So AstraZeneca, Seroquel's maker, filed papers with the FDA today (er the 30th) to have Seroquel licensed and approved for use in what's called bipolar depression. That's a subtype of the disorder and would be yet another big market for AZ. The two studies they cite as evidence of the drug's efficacy wound up with about 50 percent of patients seeing results over 8-12 weeks while the other half saw no improvement, went off the med, etc. AZ happily notes in its press release that if approved Seroquel would be the only drug approved for both manic and depressive sides of bipolar. That's a sly way of them announcing that if this new licensing is granted then they will market the drug as the new mood stabilizer, a la lithium, Lamictal, etc.
The trouble is that, as many of us know, Seroquel can be a very debilitating drug to live with. I have no trouble with it being used judiciously in short term situations where it is justified, but I am against its long term use. Although the FDA would only technically be approving it here based on shot term studies, it would allow AZ to market the drug with the wink and nod that patients should take it all the time for a lengthy periods as a maintenance drug. The doses they are pointing to as efficacious are 300 mgs and 600 mgs.
Anyone feel like getting juiced on that much Seroquel? Anyone feel like standing by quietly and letting AZ snow the FDA and thousands of doctors who will prescribe anything they see favorably mentioned in a journal article while patients with long-term experience with the drug remain silent? Let's tell the FDA what we think of Seroquel. We need to have our voices heard and our experiences as patients count for something with the very safety officials who are supposed to be looking out for the public.
Let's at least ask them to add cautionary language to the license about its long term use. As far as i know, psych patients have never gotten involved this way before...so this would be a first. (They of course got invovled after the fact with Prozac, Paxil etc.) We need to think of other, future patients and figure out how to help address this situation.
If anyone is down to write the FDA, then reply in comments and i'll do some digging next week and figure out to whom at the agency we can address our concerns--and praise for those of you who want--and i'll let you know what's next. Or reply at the myspace.com bipolar groups.
Sound OK?
For background reading, please read this and this as well as this and this cranky post on Seroquel's lack of efficacy in the very studies AZ cites as proof of its positive qualities. Also, there is this on the ignorance of researchers about the long-term effects of Seroquel and other atypicals on patients' cognition and this post on how the company hype's the drug's balancing abilities.
This is one of those things that I am not sure how to get into words that mean anything. But no one is reading this anyway, so whatever.
I know a few schizophrenics fairly well, two of them in particular. Last night, I was talking with one of them. She was in a very bad space and I was at a loss trying to explain to her how the things she was seeing and hearing and people she perceived to be doing things to her were not real. "I don't know," she said to my insistence that she could cognitively push the beasties out of her mind.
She's right, of course. These hallucinations are very real for schizophrenics and it is very difficult to watch people you care about be consumed by them. No one has really hit on a method of addressing this, which is sad because schizophrenics have as much of a right to a life untrammeled by mental illness as so the rest of us bipolars and depressives, et al.
The current answer is meds, meds, meds--atypical antipsychotics, most commonly. Unfortunately, these meds don't treat schizophrenia well for about half of the people who take them. For the half who get some level of relief, the meds are great, despite the wreckage they do to patients' bodies. I am frustrated by this state of affairs because, honestly, schizophrenics have a much harder road to travel than do any of us with bipolar disorder or depression or anxiety. We've got mental illnesses, but we've also got something that we can work on, something that doesn't destroy our minds and relationships with reality on the level that schizophrenia does.
It's more unfair than almost anything in human existence.
I am completely at a loss as to know what to do for schizophrenics, and it angers me and breaks my heart all at once. But there is a piece of me that believes the rest of us with mental illness--especially those of us who, like me, have managed to somehow carve a decent life out of the situation--have an obligation to schizophrenics. We've got to do something to help these people because all the meds, researchers, doctors, social workers and families in the world aren't getting the job done. These poor folks need to have their lives redeemed.
I wish to god I knew what to do to make that happen. But then even god seems to be at a loss, too.
During the past few years, I have been in fairly regular contact with hundreds of bipolars, schizophrenics and depressives. Lots of them, especially the newly-diagnosed, have trouble accepting that they have a mental illness. It's been so long since I was diagnosed that it is hard for me to summon the anxiety, shock, fear, shame, self-loathing and so on that comes with getting pegged with a mental illness. What I gather is that I was a rather unusual case--I accepted my diagnosis out of the chute, didn't dilly-dally about "oh I am really this other thing over here," and got busy trying to make my life work. Sure, it was scary and shame-filled, but that was more the world than the illness itself biting on me. OK, it was both, but...
I mention this because I know several people who are currently fighting their diagnoses, refusing treatment of any kind and making their lives a living hell in the meantime. I can understand the impulse, of course. But the evidence, both anecdotal and scientific, is that people who go into denial--"my perfect life is shattered! Poor me!"--end up losing big time in the long run. Hell, in the short run, too. They are the ones who end up with broken lives, shattered families, ruined careers and all the other social fallout of untreated mental illness. They also end up dead or staring at the ceiling of a psych unit more than any of us would like.
This kind of fucking around is stupid in the short-term and life-reducing in the long-term. I am seriously tired of seeing bipolars and schizophrenics go flying off their meds as if they were somehow immune from reality. Bad things happen when they do. And, yes, we all know that meds can suck and beat the hell out of you. So what? Accepting the bad business that you've got is a far better option than fighting it and ending up on the slab. The stakes are far too high to not be serious about tackling mental illness head-on.
Life will work a lot better--says me!--if you accept your diagnosis and actually get some treatment. And, yes, meds of some kind are part of the package deal. If the ones you get prescribed don't work too well, a high probability, then go try something else. Just don't expect it to make you immune from relapses and what the docs like to call symptom breakthroughs. Meds are far from perfect, but are essential for setting the baseline for recovery--ie, living a decent life. But enough of meds.
What often gets lost in the clinical picture and American society's reliance on meds is that good old-fashioned self-awareness and determination play a huge role in patients getting better and getting ahead. I have seen more examples of the right "mindset" having positive outcomes to believe that it is essential to making mental illness work for you. I cannot teach you how to be self-aware and determined. But I know that it starts with acceptance of your DX and acceptance of how that changes your life. And that's OK. That kind of self-acceptance is actually quite freeing and can feel damn revolutionary in your own life. And it's the best option you've got.
So stop fighting it--and welcome to the show.
For eons, researchers have stated that bipolar disorder manifests in person's late-teens or twenties. For a long time, that has also meant that the disorder was largely undiagnosed in adolescents and children, although that has been changing in recent years. Here's a study showing that 20 percent of the teen admissions to a psych hospital met the criteria for bipolar disorder. That has interesting implications for the old debate, as well as for the fact that most of these teens' initial diagnosis was depression. Keep in mind, too, that we are talking about admits to psych unit, not prevalence in the general population. Of course, it also has all manner of implications for treatment and meds, but that's for another day.
I nitpicked the New York Times the other day--and I promise to return to them soon. But the media screws up with mental illness almost every time it tackles the subject. This TV news piece (just the script) is hardly an exception. It is so feeble on so many counts that I think I'll let it speak for itself.
A few of you have recently commented that the mentally ill have no voice and that we desperately need one. That's something I've been saying for a while myself. Someone also wrote that we need a spokesperson. We might need a few of those, too.
For what they are worth, my thoughts:
Often, in America the voice for social change comes from a charismatic individual, or individuals, who is tied in with an advocacy group that works to make its voice heard in non-traditional ways. This was true of the civil rights movement (MLK there, principally) and of the conservative, economic-reform movement (Reagan). The pattern didn't hold as tightly for the gay rights movement (Larry Kramer was a force, but far from the central figure) nor for the women's rights movement (so many women played key roles). For the social conservative movement (this is separate from the Reagan Revolution, which had more to do with economics and smashing Communism than anything on the moral-religious index), there were also many rainmakers. That's some simplistic background.
So what about us? The two large advocacy groups in the US (NAMI and NMHA) are not the bodies through whom the type of change we want is going to happen. They are too focused on national and state-level policy and politics to have any ability to shake up American culture. They are insiders without charismatic central figures. Also, both groups are too dependent on funding from sources that just wouldn't appreciate the kind of pushiness that may need to go down in order that our voice be heard. Many in the mental health community believe that NAMI is too dependent on pharma contributions, for example. (NAMI claims that the amount is much smaller than it used to be.)
My guess is that we'll eventually end up with several key figures. The media--and let's face it, the media is often the kingmaker in these deals--is far too diffuse these days for any one person to be "the hero," as it were. That's a good thing. The issues around mental illness cross so many lines in our culture that it wouldn't be possible for one person to get a grip on addressing all of them with genuine impact. And we need impact and results, not just consciousness raising and getting the rich and powerful to say nice things about the mentally ill. We need the real thing.
The trouble is that our time hasn't come yet for the change agents to be in a position to have results. But we are getting damn close to that time. Still, there are signs that America remains hesitant to change its thinking around mental illness in the expansive way in which it must. There have been several best selling books on mental illness over the past 15 years--Darkness Visible, An Unquiet Mind, Prozac Nation and Listening to Prozac. (There are a few others, of course.) These are all good books, but they are largely restricted to memoirish affairs (message: mental illness is fucked up, I have mental illness and am fucked-up, but the meds work fine, so take meds) and clinically-based accounts (message: science says mental illness is a brain problem, meds address the brain problem, so take meds). They are not instruments of social change, nor do any of the authors really see that as their goal, and, as a result, none of them did, or do, much for the mentally ill. That's ok. Kay Jamison's work has, over the years, made me feel a hell of a lot better about my own fate.
I mention all of that because several of those authors have been referred to as "our voice" by some people. Anyone who has ever seen Jamison on television knows why she'll never be our voice. She's a psych doc and her concerns are very doctorly, not social change. This past spring, I was in Washington, D.C. when NMHA officials spent much effort trying to convince Jane Pauley--who outed herself as being bipolar on her tv show a a year ago--to become a major spokeswoman for mental illness causes. She declined. Many in our "movement" pine for some famous celebrity to come forth and make the sick walk again. I think going the Hollywood/celeb route is a terrible idea for two reasons: one, it's been tried and failed. Last year, one of the pharma companies sent Terry Bradshaw (the great quarterback) on a media tour in several major cities to discuss depression and men and how getting treatment was a cool deal. I got one of the press releases, but, as a reporter, I couldn't see much of a story there. Neither could the rest of the media, which didn't cover his visit to Seattle. His visits elsewhere didn't generate many press notices either. Working in the media myself, I can assure you that anytime a celeb wants to talk to the media about an issue of any kind, we tend to roll our eyes and pass--it's largely a play for publicity by a figure already well-known. Why give them more ink?
What's more, the general public tends to blow off the celeb spokesperson--unless they are talking about acting or football!--because what they are saying about themselves ("Hi, I'm Terry Bradshaw and I'm depressed.") doesn't register because we already know these people. What we are getting now is just a slightly new wrinkle on their lives, and the whole thing reeks of corporate PR manipulation anyway. The only time where I have seen this approach work in a powerful way was with Lance Armstrong, a man I truly admire. But keep in mind that Lance had been doing his cancer advocacy work for more than five years before the Livestrong business blew up this year. Also, it got the most attention when he was at the peak of his sports career, not years after he had left the limelight.
Social change is dicey stuff. It requires an outsider figure. I am not sure who those people will be for us. But I am certain they will not be a celeb and they will not be someone speaking on behalf of Eli Lilly or any other pharma company. And this is as it should be.
So why, as I mentioned earlier, do I think our time hasn't come yet? You may remember John Nash, central figure in the movie A Beautiful Mind. The man was/is profoundly schizophrenic and still won a Nobel Prize. I cannot think of many more profound examples of just how well people can do with mental illness. When the film came out four years ago, I expected Nash to become one of our great public voices. But that didn't happen.
So, we're still looking. Anyone have any ideas?
Every so often I grind my teeth over the non-coverage of mental health issues in the mainstream media. Case in point: the New York Times. This year, the paper has had a decent series in its pages called "Being a Patient." Part 11 just ran. The series has looked at information overload on patients, the struggles of cancer patients, and so on. You may have heard that mental illness is kind of a serious issue in America. You wouldn't be able to figure that out from this series, in which the lone article on mental health matters concerns 20somethings in Lower Manhattan dealing out psych meds to one another--mostly ADD meds and anti-depressants--and skipping psych docs altogether. Interesting stuff, but hardly the most pressing of issues before psych patients. (Meds and docs are, of course, but the article really only pushes those questions by implication.) The reporter even managed to misspell Seroquel (the paper later ran a correction).
So why is it that mental health issues barely tip the scales in this series? Mental illness affects 30 million on so Americans--a conservative estimate--and, just by the raw numbers and inherent suffering, that puts us ahead of cancer as a widespread health issue. Are we still so screwed up as a culture that the nation's leading paper cannot even ask incisive questions about what mental health patients contend with? I have my hunches, which go to a much broader bias against intelligently tackling these issues in our society, but I'll leave them lie. It's Christmas, after all. I hope that Bill Keller and kids at the Times have a nice one--and wake the fuck up on the 26th.
I promise not to do this too much, but some of you can say things better than I can. Here's a recent comment that nails my frustrations--yours too most likely--better than I can.
So many of us are tired of this system. And you are correct- when do we demand something else? Maybe I feel so strongly about this right now because I'm in the middle of switching meds. I've been in this game 19 years and I haven't seen much change. The entire process is exhausting and dealing with the insurance companies is even more so. Recently on the phone with a new potential drs office- they asked for the mental health phone number on the back of my insurance card. Why? Why is this still a question? I've seriously debated over the years calling all of my contacts and recruiting a celebrity to speak out on the many issues the mentally ill still fight. AIDS has Bono. The UNHCR has Angelina Jolie. NCCRA has Katie Couric. Cancer has Lance Armstrong. And now we have a very powerful celebrity speaking out against the use of psychiatric meds. Or maybe rounding up thousands to march the streets would work. Unfortunately in today's society, I doubt it. Either way, something must be done. We need better research. We need understanding. Patients need to demand more from their doctors. We need a voice.
Correct.
I'm always a little leery of studies connecting this or that condition with depression. Whether this pans out or not, we'll see. But, for now, Swedish researchers say they've connected heart disease--especially in people aged 25 to 50--with depression. I'd be more interested if they could nail down the actual mechanism, but I'm weird that way.
In a prior post, I pointed to research data showing that atypical antipsychotics work well for schizophrenics about 30 percent of the time. Seventy percent of the time, patients switch off whatever med they are taking to yet another atypical, often within a year of taking the first med. This leads to an endless cycle of med switching.
This same phenomenon exist with bipolars, although it remains unstudied with the kind of scientific precision I'd prefer. We are taking tons of atypicals, too, and are half the $10 billion market for atypicals. What I've gleaned from interviewing numerous bipolars, as well as researchers and clinicians who work with bipolars, is that patients switch from atypical to atypical the majority of the time. These meds come with profound side effects--collectively known as the metabolic syndrome--for those who take them.
So why are docs pushing atypicals on bipolars so aggressively when their performance is so weak? Sadly, atypicals are the only meds that work at all for schizophrenia, so I understand why they are used there, as problematic as that use may be. (I don't say that lightly, by the way.) But for bipolars there are far more options than there are for schziophrenics--mood stabilizers and anti-depressants. There are performance issues with these meds as well, but the side effects simply aren't as severe as with atypicals. So why prescribe atypicals so aggressively? Where's the logic in forcing bipolars into an endless cycle of med switching with such powerful meds?
Advocates and clinicians and researchers typically respond that "that's the way it is." Med switching is just something patients have to accept, and if they keep bouncing from med to med, then they will eventually find something that works well. That's a lame, evasive stance to take, one that suits the needs of advocates and clinicians and researchers. But it ignores the reality patients live with. Med switching is a nasty, risky business--ask any bipolar--and often leaves patients more screwed up than they were before.
I am tired of a mental health system that expects patients to accept this state of affairs. The system ignores patients at their peril. The question: When do we push back on the system? When do we, in effect, say fuck this shit? When do demand, not ask for, something else?
It amazes me how much data I continue to run into that supports the National Institute of Mental Health's contention that psych meds work about half the time. There is much anecdotal data, too, from clinicians and patients that support the same basic number. Even stronger scientific data came in September via the CATIE study, which showed even worse performance on the part of atypical antipsychotics with about 70 percent of patients ditching their initial antipsychtoic in favor of another because the first med either didn't work in treating symptoms or generated unacceptable side effects.
Now, from a health care data research company comes news that schizophrenics switch off the first med they take 70 percent of the time. There's slighly better news for some of the drugs schizophrenics take. Patients switch from Zyprexa, an atypical antipsychotic, 43 percent of the time. They ditch Risperdal, another atypical, 46 percent of the time. The data comes from sifting national data from schizophrenics in the private insurance system, which is to say patients who aren't in the Medicaid system and are, thus, less severely ill. The fact that the discontinuation rate--or more properly, the switching rate--lines up with results from the CATIE study is sobering. We don't have many options other than antipsychotics for medication-based treatment of schizophrenia. These meds are the only thing that can knock down hallucinations, for example, when they work well. Too bad they don't work all the time. There are no new classes of meds of the horizon. I pity these unlucky folks.
In short, this fresh data is further evidence that antipsychotics just don't work as well as they need to in patients who desperately need these meds to work for them. It's further evidence, too, that the NIMH was dead on with its assessment of half-performance of psych meds as a whole.
So why is there virtual silence in the media about how poorly psych meds perform? Why is there only the most perfunctory news accounts, for example, of the CATIE study and no examination of what spotty performance means in the lives of patients? (By the way, this is one place where I must actually praise the New York Times for poking away at this issue albeit in a piecemeal, "a new study says" way and usually only in regards to anti-depressants.) Where is the accountability? I won't even guess at the reasons for the time being.
Here's a study from Eli Lilly that's a well-timed attempt to gently counteract the landmark CATIE study released in September. The take away from CATIE is that atypical antipsychotics don't perform much better than first-generation antipsychotics yet cost 10 times more. The implication for treatment for schizophrenics was the fear among mental health adovcates and clinicians that state mental health systems--each state has its own Medicaid system, and pays for care of millions of schizophrenics nationwide to the tune of $4 billion to $5 billion in medication costs--would try to force many patients back onto the older, cheaper antipsychotics in order to save money. In Washington State, for one, the state Medicaid system spends $100 million a year on antipsychotics--about two-thirds of that goes for schizophrenia treatment, the rest for bipolar disorder--and $90 million of that goes for atypicals. State like California and Flordia spend many times more on atypicals.
Such a move away from atypicals would be billions of dollars of bad news for pharma companies. Eli Lilly, in particular, has aggressively responded to these implications by releasing positive news about Zyprexa, an atypical antipsychotic that's worth about $3 billion in annual sales.
This time out, the company claims that results of a study of schizophrenics taking Zyprexa show that atypicals are justified by lower cost, once total treatment costs for patients are taken into account. Total costs include medications, hospitalizations and doctor visits. It's not clear to me whether the total figure includes annual housing costs and disability payments.
That said, the data show that the average patient taking Zyprexa in the study group costs $20,891, $21,347 for Risperdal (a competing atypical) and $21,283 for patients taking first-generation antipsychotics. That's not even a significant difference, so why Lilly is touting this as news that atypicals cost less overall compared to older meds is beyond me. You just have to read the study results to figure that out.
My take on that same data, however, is to partly agree with Lilly, but not for the reason the company claims. As harsh as it sounds, atypicals like Zyprexa are the best deal that schizophrenics have got. They don't zombiefy patients the way older antipsychotics do. That alone justifies use of atypicals in schizophrenics.
What is striking news from the study is just how much money an average schizophrenic costs the public each year--about $21,000. (If housing and disability payments need to be added atop that figure, the cost would be around $30,000 a year.) That's a lot of money, well worth it when you consider that housing such patients at a state mental hospital can easily top $100,000 per patient. But it's still a ton of money per patient. Patients who aren't in the public system--meaning they are on private insurance or nothing at all--likely cost far less.
By comparison, a large HMO in Washington State tells me that the average bipolar in its system costs about $3,200 a year in total costs.
What the study doesn't address at all are the side effects of these meds on patients' bodies. But that's another story.
Several smart people in the mental health world have bitched at me because I describe bipolars as being bipolar. They would much prefer the term "person with bipolar disorder," as if the rhetorical distancing somehow makes having bipolar disorder easier to come to grips with. The also tell me that saying bipolar to describe someone with the disorder is stigmatizing. If that's true, then let the stigmatizing begin! (That's a joke. Honest.)
First, I don't see the sense as a writer--and, on occasion, a thinker--in accomplishing in four words what takes me one. Second, I don't understand where such political correctness buys the mentally ill any leverage in society. Third, we have bigger concerns to spend our time and energy on if we are ever going to get any relief for schizophrenics, depressives, bipolars and the rest of our crew. Worrying about the cleanliness of our political language is a waste of time and resources.
We've got bigger problems around the performance of psych meds, access to treatment, the scope of what's considered treatment, a public mental health system that doesn't work, a private mental health system that's even worse, a health insurance system that is inadequate by any measure, a criminal justice system that is being used to house "persons with mental illness" and patients who give up on themselves. There's so much more, of course, too.
So, until someone can come up with a more effective two-syllable term, then I am calling bipolars bipolars. Besides, I am one myself (of very long standing) and I get to describe myself and my cohorts any damn way I please.
Here's a news release on a calcium channel modulator that the company claims may work in treating acute mania. Apparently, it has also shown promise in treating dementia. I have no idea how a calcium channel modulator works--hell, I can't find much on the net about the mechanism--but it sounds like something a bit more refined than the receptor chasing meds we are all taking now. Second phase of clinical trials forthcoming. I'll be curious to see what the side effects of this treatment modality are and whether it has long-term effectiveness.
The received truth that mental illness is strictly a medical problem, the result of a chemical imbalance alone, is the loose equivalent of a lie. It's the kind of fib we tell ourselves in this culture. It soothes us somehow when we know half the answers to a riddle, and find the answers that we do know to be unsettling while the answers we don't know terrify us. Of course, it's a natural enough impulse.
But it's still a lie. The brain chemistry imbalance theory of mental illness remains unproven in strict scientific terms. And there is a decade of data, scientific and anecdotal, which establishes that psych meds don't work very well. That's not my wild ass assessment of the landscape facing patients, caregivers and families. The National Institute of Mental Health says it. Doctors who are honest know it, even if they won't speak the truth publicly. Patients know it all too well.
If I had read those same words 5 years ago, I would have thought whomever had written them was off the deep end. But I'm not.
The sad truth is that nothing is quite as it should be with mental illness--the science base is shot with holes, treatment paradigms rely excessively on medication, patients who are expected to take these meds for years and years are getting left in the lurch.
I refuse to accept this, but I will leave it at that for now.
Those of you who know your psych meds history will recall that Lithium's anti-manic properties were discovered by accident in the 1940s when an Australian doctor using the element in heart patients figured out that he had some very calm patients on his wards. Now, it appears that a drug being tested for psoriasis positively affects depression. I'm sure this isn't a breakthrough drug like Lithium was in its day, but who knows. Stranger shit has happened.
Here's a top exec at GlaxoSmithKline admitting that patented meds--of all kinds, not just pysch meds--work in only 30 to 50 precent of all patients. I bet no one else follows his lead even though this is a well-known reality in the pharma world. There is too much money and power at stake for pharma companies, doctors, advocacy groups and public health officials to let this kind of honesty persist. It must be stopped now!
As I've written elsewhere, marijuana has long been thought to have anti-depressant properties. Lester Grinspoon, an emeritus psych prof at Harvard, has been saying this since the 1950s. Many in the psych profession have written him off as a quack, as a result. (I've interviewed the man. He seems as rational to me as any other psych doc who, for example, trumpets the effectiveness of Seroquel.) Such is the prejudice towards pot in the medical community. Of course, many patients and docs have discovered through their own, ahem, research that pot can kick depression's ass. In states with medical marijuana laws, depression should be an approved use.
Now, here's further evidence that there is something going on with cannabanoids and the brain. The drug involved is known as URB597, a chemical cousin of cannabis without the THC. This study lends credence to earlier research that the compound could be useful in addressing depression and anxiety. I'm sure this won't cause anyone at NIMH to rush out and fudn studies on pot and depression. The White House, the drug czar and the DEA just can't hang with such free thinking. But they should, because if you are interested in having treatments that actually work, then you'll look anywhere. After all, it's not like the SSRIs and their chemical kin are doing such a thorough job of treating depression in American society.
When it comes to bipolar disorder, typically all you ever hear about is the bad stuff. Ask a bipolar, though, and you'll often hear how much they--ok, me, too--love the hypomanic state. Here's a brief article from the New York Times, recounting how two researchers speculate that hypomania may be at the heart of America's great adventuring, risk-taking spirit.
I'm not surprised that researchers are now diagnosing bipolar disorder in preschool-aged children, i.e., 2 to 4 years old. After all, it's being diagnosed like, um, crazy in teens and adolescents. I won't even get into whether I think it's legit to do this in children so young. What troubles me isn't the diagnosis, but the inevitable implication that it will lead to the use of powerful psych meds--such as atypical antipsychotics--in the terrible twos. I have a hard time believing that can be both safe, especially long-term, and socially desirable, except in extreme cases. But that's a more complex conversation for another time. For now, read this press release...and learn that some of the research with children was done using "age appropriate" puppet interviews. Oh, those wacky psych researchers.
I've been waiting for the other shoe to drop on the Vioxx story--confirmation that the company actually withheld data. Here it is: happy reading. Think of this next time a doctor touts the results of a study to you.
As you know, a bipolar man was shot and killed by federal air marshalls in Miami today. Most accounts confirm that he was bipolar, so I'll take that as fact. News accounts also state that he went running off the plane in a deranged state, allegedly claiming he had a bomb. His wife followed saying that her husband was bipolar and hadn't taken his medication. The air marshalls blew him away when he refused to give up his bag, which he wore across his front, allegedly.
If this poor soul was truly bipolar, then I am sure that what will eventually come off is that he was off-meds, likely altogether or had been taking them intermittently. Probably years of struggle with trying to make treatment work, and bouncing back and forth between being treatment compliant--meaning meds, therapy, anything--and non-compliant. Sad shit. He likely didn't have to die in such a fashion. A wife didn't have to lose her husband. And the cops wouldn't have had to plug a fairly innocent creature.
Moral: take your meds. Find the right ones. Take them all the time. If you have very severe bipolar disorder, then be self-aware and know when you are getting psychotic and knock that shit down with an atypical antipsychotic. Be responsible for your own life. It will help the lives of others around you. And your own.
And for god's sake when the cops say "halt," then stop. Don't be a dumbass.
Six months after actor Tom Cruise went off the deep end with rants about psych meds, mental health treatment, 'dissing pregnant women's health care choices and scaring poor Oprah half to death, the star finds himself in a career tailspin. He's just been rated the coldest star in Hollywood--cold as in terms of box office chill and, inevitably, difficulty putting togetehr new deals. Tough shit, Maverick!
There was a good piece to all the attention on Cruise's statements about anti-depressants. A poll was done that showed two-thirds of the American public believed him to be wrong on the facts of treating mental illness. Good news. However, lost in all of this was that Cruise made one salient point: We are using too many powerful meds in order to treat mental illness, especially in youngsters. Too bad he was arguing that from religious orthodoxy, not from evidence.
As I've noted before, over the summer Eli Lilly settled a lawsuit brought in federal court in New York by thousands of patients who'd taken the atypical antipsychotic Zyprexa. Many of these people developed diabetes. The settlement was for $750 million and, for some reason, escaped media notice, despite the fact that it caused a major pharma company to incur a loss for one quarter. Anyhow, now a lawyer has challenged that settlement in court on technical grounds, and once again the media is ignorning the existence of the settlement, excepting the fine folks at the Indianapolis Star, who deserve credit for actually writing about the case.
A commenter notes that schizophrenia is genetic regardless of what's said in the previous post. There's no question that there is a genetic component to the illness. The real question is whether it is solely genetic in its causes or whether something else is going on. The article I had linked to points to a growing sense in the psych community that schizophrenia may be caused by environmental factors. Also, the famous Fuller Torrey continues researching a connection between children picking up viruses from cats that leads to schizophrenia--no I am not kidding...and yes he is a credible researcher, as out there as his hypothesis seems. Whatever the exact cause, enough psych researchers have told me that they feel schizophrenia is only about 50 percent genetically-caused to where I think it is important for all of us to consider that it may be the work of something interacting with genes, and that meds alone isn't going to address the entire situation. I find that both hopeful and scary. What do you think?
Or maybe it is. Either way, here's a rundown on some current thinking in schizophrenia research that strangely enough fills me with hope. (That's a word I don't use very often.)
Also, in the same article, APA president Steve Sharfstein questions the meds-only approach to treatment. I think Steve is my new hero. Money quote: "As a profession, we have allowed the bio-psychosocial model to become the bio-bio-bio model. In a time of economic constraint, 'a pill and an appointment' has dominated treatment."
Here's news of a conference the APA held in October. The purpose was to gather business leaders, the APA and government officials to discuss how to get folks with mental illness back to work. Great idea. Much needed discussion. I'm sure it was a rousing moment...but where the hell were the patients themselves? Pardon me, but we are the largest stakeholders in this whole question. We have the right to be represented and not have muckety-mucks make decisions that affect us without our input. So, um, APA, next time you put on one of these conferences, check in with me please.
Always nice to have the president of the American Psychiatric Association agree with me on something I've alread said. In this case, the prez, in an editorial about the landmark CATIE study and its reception in the media, says that too much emphasis on the news around atypicals' shabby performance in schizophrenics has focused on pharma company marketing and cost implications for the public health system at the expense of appropriate consideration of just how rotten the clinical situation is for actual patients. You go, Steve.