So my long sweated-over article is finally live. It's called "The Drugging of the American Mind." Happy reading.
Here's results of a study published in the British Medical Journal. Conclusion: pets are good for humans. Second conclusion: older folks sometimes blow off health care--ie, getting moved into long-term care--because they fear losing a pet. Answer: "Greater understanding among health professionals is therefore needed to assure people that they do not need to choose between pet ownership and compliance with health advice." Wow, breaking news. I cannot believe that researchers get publication credit for something you and i could agree upon in five minutes over coffee. Guess you need a PhD or MD to get credit for such obvious thinking.
Here's a New York Times article on pharma companies actively recruiting cheerleaders to be salespeople for their drugs. I won't say a word, but someday promise to go into my own experiences working as a sales rep for Abbott Labs. For now, however, I leave you with the sweet Cassie Napier. Go team!
I've long bitched about the fact that there are virtually no studies on the long-term use of psych meds in patients. This is true of anti-depressants. Kind of startling given how widely Prozac and its cousins have been used for the last 15 years. Apparently, the lives and well-being of tens of millions who take these drugs is not important to our government and pharma companies once a drug is licensed for short-term use. Here's a Norweigan study that should give new impetus to the need for long-term studies. The study states that Prozac may stop bone-building cells and lead to the breakdown of bone mass. Fabulous, absolutely fabulous.
I've been hearing for some time about Risperdal--one of the leading atypical antipsychotics--being used in kids as young as six for outbursts, bipolar disorder and the like. Now, here's a study of the drug's use in kids aged four to 14 for attention-deficit problems. The study was done on 14 kids, so I am dubious of the claim that it was well-tolerated by all and got the job done. Even if it works, you've got to wonder about the long-term effects of this drug on young minds.
When I started this site two months ago, I figured about half of what I posted would relate to mental illness and the rest involve politics and culture. I was wrong. That's because there is so much screwed-up crap around mental illness, mental health and the folks who control the system that I could write about nothing but that all the time.
There is much good, bad and ugly out there. If anyone thinks we've made tons of progress on mental illnesses in this country, consider: the suicide rate in America is virtually unchanged since 1958, hospitalization rates are higher than they ever have been, and just as many patients are as miserable as they were in 1990 when the pscyhopharmacological revolution hit the mainstream. That was the year Prozac blew up in this country. And suddenly millions of Americans were taking anti-depressants and so on. In the mid-90s, it seemed like every third teen was a diagnosed bipolar. And so on.
Has anyone noticed that things don't seem to have gotten a whole hell of a lot better? Has anyone noticed that there doesn't seem to be a lot of honesty about this in the mental health world? Have you ever wondered why this is the case? I'm not an anti-meds guy and I am not going to allege a conspiracy between big pharma and doctors and the government. Still, there is something weird going on when so much money has been spent on meds, therapy, research, etc. and not a damn thing has truly changed. Mental illness is still raging in our culture. Pharma companies are minting money. Where people have insurance, their companies foot most of the bill, but that gets factored right back into the cost of coverage for everyone else. Where people don't have insurance and no Morgan Stanley guy helping them out, then god help them.
So what's the deal? Why isn't this working?
The prime mover behind diagnosing people, putting them on meds and keeping them on meds forever is that doctors and researchers believe that meds are capable of eliminating any and all symptoms of mental illness--symptom remission as it's known. If med A doesn't work, then you need to switch to med B because there is hope, don't you know? If med B doesn't work, then you need to try med C. And so on. That would be a nice approach if it bore fruit more often.
The frustrating thing is that 50 percent or more of patients continue to have symptoms break through meds. And then they end up on a cycle of med switching that goes on for years and still they never find the right med or combination of meds. I know I am stating what's obvious to many patients. The proof, if you want it, is hidden in research studies and academic papers. There, you will often see if asserted that med A remits symptoms of depression in 52 percent of patients, for example, versus 25 percent in placebo. The trouble is that 48 percent of the patients on med A had no remission (and the people who got remission got it for the short-term). They aren't as likely to suddenly get it on some other meds either. But still these same studies are used to determine what docs prescribe in the real world, what the FDA licenses, etc. , but you'll hear very little acknowledgment of this from doctors and researchers and the public health crowd. I am confused about that. But then myths die hard, don't they?
The sad fact is that 15 years after Prozac and its brethren were supposed to make millions of Americans whole again, things are just as screwed up as they ever have been. That's not all bad.
I think there's a certain power to be gained from the admission that complete symptom remission is a false god and that what we really ought to be doing is getting symptom remission where we can and letting people live where we cannot instead of pounding them to death with meds and wasting billions in the process.
Or maybe I am just being a bit too skeptical tonight. But that's what happens to someone who's already made his way to med R--and has yet to see the kind of symptom remission that is the basis of the current psychopharmacological paradigm.
I so love psych researchers. They'll research anything and get paid for it, of course. In this case, they makea claim that swimming with dolphins lessens depression. Um, I report. You decide.
Just letting you all know that I have finished a large project and will be back to regular posting here over the holiday weekend and for the foreseeable future. Thanks for your patience.
Have a nice Thanksgiving.
This shouldn't come as a shock, but here's a study that shows the huge shift away from using psychotherapy to treat depression in children to just slapping them with meds. Nothing wrong with using meds where they are indicated and with proper monitoring--which almost never happens--but as almost always happens when doctors get revved up about a new paradigm, they go too far overboard in using the new technology. My guess is we're only a few years out from studies like these being done on the use of atypical antipsychotics in children--and adults!--and coming to a similar conclusion that the overuse in bipolar disorder was quite dramatic. Why doctors never learn from the past is beyond me. Could we have some judiciousness, please?
Psych researchers--very infleuntial ones, I might add--whom I have interviewed in recent weeks are openly touting atypicals as the new mood stabilizers. That would mean replacing Depakote or Lamictal or Lithium with an atypical as a first-line approach to dealing with bipolar disorder. It would also mean using them as a monotherapy for long-term use. Some of the docs I spoke with were so enthusiastic about atypicals--despite having NO long-term studies to support their view--that they were effectively pimping for these drugs.
I won't get into who these researchers are right now--I'll name them in a forthcoming article--but suffice to say that when these researchers put their views on paper in scientific journals, other researchers listen to them. So do advocates. So does the media. So do psych docs in private practice. So do gps (who, by the way, are writing about half the atypical scripts). So this is clearly the direction the field is moving in.
The atypical the docs keep mentioning as the most likely candidate to become the mood stabilizer of choice is Seroquel (very much the IT drug these days).
What's worrying about that is I know of few bipolars who have had decent long-term results--much less medium-term results--with Seroquel. Or other atypicals. Weight gain, other metabolic side effects, that kicked in the head feeling the next day, etc. You know about this shit. The side-effects alone are proven not only by the anecdotal experiences of bipolars, but by the recent CATIE study. That study established that in long-term use in schziophrenics that atypicals were difficult to tolerate and that the side effects are leading to patients running smack into the metabolic syndrome--a fancy term docs use to describe increased cholesterol levels, increased sugar levels, and so on. In short, the recent evidence for atypicals isn't so good. And, I cannot stress this enough, there are NO studies of the use of these meds long-term in bipolar disorder.
And yet the psych field wants to make these the new mood stabilizers. My view is that such an approach will turn out to be a disaster for patients--hell, I'll predict that--and a boon to pharma companies.
So what do you think of using atypicals as the new mood stabilzer? If anyone thinks atypicals totally rock for long-term use, then get back to me.
I'll be posting very little over the next week or so. I am too tied up with the day job to put any substantive effort into posting here for the moment. But keep those cards and letters coming!
Last week, a psychiatrist with one of the country's largest HMOs and I were talking about the state of the art in treating mental illness. We discussed just how many people in America actually have bipolar disorder. Both of us are dubious of the assertions by pharma companies and some advocates that the commonly-accepted 1 percent to 1.5 percent prevalence of bipolar understates bipolar disorder in America. There are pharma websites that claim as much as 5 percent of America is bipolar. Neither of us have ever seen any solid proof that such is the case.
But once we got done agreeing with one another, he told me that in his HMO's experience only about 40 percent to 50 percent of people diagnosed with bipolar disorder get treatment or stick with their treatment. Of course, it's not news that many people diagnosed with a mental illness start taking meds and then stop soon thereafter. You know the reasons for that.
While I am sympathetic to why people find meds problematic (let's say it altogether now: meds suck), I have little patience for people who blow off treatment altogether, alleging that they feel fine, that they don't need those pills, etc. They always end up crashing and burning, only it's worse than the last time. And, then, the cycle repeats.
There's very good evidence to support that getting treatment and sticking with it wins the game in the long run. Why more people don't get that is beyond me. Why more people aren't willing to commit to doing the hard work of finding a med combination that works for them without turning themselves into dunces escapes me. As much as I complain about meds, there is almost always a way to find meds that will work well enough to keep you from running crazy through life, even if they aren't a perfect fit. Finding such a situation beats the hell out of the alternatives: death, jail, a shitty reduced life, unemployment, etc. To not work at finding treatment that works more or less is utterly irresponsible--and I'll come back to that in a future post.
I've been taking Lamictal as my main mood stabilizer for 18 months now. So have lots of other bipolars, especially those of us who've taken Lithium and Depakote for long periods of time and had all the lovely side effects of those meds catch up with us over time. I've been reserving judgment on Lamictal. I've taken plenty of meds that seemed great out of the chute only to have them turn into problems down the road. But Lamictal has been a pretty good ride for me. I am official fan of Lamictal. In fact, I think it may deserve rock star status among psych meds. Its side effects seem miminal and it does seem to keep me and other bpers from swinging into depression too much. It's not much of an anti-manic med, but, oh well, I can deal with that in other ways (short-term use of an atypical, for example). When I do slip into depression on Lamictal, it doesn't seem to too hard to dig out of. The funny thing is it seems to work on my depressive side as well as all the other anti-depressants I have taken--all 6 of them!--without any of the crappy side effects.
Every so often, it's nice to run into a med that works and does so over the long-term.
It's long been the argument of mental health advocates--ok and me too--that this country needs to take depression seriously and do it in a way that destigmatizes the treatment process. Here we go. One of the largest insurers in America has announced that it will pay family practice docs extra to screen for and monitor common depression. More serious cases will be referred to psych docs. It's about damn time. I hope we are at a tipping point.
Now, if only we could anti-depressants and other meds that work more often than 50 percent of the time.
As much as I bitch about atypical antipsychotics (especially their aggressive use in bipolars), these meds have clearly been a godsend for schizophrenics. Thousands of schizophrenics do not have to spend their lives in state hospitals or on the streets or locked away in group homes because atypicals treat hallucinations and such without turning patients into total zombies the way older antipsychotics do. Here's more evidence.
I am far more dubious about using APs in bipolars over the long-term. But that's for another day.
Here's my thinking on atypicals, for what it's worth. They are damn effective for use in treating short-term mania and depression that's spinning towards psychosis. Take them for a day or two and you can knock that bad shit down. The trouble is that the meds knock you down in the process, even at pretty low doses. But I am not convinced that Seroquel, Risperdal and the like work in the short term any better than older antipsychotics. That's important because the atypicals cost 10 times more than older antipsychotics.
What I am having a hard time understanding is why there is such a big push to use the atypicals for long-term treatment of bipolar. There are no studies in patients to support long-term use. So this new paradigm of handing out atypicals like candy--let's be honest, that's what's going on--is not supported by scientific research unless we are talking about short-term use. The meds are not well-tolerated by many users--some users tolerate them just fine of course--and the side effects of these meds are now well-known. Also, I know many patients who've taken atypicals long-term and they still run into serious depression and mania.
So I remain unconvinced that using atypicals as long-term mania preventers is indicated in bipolar disorder. Now, the question is why are so many docs doing that? And why are so many patients rolling over and taking atypicals that way?
Here's what I think about the product of the year around 10.30 pm. Things were spiraling badly today--depression and all the black thoughts that come with it of course. So I did what work I could, went home and popped a Seroquel. I hadn't taken one since July and the pill took me down quickly. I slept four hours straight, awoke, was groggy and cognitively slowed downnnnnnn, couldn't type, couldn't face the thought of staying awake several more hours before sleeping naturally and being hassled by the blackness. So I popped another. I will be signing off any moment now.
But first: I think I will adapt and use Seroquel the way I used Mellaril in the 1990s. I used to take Mellaril back then to knock down these same blacknesses. I'd take the pills for a couple-three days tops and just try to ride the bus back to normalcy. That's the way the doc wanted it and that's the way I liked it. I'd get back to normal soon enough. Then, I'd ignore the Mellaril pills until the next time they were needed, usually about six months out. Impotence, grogginess, cognitive slowing: I could handle all of those for a few days in exchange for getting back to the happy mean in my life. But with Seroquel, the docs, pharma companies, policymakers and society in general want us to take the pills all the time, for life. With two years of Seroquel under my belt--literally!--that is not a deal I am willing to accept as a conscious actor in the universe. I'll forfeit days, but not a lifetime. And, so, now, I will only take Seroquel a bit at a time--it doesn't knock down depression and mania all the time, so why would I take it all the time? Good night.
Wow, I was wrong all along. Seroquel is a spectacular drug and was just named product of the year--break out the champagne and balloons!--by the National Business & Disability Council. Maybe, these business blow job groups ought to check in with patients who live in the real world before providing propoganda to major pharma corporations. Of course, it's this thrum of acceptability that helps explain why none of the main mental health advocacy groups in America--who are allegedly working for patients--will criticize atypicals. This sickens me. I don't expect them to denounce atypicals but to actually listen to the millions of bipolars and schizophrenics who take these meds in a non-public health setting (ie, the 75 percent of us with mental illness who aren't on Medicaid, SSI, etc.) because these drugs are not proving out as something we can live with on a day to day basis while trying to have fully engaged lives. Some honesty is needed and this is apparently the only place providing it.