Making Sense Of Bipolar Disorder Overdiagnosis

Most of you are likely aware of a study that was released last week showing that bipolar disorder was being overdiagnosed at about a 50 percent rate. I've now had a chance to review the entire paper from the Journal of Clinical Psychiatry and, before I try to make sense of its findings in a real world way, let me add a note of caution. This study involves only one large clinic in Rhode Island, so it's not necessarily representative of America as a whole (except I fear it well could be) and Mark Zimmerman, the lead author, calls for others to attempt to replicate his findings. I hope other researchers look into this matter because--and this is Zimmerman's view--we may have a crisis of overdiagnosis (or false positives) as a result of doctors who either aren't using the appropriate clinical instruments to assess someone's "bipolarity" or are just diagnosing by the seat of their pants. As a result, hundreds of thousands of people are winding up on meds they don't need, meds which injure some people (not everyone. Yes, I know some people do derive some benefit from them) and a diagnosis that follows them for life and can lead to discrimination in employment, health and life insurance and personal relationships. That's serious stuff.

Zimmerman's paper can be accessed in full here. It is an important study, in my opinion, and one I encourage all of you to read. CL Psych has already offered his thoughts here. My earlier assessment is here. It's deeply ironic, of course, that Zimmerman's paper appears during Mental Health Awareness Month.

I want to point out that this is not an attack on anyone or any school of thought in particular. It's not an argument that someone should or shouldn't be on meds or off meds. I am simply not looking for that kind of a fight. So please read the following in that light. Because I think my own case may be illustrative of the phenomenon Zimmerman describes. I want to stress the "may" part of that again. I have not reached any final conclusions. I simply have lots of questions.

Posted by Philip Dawdy at 12:05 AM | Comments (0) Stumble It! del.icio.us Digg it Google Netscape reddit

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British Lawyer, Crazed On Anti-Depressants And Booze, Killed By Cops

This a very sad story and should serve as a warning to anyone taking anti-depressants, particularly someone new to them or going through a dose change. A London lawyer was shot dead by police last week after he came home drunk from a pub, began acting erratically and, then, began firing his shotgun from his home. His name was Mark Saunders, aged 32, and he'd reportedly been taking an anti-depressant for a few months.

After a standoff, the cops shot him five times.

This is a tragic outcome and points to a very simple rule that people who take anti-depressants should adhere to: be damn careful about mixing alcohol and anti-depressants, particularly until you know how you react to the mixture, adn I simply do not care where you stand on the great meds divide. There have been too many stories over the last 20 years of people who met tragic outcomes from mixing booze and anti-depressants (and booze and Chantix) and tragedies such as Saunders' should serve as a reminder to all.

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The New York Times On "Mad Pride"

There's an interesting piece in today's New York Times discussing how some writers with serious mental illnesses--bipolar disorder and schizophrenia, according to the paper--have taken their writing online. That's of course nothing new to readers of this site which has been tackling the issues around mental illness for three years (and I was tackling them before that in a certain newspaper as well).

The article includes photos of Liz Spikol and mentions Elyn Saks (USC law professor who's diagnosed with schizophrenia), MindFreedom's David Oaks, The Icarus Project's Sascha Scatter, and The Freedom Center. It includes quotes from Charles Barber, author of Comfortably Numb. It also includes Fuller Torrey's assessment of the phenomenon of people with alleged serious mental illnesses writing on the 'Net.

"While psychiatrists generally support the mad pride movement’s desire to speak openly, some have cautioned that a 'pro choice' attitude toward medicine can have dire consequences.

"'Would you be pro-choice with someone who has another brain disease, Alzheimer’s, who wants to walk outside in the snow without their shoes and socks?' said Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute in Chevy Chase, Md.

"Dr. Torrey, a research psychiatrist who specializes in schizophrenia and manic depression, said he understood the roots of the movement. 'I suspect that not an insignificant number of people involved have had very lousy care and are still reacting to having been involuntarily treated,' he said."

Always interesting to hear the views of the dark prince of forced medication. Why the author, Gabrielle Glaser, chose to sound out Torrey on this phenomenon is beyond me. The guy is as relevant to a discussion of how patients lead their lives as are testicles to a heifer. And, from what I know, very few of the people mentioned in the article write about their experiences in response to having been involuntarily treated. Lousy care, though, is a great motivator and unites many of us who write about these issues.

Anyway, it's a decent article and it's nice to see some good people get some well-deserved attention.

Too bad the reporter in question decided to overlook this wee website. It's kind of hard to understand why, given (insert apology for self promotion here) that this site has about three times the number of unique readers each month as does Icarus (the "reporter" pegs Icarus's monthly uniques at 5,000. This site's uniques currently run between 13,000 and 15,500 a month, depending on the time of month, time of year, etc.) and given that this site has been kind of aggressive in taking on the issues around mental illness that float around our culture. What's more, it was this site that got the Times's back during the whole Zyprexa documents saga last year, and it's been this site that has been--um, what's the word?--"helpful" to a few journalists who write about mental health issues. In this regard, the oversight feels like a slap in the face, or is proof that a certain reporter at the Times is rather incomplete in her reporting.

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Slate Responds To "The Infinite Mind"'s Criticism

Jeanne Lenzer and Shannon Brownlee--co-authors of the recent Slate piece criticizing "The Infinite Mind" radio show for, among other things, not revealing its ties to the pharma industry and for not revealing the pharma ties of its host and guests on a recent program defending anti-depressants--has now posted a response to Bill Lichtenstein, the show's producer, in response to Lichtenstein's response to the initial article. That's a whole lot of responding and there's a whole new set of accusations floating around.

A snippet of Lenzer's response:

"Bill Lichtenstein fails to contradict the key points we made in our article; namely that The Infinite Mind series was funded in part by drug company money; that each of the four experts on the show, “Prozac Nation: Revisited” has received drug company funding; that despite enormous controversy about the safety and efficacy of antidepressants, the experts all expressed a singular viewpoint; and finally, listeners were not told about the experts’ financial conflicts of interest."

The rest, which is fairly detailed, can be read here. The original Slate article is here. My thoughts on the article are right here and my take on the show, which aired in March, is here.

Lenzer does offer a completely different account of what Lichtenstein cast as the Slate authors' payback motivation--if that's the right term--for the article. Short story: Lichtenstein claims that Lenzer tried to pitch him a second show on anti-depressants and their problems and that somehow his not going ahead with the program and the subsequent Slate article are connected. That is of course a huge jab at the Slate authors' credibility and journalistic ethics.

Lenzer and Brownlee state:

"Mr Lichtenstein claims that one of us (Lenzer) pitched him a radio show. Quite the opposite. When Lenzer called Mr. Lichtenstein for an interview, after he realized our interest was in the funding of his guests and the absence of those with contrary views from the show, it was he who suggested that we do a show, telling Lenzer that sometimes differing viewpoints are better heard with separate shows (which he used as a defense for why only those experts with pro-antidepressant viewpoints were present on Prozac Nation: Revisited)."

I do think that "The Infinite Mind" should do a second program on anti-depressants and their problems. The sad thing is that this whole dust-up could've been avoided if the show had revealed its various conflicts upfront. The show gets some funding from Eli Lilly and ran a program actively and questionably defending Prozac and other anti-depressants yet didn't reveal that it took money from Lilly nor that the show's host, Fred Goodwin, has also taken money from Lilly.

For what my peon-on-the-Left-Coast's opinion is worth, it seems to me that since Goodwin and his guests, two of them well-published academics, regularly reveal their conflicts of interest in their academic writing for the smallish audience of doctors who read their journal articles, then they should've done the same for the 500,000 or so listeners to the program. The public deserves just as much full disclosure as doctors do. In fact, we deserve more.

We also deserve a public radio show that is willing to take on these matters is a more thorough fashion than the one-sided manner in which "The Infinite Mind" defended anti-depressants.

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"The Infinite Mind" Producer Responds To Slate.com Article

It's just been brought to my attention that Bill Lichtenstein has posted a response to the Slate.com piece earlier this week taking "The Infinite Mind" to task for not disclosing its Big Pharma funding as well as the ties to pharmaceutical companies of its host, Fred Goodwin, and three guests on a recent program, "Prozac Nation: Revisted." The original Slate piece is here. My earlier critique of the program (well ahead of the Slate article) is here and my thoughts on the Slate piece are here. Lichtenstein is the senior executive producer of the program.

I'll let Lichtenstein's response speak for itself. Feel free to chime in in comments or go leave comments on Slate, if you are registered there.

"From Bill Lichtenstein "Senior Executive Producer, The Infinite Mind

"In their May 6 Slate article, Jeanne Lenzer and Shannon Brownlee use The Infinite Mind's recent program "Prozac Nation: Revisited" to frame an argument that pharmaceutical companies are planting "stealth marketers" inside seemingly objective media outlets to manipulate public opinion. The article suggests that as public radio producers we have allowed our guests on our national weekly program to hide financial links with pharmaceutical companies for the purpose of promoting the use of dangerous prescription drugs.

"Ironically, "Prozac Nation: Revisited" was intended to examine the way the media has handled links between violent behavior, suicide and antidepressants. Our interest in the story began with press reports about Steven Kazmierczak, whose shooting rampage at Northern Illinois University left six dead and 16 wounded. We wanted to know: Why did the major news media uniformly target Steven's withdrawal from an antidepressant as explanation for his violent act? Why did the media ignore any number of other factors, such as his gun collection, his work as a prison guard, or his troubled childhood? We were interested in exploring the reflexive public reaction that ends up making the medication the culprit, and so simplifies a disturbing violent act while stigmatizing the already vulnerable people who take or consider taking prescription medication for depression.

"And at the core of the program, we asked the question we always ask, the question that has guided the past 10 years of The Infinite Mind: Where is the best science on this particular issue? In this case, does the science find links between antidepressant medications and out-of-control behavior?

"To help us, we turned to recognized experts in the field. Framing the discussion, we began with Dr. Andrew Leuchter, director of UCLA's Laboratory of Behavior and Pharmacology, who himself has conducted much of the important research in this area.

"Next, we spoke with Dr. Nada Stotland, current president of the American Psychiatric Association and an expert in medical ethics. Dr. Stotland, another distinguished research scientist and clinician, spoke about the gap between public perception and the research about violence, suicide and psycho pharmaceutical medications.

"Finally, we talked to Peter Pitts, a former associate commissioner for the Food and Drug Administration who was involved in the FDA's 2004 "black box" labeling of antidepressants as carrying a risk of suicidal thoughts and behavior, and who was at the time the "go-to" guy for the FDA on that issue.

"What we didn't know, because he didn't disclose it to us, was that Pitts is currently working for a public relations firm whose clients include major pharmaceutical companies. If we had known, and (full mea culpa here) we should have, we would have disclosed that connection. Pitts apparently didn't disclose it elsewhere, either - he's appeared on NPR's Talk of the Nation as well as PBS' News Hour with Jim Lehrer, without either of those programs mentioning the PR company ties.

"In any case, to suggest that distinguished researchers such as Drs. Stotland and Leuchter are shills for the drug industry is bad journalism. Pharmaceutical companies fund the lion's share of research being conducted today. There are strict ethical codes and laws governing the use of such funds. Journalists covering this industry know that, and routinely disclose only those ties that are likely to raise serious questions about a researcher's neutrality. It would be patently ridiculous, for example, to presume that Dr. Stotland, speaking for all American psychiatrists as president of the APA, would somehow distort the truth because of some past connection to an industry speakers' bureau.

"It is important to state that we stand by the program and its editorial content. There is, as our guests observed, no credible evidence that the use of antidepressants contributes to the sort of violence that erupted at NIU. There is, on the other hand, a study by the Centers for Disease Control and Prevention suggesting that more young people may be dying in part because of the chilling effect of the FDA "black box" warning. While some will take issue with these studies, we believe they are important, that they deepen the public dialog, and that they've gotten lost in superficial media coverage of a complex issue.

"So finally, let's tackle the other question raised in the Slate article: Is it acceptable for a public radio program about the human mind to take grants from the pharmaceutical industry?

"Back in 1994, I came face to face with that question. Preparing to produce a program about people living with schizophrenia, I met with Delano Lewis, who was at the time president of National Public Radio. I told Lewis that I had offers of unrestricted educational grants from several pharmaceutical companies who were interested in helping lift some of the stigma about this misunderstood and feared disease, but that I wasn't sure whether it would be proper to accept the grants.

"The conversation that we had helped set the ground rules that have governed our underwriting ever since. Lewis began by observing that in many cases, especially on difficult and unpopular subjects, it would be hard to find support from organizations without some kind of substantial interest in the subject matter. The important thing, he said, was to assure listeners and stations that there was an absolute firewall between funding sources and editorial decision-making.

"With this in mind, 14 years ago, we created a system with the following rules: We would take no more than 15 percent of our total budget from any one industry sector. We would not take substantial amounts from any one company. Corporate support would have to come in the form of unrestricted "no strings attached" educational grants. Corporate funding would be mixed with support from other sources (in the case of The Infinite Mind, that's been sources like the MacArthur Foundation, the National Institutes of Health and the National Science Foundation.) We would list underwriters on the air. Under no circumstance would producers ever have editorial discussions with any funder; and it's probably important to note that in the case of the pharmaceutical industry, such conversations would be a violation of federal law as well as a violation of our own ethics as journalists. And, we would require employees to sign a code of conduct that requires disclosure of any potential conflict of interest and makes failure to disclose a fireable offense.

"By the way, our 1994 program on schizophrenia, with substantial and disclosed support from the pharmaceutical industry, won a Peabody Award and was credited with changing the way Americans look at people with serious mental illness. Over the past 18 years, following these rules, our programming on the human mind has been honored with more than 60 awards for journalistic excellence and offering insight into issues that society would often prefer to ignore.

"In the interest of full disclosure, I also should note for the record that Lenzer, who co-authored the Slate article, called me a few days after the "Prozac Nation: Revisited" program aired to pitch a program that she wanted us to do for The Infinite Mind, called "Journalists on Prozac," which would feature her and her writing partner Shannon Brownlee. Checking into Lenzer's credentials, I found a troubling article in The New York Times taking her to task for a British Medical Journal article that suggested that Eli Lilly and Company, which makes Prozac, had concealed documents about the link between anti-depressants, suicide and violence. The BMJ subsequently retracted the article, with full apologies, and the whole matter was widely covered in the news media.

"After we told Jeanne Lenzer that we would not be proceeding with a program featuring her, she and Brownlee wrote the article for Slate."

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Article Exposes Injuries, Deaths At Texas Psych Hospital

Among other things, staff at this hospital did not properly recognize or treat a 6-year-old with a broken arm, one of the most obvious and easy diagnoses to make in all of medicine.

And, then, there's this:

"What is specifically known from other reports is that on June 14, 2007, patient Mario Vidaurre died at West Oaks when the one-on-one tech assigned to him beat him to death [see "Death in a Box," by Margaret Downing, October 25, 2007]. An investigation by the state found West Oaks was at fault. On March 22, 2007, Alan Chambers, a man who was supposed to be under suicide watch, hung himself behind the closed door of his room on Unit 1. On May 12, 2006, a 17-year-old girl who tried to hang herself with one of her shoelaces was allowed to keep the other shoelace of the pair in her West Oaks room.

"Frederick Williams, the tech who fought with Vidaurre and caused his death, has left the psychiatric center and retained an attorney to represent him in a lawsuit against his former employer. He's arguing he had no business being assigned to Vidaurre; he never got trained for that kind of job."

A tech beating a patient to death? That's crazy. Keep in mind this is a private psych facility not a state hospital (not that this should go on anywhere, ever). Why is the Treatment Advocacy Center silent when this kind of stuff is going on? Cat still got your tongue Fuller Torrey?

There's plenty more on West Oaks in this fine article by the Houston Press. Why is this hospital even still open?

Posted by Philip Dawdy at 08:56 AM | Comments (8) Stumble It! del.icio.us Digg it Google Netscape reddit

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Congress Tells Pharma Companies To Rein In Deceptive Ads, Or Else

At a hearing today on recent pharmaceutical television ads, Rep. Bart Stupak (D-Mich.) let rip on what he considers deceptive TV ads by pharma companies.

"'It appears that we need to enforce significant restrictions on DTC (direct-to-consumer) ads to protect American consumers from manipulative commercials designed to mislead and deceive for the profit of pharmaceutical companies,' said Stupak, head of the U.S. House of Representatives Energy and Commerce investigative panel.

"The Michigan Democrat said Congress should consider whether ads promoting medicines should be allowed to continue to target consumers in the United States, the only country that allows such marketing except for New Zealand.

'Pharmaceutical companies should consider it a privilege to be allowed to air DTC ads in this country,' he said. 'We should make sure that pharmaceuticals companies conduct themselves responsibly.'"

One pharma company defended the infamous Robert Jarvik Lipitor ads thus:

"James Sage, a Pfizer senior director, said ads are necessary because companies cannot sell prescription products directly to consumers. Such patient-targeted spots 'motivate them to seek additional information ... consult their physicians ... and follow treatment plans,' he said."

Yes, motivate them to seek additional information from their doctors who the pharma companies also go out of their way to misinform and deceive.

As much as I am against limiting anyone's free speech, the pharma companies have gone way too far in their advertising the last 10 years and I have a hard time understanding the benefit to the public when doctors can simply access the same information, twisted as it might be. Congress was not examining any ads for mental health meds today, but it is certainly the branch of pharma advertising that Congress should look at, especially magazine and online ads for anti-depressants and antipsychotics (I'm thinking of the Pfizer ad for Geodon featuring a serene looking woman practicing yoga).

I've written before that pharma ads for psych meds should be banned or greatly restricted. I stand by that statement.

Posted by Philip Dawdy at 08:35 AM | Comments (1) Stumble It! del.icio.us Digg it Google Netscape reddit

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Quiet Today

Not a lot of news on the mental health front in the last 24 hours after a fairly busy week, so I am going to use this opportunity to take a bit of a breather today and catch up on some personal stuff.

For now, however, take a look at this piece on a child in Kansas--a kindergartner no less--with alleged child bipolar disorder. Despite my own disbelief in the disorder--no mania means no bipolar--it's clear that there is something very dramatic up with this child. And it's sad regardless of the cause.

Have a nice day and weekend.

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New Abbott ADHD Drug Is "Drug Dealing," Plus Adderall Snorting Explained

Yesterday, my good friends at Abbott Labs rolled out phase II data on its experimental adult ADHD drug known as ABT-089. One assumes that the phase III trials are well underway and that the drug will have a much sexier name if it ever heads to the FDA for approval. I'm betting that it will because Abbott is clearly aiming this drug at the adult ADHD market and in its press release the company talks about it as a lifestyle drug:

"Phase II study results show that ABT-089 appears to significantly improve the core symptoms of ADHD, improve quality-of-life and work effectiveness, and reduce overall work impairment in adults with ADHD. Data also revealed that ABT-089 appears to be generally well tolerated with no significant negative effects on sleep, appetite or vital signs (heart rate and blood pressure).

"ADHD, an ailment historically associated with childhood, persists into adulthood in more than two-thirds of cases."

How much ADHD persists into adulthood is debatable (recent studies put it at closer to 50 percent), but you know how the ads for this drug will go: "Having trouble getting your reports done on time for the boss and still having spare moments to catch the kid's soccer practice and shag the wife? Abbo-Fix is the answer for you." Something like that at any rate.

Given the company's emphasis on lifestyle improvement, you know Abbott will market the hell out of the drug once it hits the market, possibly in 2010. And why wouldn't they? Abbott hasn't had a homerun mental health drug since it turned Depakote into a "mood stabilizer" for bipolar disorder in the early-1990s (David Healy is deeply critical of Abbott for creating that terminology). But one does have to wonder about just what we are doing when we are introducing a lifestyle drug into the marketplace as opposed to something that addresses a truly debilitating problem. I guess that would make ABT-089 the Viagra of psych meds.

Aaron Rowe over at Wired Science put it thus:

"In my opinion, selling chemicals which affect the brain, but do not treat a major human malady, is a legitimized form of recreational drug dealing. But from a capitalistic point of view, it is a brilliant idea: A drug which strikes α4β2 nicotinic acetylcholine receptors is sure to have more off-label uses than duct tape, which means it could be a really big seller for the pharmaceutical giant."

That's a bit more harsh than I'd be, but since he opened the door, let me budge on in: So many ADHD scrips wind up being diverted into the underground market and so many teens and college students (and, hell, probably adults) are laying hands on ADHD drugs without a scrip, grinding the pills and snorting them like speed that I think Rowe's terminology is apt. This is especially true of Adderall, which goes for about $5 a pill on da' street and is quite popular among the college crowd as a, ahem, study aid.

I recently had a chat with an admitted Adderall snorter, who told me she didn't have an ADHD diagnosis, but that she and her friends in college often use the drug to help them stay up for days on end and cram for mid-terms and finals and term papers and such. She liked how easily available it was and how focused she was while on the drug. It also gets her high as a kite. I asked about side effects, fluttery heart beat and the like. She said she'd had no problems and that the only downside of using the drug in this fashion was when she had finals later than her fellow whiffers. They'd come off the drug first and be all zonked out and she'd have no one to stay up late and study with.

Oh, yes: there is apparently a very big crash coming off Adderall and the once-snorter becomes the many-hours-sleeper. This has become much larger phenomenon than I'd thought a few years ago (witness all the busts of teens for dealing Adderall) and whenever I speak at a college, I get asked about it.

I once took speed ("greenies") to keep me up all night for a Econ final when I was a freshman in college, in the days before ADHD meds were commonplace. So did a few pals of mine. The speed made me shiver internally and I felt chilled. It was such an icky feeling that I promised myself after the final that I'd never touch speed again (I haven't) and that I'd make sure to organize my life better so that I never had to pull an all-nighter ever again. And I never have.

What's interesting and spooky is that ABT-089 is not a stimulant, it's a neuronal nicotinic receptor agonist, making it somewhat akin to Chantix (Champix outside the US), the very messy stop-smoking drug that keeps acting like an SSRI and causes erratic behavior, suicidality, suicide and, in some reported cases, depression. It'll be very, very interesting to see how ABT-089 performs in the real world.

BTW, Rowe implies that ADHD is not a major human malady. I have no idea whether it is a major one or not since I don't have it myself and the adults I know with the disorder don't seem particularly disabled to me. What do you think? ADHD: major or minor malady? Is Abbott trotting out a mere lifestyle drug or are they addressing a major health issue?

Full disclosure: In the late-1980s, I was a sales rep (and a very good one) for Abbott Labs for its then-tiny Abbott Critical Care Systems which sold critical care monitoring devices commonly used in operating rooms and ICUs. I never repped drugs for Abbott.

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Antipsychotic Set For Approval For Depression, Anxiety Has Big Problems

Most of you are well aware that AstraZeneca has been trotting out data--not especially impressive data BTW--touting its antipsychotic Seroquel as a treatment for depression and generalized anxiety disorder. The drug is already approved for treating schizophrenia, mania in bipolar disorder and bipolar depression. It is widely used off label for treating sleep problems, agitation, anxiety, depression, public speaking anxiety (bring back Toastmasters!), ADHD and so on. It rings up about $4 billion a year in sales and AZ is determined to wring every nickel possible out of this molecule, especially since it's not a particularly good performer in treating schizophrenia as the 2005 CATIE study showed.

What strikes me as strange is how the media has largely given the drug's many well-known problems a free pass and has instead largely parroted AZ's press spin in announcing the depression and anxiety data the company presented at the APA on Monday. Here's an example from WebMD.com wherein the "reporter" (or would that be copywriter?) details the new data on the drug and ignores its propensity to induce rapid weight gain in patients and cause diabetes and all sorts of fun extra pyramidal symptoms as well as daytime somnolence. Instead, she sticks to the AZ script.

Why does that piss me off? First, a lot of people read WebMD.com. It is the number 34 website in the world, according to quantcast.com, as it's read by an estimated 19 million unique readers a month. Regardless of what one thinks of websites like WebMD (I think it largely blows), it's clear that the public is paying attention to the site's prose. The public certainly deserves more complete information about any drug the site writes about. Second, the Seroquel article on WebMD was allegedly reviewed by a doctor. One has to wonder precisely what kind of doctor would let pass an article that doesn't even offer the most basic set of information about the drug, especially since Seroquel's problems are well documented. Third, you also have to wonder what kind of media ethics and editorial oversight are in use at the company if that's the kind of prose they feel compelled to offer the public.

In short, WebMD is not being fair to the experiences of the many millions of people who have taken this drug and run into problems on it. And, fairness much less objectivity is supposed to be the hallmark of the mainstream media and WebMD clearly flunks that test. You can read my own writing about this drug here. While I don't always acknowledge that some people do derive benefits from the drug, no one really expects me to since blogs are supposed to be the metaphorical equivalent of an old school newspaper column and they are not required to be as fair-seeming.

What blows my little mind is that WebMD makes no mention of the fact that AZ faces a large class action lawsuit in federal court in Florida over its handling of the drug and that the drug is sometimes converted into a drug of abuse by crushing it and snorting it or by melting it down with cocaine and shooting it (a Q-ball). The drug already has some catchy street names such as Susie Q and Quell and is a favorite of prisoners. For WebMD to pretend that such information wouldn't be important to the casual reader looking for information on the drug is galling. This is basic stuff that most any responsible journalist would find a way to slide into an article on the drug, pro or con.

And it's websites like WebMD that have helped drive thousands of journalists out of their jobs. Keep that in mind every time you read its prose. These are the clowns driving hardworking people out of their jobs and they are doing a bad job of replacing them. Personally, I trust WebMD about as much as I'd trust adders fanged, to steal from Shakespeare. The article doesn't even mention that the "studies" it cites are in fact unpublished (meaning the data has technically not passed peer review yet) and that the data it pimped at the APA is little more than averages of each arm of the placebo controlled studies, not a report of what percentage of patients in which arm saw how much benefit from the drug. That's just lame.

The sad fact is that I get dozens of hits to this site each week from readers searching for information on "shooting seroquel," "snorting seroquel," "Susie Q" and the like. Teens have been arrested around the country for dealing the drug.

And that's just really strange for a drug that is on the verge of being approved to treat depression and anxiety. And it's strange that the mainstream media--online and offline--hasn't noticed. Weirder still: I've recently begun to get stray hits from people searching for information about "snorting Abilify." I kid you not.

Or am I wrong to be bothered by any of this?

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Cymbalta Hand Soap, Zyprexa Cosmetic Bag, And More!

Soulful Sepulcher has a wonderful set of pictures of various pharma swag she's run into over recent years of following her daughter through the mental health system. There was Cymbalta soap at mental health court, her daughter was given a Zyprexa cosmetic bag at a psych hospital (now that's just offensive. Couldn't Lilly at lest spring for a glucose meter?) and there are lovely DTC ADHD kits as well.

For those of you who don't know, her daughter is technically diagnosed as psychosis NOS and is one of the most profound cases of mental illness I've ever run across. Her mother, who has fought heroically for her daughter's rights in the system, is beginning to lean towards autism as the most sensible diagnosis. The docs haven't gone there yet, but then she's usually ahead of the docs.

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Lexapro For Teens!!!

The fine folks at Forest Labs today rolled out results from a clinical trial of teens diagnosed with major depression, while carefully noting that the drug is not approved for use in treating depression in teens. Let the off label marketing begin!

"A double-blind, parallel-group, placebo-controlled phase III study to evaluate the safety and efficacy of Lexapro in the treatment of depressed adolescents, aged 12-17, was conducted in multiple centers across the U.S. A total of 316 patients entered the eight week study, receiving either Lexapro 10-20 mg (n=158) or placebo (n=158). The primary endpoint was change from baseline to Week 8 on the Children's Depression Rating Scale - Revised (CDRS-R) using last observation carried forward (LOCF) approach. The CDRS-R is a commonly used clinician-rated instrument that covers 17 symptom areas of depression relevant to adolescents, including impaired schoolwork, difficulty having fun, social withdrawal, physical complaints, and low self-esteem. The study showed statistically significant improvement in patients treated with Lexapro relative to placebo based on the change from baseline in the CDRS-R score (-22.1 for Lexapro vs. -18.8 for placebo treatment; p=0.022)."

The improvement in the CDRS-R scores is an average of all the patients in a particular arm of the study, so it's not clear what percentage of patients in the Lexapro arm of the study received whatever benefit might be ascribed to Lexapro. I'll have to wait for the published results to be able to dig up those bones.

Until then, I'd say teens and their parents ought to be damn careful when using any anti-depressant--that black box warning isn't on Lexapro and the other anti-depressants for nothing, regardless of what Fred Goodwin thinks. To be fair, Lexapro is a long way from Paxil and Effexor on the ugly meter, but it's still an SSRI and the Brits banned all SSRIs (except for Prozac) for use in under-18s.

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Thanks To Whomever "Stumbled" Me

I think that's the right verb and, um, anyhow many thanks to whomever slapped yesterday's post on the nightmare conditions in Texas state hospitals up on stumbleupon.com. Many people are reading.

Whomever you are who posted that, drop me a line and I'll buy you the metaphorical equivalent of a beer.

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New Sleeping Pills As Bad As Old Ones

Now that we've been getting flooded for a few years with ads for Ambien, Rozerem and Lunesta--the new age, totally safe sleeping pills!--it's becoming clear that these drugs create as many problems as the old prescription sleeping pills which were addiction-producing benzos such as Halcion (which was so bad it was pulled from the market). That's what popped up in a recent Wall Street Journal piece (sadly, behind the subscription firewall).

"The WHO Collaborating Center for International Drug Monitoring received 867 reports from 24 countries of people encountering amnesia, often coupled with confusion, agitation and other behavior disturbances, while taking the new sleeping pills, like Lunesta and Ambien, through March, 2007. That compares with 1,032 adverse reports with the older class of benzodiazepines, even though they have been on the market for decades longer.

"People under the influence of these drugs have gone on eating binges, driven their cars and engaged in other activities that they later cannot remember. The Wall Street Journal relates one story of a woman who painted her front door in her sleep, and in some cases, people have had serious car accidents and even set fire to their homes while in the seemingly-hypnotic state sometimes caused by the drugs."

Yep, that's a nice new class of sleeping pills the pharma companies have bestowed upon us.

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Bipolar Disorder Overdiagnosis Seen In Private Practice

In response to yesterday's news that bipolar disorder may be overdiagnosed by 50 percent, a psychologist in private practice left a comment here that I wanted to pass along:

"In my private practice as a psychologist, I frequently find people misdiagnosed with Bipolar disorder. If someone has an anger problem, they often end up diagnosed as Bipolar. This happens frequently by family doctors and also psychiatrists. In my opinion, it's really often a matter of justifying the meds they want to prescribe (most often an antipsychotic). I'd say, anecdotally, that the level of overdiagnosis I see is pretty consistent with the studies results (50-60%). I do evaluations for people seeking disability based on mental illness diagnoses, so I frequently see people labeled as Bipolar. More often than not, the diagnosis is more consistent with a cluster B personality disorder (erratic, unstable, and hyperemotional personality traits). But once you diagnose someone as being Bipolar, you can pretty well throw any class of psychotropic medication at them that you want to."

Yes, the mental health industry throws whatever they feel like at bipolars and schizophrenics. It's amazing that so many people are winding up diagnosed with bipolar in such a fashion.

I wonder when the backlash will begin because this kind of nonsense won't go unanswered for long.

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Another Satisfied Seroquel User

A reader commented yesterday:

"I took 200 mgs. of Seroquel daily for two years after a questionable diagnosis for Bipolar II (manic symptoms appeared only after treatment with antidepressants or with high doses of IV steroids). Now, a year after withdrawing from Seroquel, I still wake up every two hours, and I still have episodes of akithisia. I believe this drug has permanently damaged my nervous system. I struggled with deep depression the entire time I was taking Seroquel; since withdrawing (a painful process) my mood has improved."

This drug is being given to millions of Americans for everything from psychosis to sleep problems to "public speaking anxiety." I wonder how many other stories there are like this. I wonder how many more we'll encounter once this drug is approved for depression and anxiety.

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NPR Radio Show Tied To Pharma Influence

Excellent piece on Slate.com today detailing Big Pharma influence on "health and science" programs in the media. It paid particular attention to "The Infinite Mind," a program hosted by Fred Goodwin, who as most of you know is one of the godfathers of bipolar disorder treatment and an extremely influential voice in psychiatry, having authored the standard medical textbook on the issue. "The Infinite Mind" is carried on all manner of public radio stations stations around the US and Canada. It is independently produced.

Slate focuses in particular on three guests Goodwin had on his program in late March, a show entitled "Prozac Nation: Revisited," which laid out the view that the press had wildly overreacted to concerns around anti-depressants and violence as well as suicides and suicidality connected to the drugs. As it turns out, the guests and host all have financial ties to pharmaceutical companies.

"Which brings us back to The Infinite Mind and "Prozac Nation: Revisited," a show that may stand in a class by itself for concealing bias. In addition to the show's unrestricted grants from Lilly, the host, Goodwin, is on the board of directors of Center for Medicine in the Public Interest, an industry-funded front, or "Astroturf" group, which receives a majority of its funding from drug companies. CMPI President Peter Pitts was one of Goodwin's three guests for "Prozac Nation." We don't know which companies fund his group because when we asked him, Pitts said, "I don't want to go into that." But CMPI took in more than $1.4 million in 2006 and, according to its tax forms, spent $210,000 to influence the media through a large conference, a blog the group maintains, op-eds published in major newspapers, and multimedia programs and podcasts. Pitts has another title that might have been relevant to The Infinite Mind; he is the senior vice president for global health affairs at the PR firm Manning Selvage & Lee, which represents Eli Lilly Inc., GlaxoSmithKline, Pfizer, and more than a dozen other pharmaceutical companies. Yet on the show, Pitts was identified only by his title as "a former FDA official."

"The second guest on "Prozac Nation," Andrew F. Leuchter, is a professor of psychiatry at UCLA who has received research money from drug companies including Eli Lilly Inc., Pfizer, and Novartis. The third guest, Nada Stotland, president-elect of the American Psychiatric Association, has served on the speakers' bureaus of GlaxoSmithKline and Pfizer. None of Leuchter and Stotland's ties to industry was revealed to listeners—instead, each was introduced as a prominent academic.

"The Infinite Mind's Web site states, "Our independence is perhaps our greatest asset." Perhaps, indeed. Neither Goodwin nor the show's producers responded to our repeated requests for interviews and queries about their funding. Pitts, who to his credit did give us an interview, said he didn't know why his ties to industry weren't revealed on the show. Curious, we tried to learn more about the funding for The Infinite Mind—and could discover only that the show's award-winning production company, Lichtenstein Creative Media, was dissolved by the state of Massachusetts on March 28 for failing to file a single annual report since its establishment in 2004."

I congratulate the reporters on this piece--Shannon Brownlee and Jeanne Lenzer--for kicking butt all over the place. They didn't get into Goodwin's industry ties--probably because they speak for themselves--but here's a statement he made on behalf of Eli Lilly when Zyprexa was approved as a maintenance med for bipolar disorder in 2004 (and, you can bet such a statement isn't made for free):

"'It is good news that the FDA has now approved Zyprexa as a new tool for physicians to use to delay relapse and prolong periods of stability and wellness.'"

Here's Goodwin's financial disclosure from a 2004 paper in the Journal of Clinical Psychiatry (.pdf here) touting Lamictal:

Dr. Goodwin has received research support from Abbott, GlaxoSmithKline, Solvay, Janssen, Pfizer, Eli Lilly, Forest, Sanofi and Bristol-Myers Squibb; has received honoraria and participated in speakers/advisory boards for Solvay, GlaxoSmithKline, Pfizer, Janssen, Eli Lilly, AstraZeneca, and Bristol-Myers Squibb; and has been a consultant for GlaxoSmithKline, Eli Lilly, Pfizer, Bristol-Myers Squibb, Solvay and Novartis."

If Goodwin is willing to release his financial conflicts to his own academic peers in a juried article, then why isn't he willing to tell the public the same thing when he holds forth on criticizing the media over its coverage of anti-depressants? It is discouraging to me to see someone of Goodwin's stature--I know from a patient of his that he is well-regarded by his clients--is such a shill for Big Pharma on the side and doesn't disclose that on his program. It's even weirder to me that the program didn't disclose Peter Pitts' deep ties to Big Pharma.

I have previously criticized the "Prozac Nation" program for misstating available evidence on the issues and for not making available to the public competing viewpoints. In other words, the show was wildly biased in a way scientists and allegedly "independent" media should avoid and, frankly, had damn near religious overtones in its praise of SSRIs. If that's how Goodwin and his producers want to do things, it's a free country, but they ought to disclose whatever financial conflicts they have. It also galls me that the program, as I noted last month, is so one-sided yet is carried on taxpayer-funded and listener-funded public radio. It's heard by 500,000 people each week and one would expect a certain level of media ethics from such a program, if not some level of oversight by NPR itself. In fact, I think the NPR stations that carry the program ought to reexamine their relationship with the program, especially given that the program's producers won't disclose their funding to even the IRS.

Maybe some readers would be interested in writing the station in their area that carries the program. Let me know.

Here, I'll disclose my financial conflicts for this site: reader-supported and Pharma-free. I thank my readers for my ability to say this each and every day. In addition to reader contributions, I subsidize my work here through outside freelance writing.

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New DSM Authors In Bed With Big Pharma

The Center for Science in the Public Interest reports that over half of the 28 new members of the DSM-V writing group have ties to the pharmaceutical industry (.pdf here). Well over half of the older authors already have been outed in 2006 for their ties to Big Pharma.

As I noted then:

"But the hell with the non-disclosures for a moment. Don't the 30 million to 60 million psych patients in this country deserve a health care system in which the bases of diagnoses are made independent of any conflicts with pharmaceutical companies? You bet they do. These researchers should be ashamed of themselves and so should the American Psychiatric Association, which publishes the DSM, for allowing this situation to persist. The APA promises that for the DSM's next revision in 2011 conflicts will be revealed. I have another suggestion: No one who receives a plug nickel from pharma companies should be allowed to particpate in any way in designing the DSM."

Somethings simply never change. (Via the NYT's Well blog.)

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Chokeholds, Headlocks, Beatings In Texas State Hospitals

Thanks to a reader for passing along this account of reports indicating that 70 employees of Texas's state hospitals have been fired in recent years for openly beating patients. It's a complete outrage that such events were allowed to take place. While I know that state hospitals are very difficult places for employees to work (akin to prisons), there is little justification for such widespread abuse, especially considering that the patients are not dangerous criminals.

What's astonishing is that state employees were using chokeholds on patients. Almost every police department in the US banned the use of chokeholds in the 1980s after a series of deaths from the use of the procedure.

"The psychiatric hospitals, which have about 2,500 patients daily, had 137 confirmed abuse cases in 2007. The state schools for people with disabilities, which have twice as many residents, have an average of 300 confirmed abuse cases per year.

"But some advocates fear the mentally ill patients may face greater risks. Patients of the psychiatric hospitals are largely indigent, transient and not connected to their families, so they have few allies as they bounce through the mental health system.

"'It's a population that's easy to abuse because they're not on the radar in any way,' said Richard Hansen, a Texas mental health advocate who was chemically restrained, shackled and beaten to the point of broken ribs years ago while suffering from bipolar disorder in a New York mental hospital."

The whole thing is disgusting. How come the Treatment Advocacy Center isn't talking about this on its website? Cat got your tongue Fuller Torrey?

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Study: Bipolar Disorder Overdiagnosed

Over the last few years, I've read assertion upon assertion by psych researchers that bipolar disorder is underdiagnosed in adults and that it's vastly more prevalent among American adults than standard estimates suggest. That's usually followed by the assertion that people simply must be diagnosed or their time on Earth will be filled with unnecessary strife and torment. Pharma companies such as AstraZeneca even developed websites asserting that many cases of depression could actually be bipolar disorder and even had a website called isitreallydepression.com, which is now no longer active.

Now comes a small contrarian study in the psych world by Mark Zimmerman, a psych prof at Brown University, to be presented tomorrow at the American Psychiatric Association's convention. In a survey of 700 people, 145 indicated they'd been diagnosed with bipolar disorder yet Zimmerman found that only 43.4 percent of those diagnosed with bipolar disorder had been diagnosed by a doctor using the Structured Clinical Interview for DSM-IV. Although the doc doesn't come right out and say it in a press release, it's clear that he thinks some docs are diagnosing people far too casually (it's not clear from the press release if the other 46.6 percent of "bipolars" later checked out as bipolar on the SCID). Check out what he ascribes the cause to:

"'Clinicians are inclined to diagnose disorders that they feel more comfortable treating. We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive.' He continues, 'This bias is reinforced by the marketing message of pharmaceutical companies to physicians, which has emphasized the literature on the delayed and underrecognition of bipolar disorder, and may be sensitizing clinicians to avoid missing the diagnosis of bipolar disorder.'

"Zimmerman concludes, 'The results of this study suggest that bipolar disorder is being overdiagnosed and we recommend that clinicians use a standardized, validated method in diagnosing bipolar disorder.'"

Classically, bipolar disorder was estimated to affect about 1 percent of the adult US population but that estimate was bumped up to 2.2 percent by NIMH a couple of years ago, mostly to account for the prevalence of bipolar disorder type 2. But there have been numerous other researchers who've pressed for a prevalence of 4 percent, 5 percent and even as high as 11 percent.

Either way, Zimmerman is flat out accusing his colleagues of using their gut hunches with patients and of diagnosing based upon a person's reaction to medication, a very dangerous bit of backwards logic often employed in children (the Harvard bipolar child mafia have argued that since the kids they diagnose with bipolar disorder respond to antipsychotics and other meds then that proves they have child bipolar disorder). And, let's be clear that he's saying that doctors--you know, those rational, god-like creatures who do things based on Science--are being softened up by all those pharma ads saying bipolar is wildly underdiagnosed.

It will be interesting to see what kind of response this study gets.

Thoughts?

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AstraZeneca Releases Limited Seroquel Data For Depression

About two months ago, AstraZeneca filed three separate new drug applications with the FDA to have Seroquel XR--the extended release version of bad old Seroquel--approved as a treatment for depression as monotherapy, adjunct therapy, and maintenance therapy. I noted at the time that using antipsychotics for depression would represent an huge tectonic shift in treating depression and that it was odd that AZ hadn't released any efficacy data for Seroquel XR's performance versus placebo in treating depression (or Major Depressive Disorder, as AZ has it). AZ yesterday released limited performance data for the drug during a poster session at the American Psychiatric Association's convention. This data has not been published yet in a peer-reviewed journal, so I have no information to share on drop outs as well as whatever statistical methodology may have been used. So it's still Missouri time as far as I am concerned.

Here's the lowdown on the poster session:

1. "In a six-week, multicenter, double-blind study, 723 patients were randomized to receive SEROQUEL XR 50 mg/day, SEROQUEL XR 150 mg/day, SEROQUEL XR 300 mg/day, or placebo. At Week 6, all SEROQUEL XR groups had significantly reduced mean MADRS score versus placebo (-11.07): -13.56 (p<0.05) for 50 mg/day; -14.50 (p<0.001) for 150 mg/day; and -14.18 (p<0.01) for 300 mg/day. By Day 4, all SEROQUEL XR groups significantly reduced mean MADRS score versus placebo (-3.27): -4.91 (p<0.01) for 50 mg/day; -5.43 (p<0.001) for 150 mg/day; and -5.35 (p<0.001) for 300 mg/day. The most common adverse events (AEs) (>5% and double the rate of placebo in any SEROQUEL XR dose group) were dry mouth, sedation, somnolence, dizziness, constipation, back pain, irritability, and myalgia."

2. "In a six-week, multicenter, double-blind study, 446 patients were randomized to receive antidepressant (AD) plus SEROQUEL XR 150 mg/day, SEROQUEL XR 300 mg/day, or placebo. SEROQUEL XR 300/mg day plus an antidepressant showed statistically significant advantage versus placebo plus an AD for 1) change in MADRS total score at Week 6 (-14.70 versus -11.7; p<0.01); 2) improvement in MADRS from Week 1 onwards; 3) response (58.9% versus 46.2%; p<0.05); and 4) remission (42.5% versus 24.5%; p<0.01). For SEROQUEL XR 150 mg/day plus AD, improvements in these variables were not significantly different versus placebo, except for MADRS improvement at Weeks 1 and 2. The most common adverse events (AEs) (>5% and double the rate of placebo in any SEROQUEL XR dose group) were dry mouth, somnolence, sedation, dizziness, constipation, fatigue, and weight increased."

3. "In a time-to-event, double-blind, randomized-withdrawal, parallel-group, maintenance study, 787 patients were randomized to SEROQUEL XR or placebo and dose-adjusted as clinically indicated. The mean daily dose of study drug at randomization (last open-label dose) was similar for the SEROQUEL XR group (176.6 [95.5] mg/day) and the placebo group (177.9 [90.8] mg/day). In total, 89.0% (n=348) of SEROQUEL XR patients were receiving the same doses at study end as at open-label baseline, 5.1% (n=20) were receiving a higher dose, and 5.9% (n=23) a lower dose. The risk of a depressed event was significantly reduced for SEROQUEL XR compared with placebo suggesting increased time to event (HR = 0.34 [0.25, 0.46]; p<0.001). In total, 55 (14.2%) SEROQUEL XR-treated patients and 132 (34.4%) placebo-treated patients experienced a depressed event."

The basic story here is that Seroquel improved MADRS scores by about two or three points over placebo (if I am reading things correctly), and got about a 30 percent effect size over placebo (although I'll need the published study for a final number). Two or three points improvement on the MADRS scale doesn't really impress me much (it may impress others), especially given the many, many problems associated with the use of this drug.

But the Seroquel XR story at the APA doesn't end there. Researchers also rolled out data for the use of Seroquel XR in treating generalized anxiety disorder. AZ announced that it would file a new drug application with the FDA before the end of June seeking approval of the drug for treating GAD.

Here's my prediction: the FDA will soon approve Seroquel XR for use in treating depression (it's already approved for "bipolar depression"), AZ will market the hell out of the drug as a new wave anti-depressant for tough to treat cases, doctors will prescribe the drug (which is already well saturated in the marketplace), and soon enough the stories of even more patients packing on the pounds and unable to be wakeful throughout the day will come rolling in. Along with the stories of even more teens using Seroquel as a drug of abuse.

I hope I'm wrong but I doubt that I will be.

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Terror War Vets' Suicides May Exceed Combat Deaths

That's a claim made today by Tom Insel, head of the National Institute of Mental Health, as reported by Bloomberg. Insel appears to be forecasting into a very grim future and using recent estimates that upwards of 20 percent of Iraq and Afghanistan vets are returning home with PTSD and are not getting proper care (and PTSD is tough to treat even with proper care).

"Based on those figures and established suicide rates for similar patients who commonly develop substance abuse and other complications of post-traumatic stress disorder, 'it's quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths,' Insel said."

Insel made his remarks at the American Psychiatric Association annual convention, which opened today. To date, there have been 4,560 soldiers, sailors, airmen and marines killed in the two wars.

I have no way of sorting out if Insel's assessment of the situation is appropriate or simply fearmongering, but it is a wake up call. In case anyone has forgotten, this country has been dealing with (and paying for) the fallout of Vietnam War PTSD among vets since the 1970s. We need to do a better job of things this time out.

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Author Wants Paxil Withdrawal Victims' Stories

In response to a post I did the other day on a bunch of British patients taking on the MHRA (Brit FDA) over how it handled the many problems with Paxil (Seroxat over there), I heard from a legit author who wrote:

"I'm writing a book about Paxil Withdrawal stories. I believe we can all see from this audio that there is not going to be any progress made by trying to 'reason' with MHRA so the only hope we have is to educate the GP's, psychiatrists, etc and get them to stop prescribing this drug needlessly. If you have a story regarding Paxil Withdrawal or suicide regarding Paxil withdrawal, please send it to my e-mail hart.shelly@yahoo.com.

"I'm a registered nurse married to a doctor of medical research/ public health director for the state of Arizona. We can make a difference by educating the public and the health care professionals. The organizations are completely unreasonable and unbendable. It is time for the general public to speak out and save the lives of others in the future. You might say it is time to 'pay it forward.'"

The author, Shelly Hart, and I have corresponded some today and I am beginning to understand why I am getting so many readers from Arizona: they even have three-year-olds on Paxil in Tucson. Wow, what doctor put a three-year-old on Paxil for what alleged disorder?

Anyway, those of you who are interested in helping out Hart should drop her an email at the above address.

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To Hell And Back: College Student's Misadventures In The Mental Health System

I'm not even going to attempt to summarize "To Hell And Back," a very brave piece of writing by a University of Kansas senior, Thor Nystrom. In it, he lays out how he got sucked into the mental health system big time (he was already on anti-depressants and ADHD meds) after a fight (induced by a combo of Paxil and booze) and how he's now basically walked away from it. It's a long piece and its got "Wow" written all over it. Many diagnoses ensue (including borderline), as do many, many meds. One group home he was in sounds like absolutely everything that's wrong with the mental health system (another place doesn't sound quite so bad), and the poor guy ends up out of college, ballooning to 330 pounds, ditching meds (cold turkey even. Like I said, "Wow"), working off the weight, getting himself back into KU and graduating.

"I will graduate on May 18. The diploma’s text will read: 'Thor Reabe Nystrom, The University of Kansas, Major Emphasis in Journalism.' But that’s not everything it will say. That piece of paper will say: Determination. Resolve. Fight. Conviction. Purpose. Willpower. Persistence. Success. Failure. Happiness. Sadness. Life. Death. Blood. Sweat. Tears.

"A broken man will accept it. He will look at it, and he will whisper to himself that he doesn’t deserve it; to never, ever think that he does. But there will be another voice in his head telling him that he has never deserved anything more in his entire life."

I know exactly what he means.

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A Puppy On Prozac

I ran across a fascinating account of a woman who put her dog, Scout, on Prozac at the urging of her veterinarian. Or maybe it was the new Reconcile, Eli Lilly's Prozac for pups. Anyhow:

"When I took Scout to the vet last week, he observed her extreme anxiety and OCD behavior. He thought that a sedative, like xanax or prozac, might help calm her and help her avoid relapse. So we started her a few days ago, and so far she's spazzier than ever. But the vet said it takes 3 weeks for the blood levels to adjust to the drug . . . So, my poor pup's on prozac! My prayer is that it relieves her separation anxiety and helps calm her during fireworks season. And that it doesn't douse her vibrant personality."

Ah, the vets are beginning to sound just like psychiatrists and PHPs, although I've yet to hear the serotonin hypothesis of canine anxiety yet. Let's hope Prozac doesn't kill Scout's spirit either. No word from leaders in the cat anxiety advocacy community on how they feel about dogs doped on Prozac. I have a hunch some cats would be all in favor of the forced medication of dogs and order that the public ignore dogs' complaints about side effects.

Joking aside, I continue to be fascinated with how psych meds are crawling into every corner of our culture. They are in your kid, they are in your grandma and they are coming for you and your dog too. It's also fascinating to hear a dog owner use terms like "relapse" to describe their dog. And, I say this as someone who grew up with a dog--that'd be Rascal, the greatest dog ever!--who went utterly nuts each Fourth of July. I cannot recall either of my parents describing the event as a relapse. We eventually had to start putting her in the basement for a few hours each year. Poor puppy!

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Defining Terms And Thanks

First, I wanted to thank you all for the many kind comments in response to my depression post the other day. Let me just try to address them globally by saying a) my energy seems to be back; b) I attribute that to two long walks over the weekend, a sunny warm Sunday, being hypervigilant about getting six to eight hours of "quality" sleep a night and taking 5-HTP for a couple of days late last week (I'm not endorsing this for anyone else of course; it's the first time I've taken the supplement); c) the 5-HTP tip came to me from a very intelligent reader; d) someone asked about Lamictal: I've been there and think it's an OK drug, as these things go, but the withdrawal was a nasty affair; e) I actually told a ranking FDA official about the Lamictal withdrawal problem that many others have experienced when I interviewed him in February; dude wasn't real interested; f) thanks for the kind words about my work here.

Second, I appreciate the volume of comments (105 as I write this, yep it's a record) on my anti-psychiatry post of last week. It's actually been a decent discussion.

Third, in the last couple of weeks readers have left some interesting thoughts about the coercive and voluntary mental health system/s, and I made a comment back that makes me think I ought to poke at this some more. But I need help defining terminology. What is the coercive model of the mental health system? Is it just court-ordered treatment? Just involuntary commitment or jail? What is the voluntary model? And, what about what I called the subtle coercion of the mental health system, blending a voluntary patient response to doctors and families pressing people into compliance and treatment?

I'm interested in your thoughts on those terms.

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Eli Lilly Funds Medscape, American Psychiatric Association, Harvard, NAMI National

Eli Lilly's report detailing the company's contributions to various health care organization and advocacy groups for the first three months of 2008 is out now--and it's a doozy. Among the top recipients is the American Psychiatric Association, Harvard University's Massachusetts General Hospital psychiatry department, Medscape and the National Alliance on Mental Illness (NAMI). You can read the report here. Keep in mind that these dollar amounts are for the first quarter of 2008.

The APA, which is the physicians group for psychiatry, got $623,190 from Lilly for three separate programs including something called "Using A Chronic Disease Model When Managing Patients With Severe Mental Illness." Mass General got $500,000 for its 2008 "Psychiatry Academy," whatever that might be. Oh, wait, it's a big old CME operation run by the psych department at Mass General, home of the bipolar child mafia and the medicate people into the ground alliance.

NAMI National got $500,000 for two programs, one entitled "In Our Own Voice" and another called the "Multicultural Action Center." Various NAMI local and state affiliates also got smaller contributions, as did local affiliates of Mental Health America and DBSA.

Medscape LLC got $175,000 for something called "ADHD--Optimizing Diagnosis and Treatment Through an Online Educational Continuum" and $205,000 for something known as "New Data in the Recognition and Management of Bipolar Disorder." Medscape is, of course, the huge and hugely influential medical information and news website. They need money from Lilly to talk about ADHD and bipolar disorder for what reason? Shouldn't they just cover ADHD and bipolar disorder and let the ad dollars flow to those pages? Why would they need seed money from Lilly? Perhaps these are articles they stick online as CMEs for docs, but I'm confused as to why, if docs are so interested in educating themselves about bipolar disorder, for example, they wouldn't just develop the materials themselves. Something smells very fishy to me here. Or maybe I am just old fashioned and would like to see medical information made available to doctors and the public that is untainted by corporate largess.

Continuing Medical Education LLC--that's the big CME company--got $604,375 for programs on ADHD, depression, bipolar disorder and fibromyalgia.

And, finally, one odd little item: An organization called the Mental Health Services Coalition got $6,000 for a program called "Mental Health Day At The Capitol." I cannot find this group listed on the Net, but I imagine this is a consumer "grassroots" group of some kind that got funding from Lilly to go lobby a state legislature on mental health issues. One can only wonder what these were.

As odd as this might sound to some readers, I congratulate Lilly for being transparent about who it gives money to, as required by a recent legal settlement. It would be interesting to see the contributions of companies Like Glaxo, AstraZeneca and Pfizer, as well.

Posted by Philip Dawdy at 10:02 AM | Comments (13) Stumble It! del.icio.us Digg it Google Netscape reddit

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Recording: British Paxil Users Meet With Brit FDA

Just hitting the Net right now is a recording of a group of British Paxil users, known as the Seroxat User Group (Seroxat is Paxil's name in the UK), holding a meeting with the head of the MHRA and some other government officials in the UK. The MHRA is their FDA. The levels on the recording aren't the best, but someone in the UK is cleaning up the audio and I'll post that later. I've only been able to listen to some of the beginning of the recording, but from what I gather the government officials get questioned on why they chose not to prosecute GlaxoSmithKline (which hid all sorts of bad data on the drug from regulators and the public) and about the connection between the drug and suicidality. Listen for yourself.

I'll try and post something later today if possible.

No matter what, I congratulate the Seroxat users for challenging the decision makers on drug regulation in this fashion.

Here's the audio:

Let me know what you think.