a connection with Chris. I felt that I had to write this to let you know that Chris is not the only one out there that had these side effects. I think there should be a study done to see how many people that take antidepressants have increased aggression. The problem is that the pharmaceutical industry has deep pockets and many lobbyists. I hope this helps in some way.
And another:
I remember the case when it happened.
At the time I thought, “Zoloft right”.
Let me tell you my physician put me on Zoloft and it took about three weeks for my to become psychotic and I’m a 50 year old woman.
I have three children and I don’t make a lot of money but please let me know if I can do anything for the Pittman boy.
The jury should have been placed on Zoloft before they made they decision. Unless you’ve experience it you simply cannot believe its’ effect.
I did a bit of quick reading/research into Zoloft triggering violence in people who otherwise would have never been violent and it seems that are a few stories out there to support the assertion. I found a few comments on depressionblog.com that mentioned a link between Zoloft and rage fits. A Salon.com article published a story antidepressants inducing rage in 1999. Apparently, Brynn Hartman, the wife of famous comedian Phil Hartman, killed herself and her husband while taking Zoloft. While close friends attribute the sudden behavior on the antidepressant, others attribute it to a combination of the medication with cocaine and alcohol in her system. (Zoloft does have a warning against alcohol use in conjunction with the drug.)
One interesting thing I learned from the article is that this kind of behavior is often labeled under the name akathisia on patient safety guides. Most – if not all – of the major antidepressants list akathisia as a side effect. Here’s the initial description of this condition from Wikipedia:
Akathisia, or acathisia, is an unpleasant subjective sensation of “inner” restlessness that manifests itself with an inability to sit still or remain motionless… Its most common cause is as a side effect of medications, mainly neuroleptic antipsychotics especially the phenothiazines (such as perphenazine and chlorpromazine), thioxanthenes (such as flupenthixol and zuclopenthixol) and butyrophenones (such as haloperidol (Haldol)), and rarely, antidepressants.
Akathisia may range in intensity from a mild sense of disquiet or anxiety (which may be easily overlooked) to a total inability to sit still, accompanied by overwhelming anxiety, malaise, and severe dysphoria (manifesting as an almost indescribable sense of terror and doom).
No real mention of extreme anger or irritability mentioned there. But if you read on…
The 2006 U.K. study by Healy, Herxheimer, and Menkes observed that akathisia is often miscoded in antidepressant clinical trials as “agitation, emotional lability, and hyperkinesis (overactivity)”. The study further points out that misdiagnosis of akathisia as simple motor restlessness occurs, but that this is more properly classed as dyskinesia. Healy, et. al., further show links between antidepressant-induced akathisia and violence, including suicide, as akathisia can “exacerbate psychopathology.” The study goes on to state that there is extensive clinical evidence correlating akathisia with SSRI use, showing that approximately ten times as many patients on SSRIs as those on placebos showed symptoms severe enough to drop out of a trial (5.0% compared to 0.5%).
Furious Seasons has a post on WWE wrestler Chris Benoit, who possibly may have taken Zoloft shortly before he committed the murder of his wife and child. The article on pwtorch.com that FS linked to refers to the possibility that Benoit's friend and doctor, Phillippe Astin III, may have prescribed the drug to Benoit on Friday, the day before he killed his wife.
There are definitely some funky mental issues behind Benoit's motives for killing his family, but it wouldn't surprise me if the Zoloft played a part in influencing him to do so. I recently mentioned Christopher Pittman who killed his grandparents in 2001 then proceeded to set their house on fire when he was on an adult dosage of 200 mg of Zoloft. He was 12. Stephany of soulful sepulcher commented that her daughter suffered from a similar problem while on 150 mg Zoloft:
Pittman was about the same age my daughter was then, and she was on 150mg of Zoloft a day, and that med changed her personality into a full blown all day raging person. She had to go inpatient to get off of it, and once off of it, she's never raged like that again. The Pittman story is very sad, as are all of the others associated with antidepressant use and teen violence. Columbine had Luvox, there's Accutane–it's beyond me how this can be overlooked in connection.
I wonder if there are other stories floating out there now about how Zoloft – an antidepressant – has caused similar behaviors. It'd be interesting to observe whether Zoloft causes hallucinations, delusions, and psychosis.
depression introspection 