We all know that the fine folks at Fuller Torrey's Treatment Advocacy Center love, love, love their database of "preventable tragedies" and have defended its integrity to me when I challenged them on some of their stats back in May, as well as calling them on their data collection methodology. When I noticed back then that their data included no information on whether mentally-ill people who had (allegedly, in some cases) committed acts of violence had been taking meds (or not) at the time of their alleged misdeeds, I asked a TAC official why they didn't do so.
"It wouldn't be possible," the TACer said. It sounded like a lazy excuse to me, since I know how simple it can be to pick up the phone and get answers, even about complex circumstances around an alleged crime (or an actual crime, too). When I pressed further, I was given this emailed blow-off:
"I appreciate your interest in assisted treatment law and our statistics. However, my time is limited and I have to put TAC's mission first - so I must sign off. Best of luck."
But then TAC basically makes the blanket assumption that the mentally-ill caught up in crimes and tragedies are off-meds. The the group uses these instances to buttress its call for forced medication of the mentally-ill. Ooops, that would be "assisted outpatient treatment."
My argument isn't that meds may or may not have made someone commit a crime (some make that argument, and recently some courts have bought such defenses in criminal cases, ie, the case of Jeff Reardon and the bad-Butrin case out here in Washington State). Instead, I just think TAC needs to be fully-honest about just how effective forced medication would be in the real world. I've spent a decade observing, in a professional sense, life on the hard streets of San Diego, San Francisco, Oakland, Portland and, most especially, Seattle. Based upon that, I can report seeing many cases of people with really nasty schizophrenia on-meds getting into all manner of gnarly tangles.
Thanks to longtime reader and encourager Moira for passing along an item that confirms my hunch about that database.
On December 25, 2005, "Nathan Cheatham shot and killed his mother in the driveway of her McLean, Va., home. He then drove 10 miles to a home in Great Falls, Va., and fired more than 50 shots that killed three other people, before turning the gun on himself and committing suicide" to quote from TAC's database of Record ID #4145, citing a sole television news report two days later.
But, according to a subsequent press account in the Fairfax Times, Cheatam was indeed on-meds at the time of his crime (maybe not the right ones, but that's beside the point). Not so hard to figure out after all in the midst of a very, very sad story.
If there is one thing I have learned as a reporter, it's that TV and radio stations usually have the thinnest accounts of the circumstances around an alleged crime. Print reporters tend to be more exhaustive in their reporting. Just a tip, guys!
I look forward to TAC correcting this entry in their database, as well as to their going back through their cases and working to determine how many people in there were on or off-meds.
It's snowing in Seattle Wednesday night, almost two inches on the ground in my neighborhood where for the last few days all the side streets have been an icy mess. It was a great day to stay in and write, so I did. On another project. As a result I only have one formal post and this one, introducing you all to a couple of other blogs in the mental health world. Both are written by real live MDs.
The first, The Last Psychiatrist, is authored by an anonymous academic in the psych world. It is well-reasoned, authoritative, funny as hell at times, and even in the few places were I have quibbles with the author, his arguments are persuasive enough to make me ponder my stances all over again. I bet he's a damn good clinical professor. Assuming that that's what he does for a day job.
I won't even get into his insightful posts. He can be quite critical of the psych world, which warms my burned cinder of a heart no end. It's a blog you should add to your newsreader. OK, read this post about the biggest mistakes psych docs make.
The second, CorePsych, is authored by Charles Parker, a psychiatrist in private practice back East, who also has his fingers in a lot of pies. His blog takes the tough world of neuroscience and breaks it into the real world we all think in. He's also funny, too, and a fly fisherman and came of age doing day labor. That tells me a lot. As does his honest reassessment of the Tom Cruise/Matt Lauer snarlfest last year:
"Yes, he was disrespectful not only with Matt, but his own friends. But let's face it without new information, without a public dialog about science, we all fight over that recovery path.And yes, Tom is right on an important element: People are having problems with meds and we need alternatives. Faith, spiritual practice, is an essential part of any recovery process. And we do need to know more about the meds.
Now it's time to move on, beyond beliefs into facts. Psychiatry is loaded with useful scientific information: science works, if you work it."
I, too, think Cruise was off-base with his "history of psychiatry" but was right that there are big problems out there. Mostly, though, I was disturbed by how he was attacked by my colleagues in the media, whom I wish had more respect for a free market of ideas. Even if it's coming out of the mouth of ol' Maverick and L. Ron Hubbard.
Because I am in a moody space right now (now being about 10 p.m PST), albeit a good creative space, I am going to pass along a few recent reader comments that articulate better than I can what's going on out there. Not only am I fortunate to have you all as readers, I am especially pleased that some recent comments are from people who've not commented here before.
But I'll start with someone who has:
"The whole "Depression Hurts" campaign associated with Cymbalta is quite interesting. Cymbalta claims to relieve pain associated with depression despite the bulk of the evidence indicating that Cymbalta is not a pain relieving medication for people with depression. Does the FDA care that the marketing is grossly misleading? It would appear not. If you doubt me, go to Lilly's clinical trials online database and look at the results--the effects on pain in depression are meager at best. Then go to www.depressionhurts.com and see how Cymbalta is marketed.Yet, despite no evidence of superiority to any existing product and quite weak evidence of providing pain relief in depression, Cymbalta continues to gobble up market share due to stealth marketing and blatantly misleading advertising. But why NOT engage in these tactics when they work and nobody steps up to hold you accountable?"
Yep.
"The pharmaceutical industry is a master at manipulating victims and turning them into spokespeople for the very medications that killed their loved ones. It really makes me sick."
"Everything you wrote on this blog regarding using Seroquel as a short term only medication is right. I thought I was gonna prove ya wrong on it, but dude. You were so right. This shit is not good for long term use, and at the 7 week mark for myself, I am waving it a long goodbye. I am glad it works for some, but I can safely say it has failed me as the wonder drug it claims to be. Short-term--it worked great. Stopped the mania I was having. The longer I remained on it, the worse I felt (feel). I say use it 2-3 nights to get sleep if that is an issue, otherwise keep that shit in the medicine cabinet as a PRN. Thanks for the insiteful postings here re: Seroquel use. I hope readers pay attention to a rookie here and listen up: short term use only."
I think AstraZeneca may have a cheerleader sales rep or or two in their corporate family who might like a word with you.
And on the wild price differential between first and second-generation antipsychotics, despite their virtually equivalent performance:
"This is from TAC's blog, Aug. 4, 2006. They have been speaking out about the cost of meds for a long time. Thanks for your blog, I read it very often."
Thank you, too. As much as I bang on TAC's "the mentally-ill are so violent" blather, there is actually more we agree on than not, which proves, once again, that I am a moderate.
And, now, I think I will go moderate or regulate or, um, whatever.
I used to spend lots of time in the MySpace bipolar groups, principally because I know how scary and isolating it can be to be diagnosed with bipolar disorder, and I wanted to encourage people there--young and middle-aged alike--that bipolar is not a death sentence, and that they have decent futures as human beings to look forward to. In the last two years, I have talked three people out of killing themselves, so it's had positive results. But those groups aren't as intelligent and healing as they used to be back when there were like 1,500 members of the main group. Now that there are 4,300 members of that group, the conversation has gotten into people reveling in being fucked up and buying into America's disastrous groupthink on bipolar disorder.
For example, today someone started a thread about how they hated being hit with all the stereotypes around bipolar disorder and a bunch of other bpers got in there and basically agreed with the stereotypes. Which led to me posting the following:
"The bp/creativity nexus is well known, but I wonder why, in sociological terms, it's now fashionable to take highly creative people, as many of us are, tag us with a mental illness, and medicate the fuck out of us. Guess that's how we got from bp being one percent of the population to bp being anywhere from three to five percent, depending on who is doing the estimating. I think America just doesn't know what to do with screwy creative people, not that it ever has.From time to time, I think bp--and I am talking non-psychotic bp here--is as much a personality situation as it is an organic brain disease. But then maybe i am being extra skeptical today.
Either way, i don't simply blame the pharma companies for this situation. I expect them to create markets for themselves. That's capitalism. I do however blame doctors and public health officials (neither group being particularly creative types) for not being skeptical enough about the 'everyone is bp all of a sudden' talk. But then doctors and public health types love to create markets for themselves, and cast themselves as being pure ethicists in the process, removed from commercial concerns.
BTW, if anyone thinks I am off-base here, I can assure you that these questions about bp and how many people are truly bp are being debated in the medical community these days.
Thoughts anyone?"
Total silence--although a couple of people sent me nice emails, no one would step up and agree or disagree. Instead, they went on, reveling in being "fucked-up" and weird, bruised loners.
I've been doing a fair amount of reading about bipolar disorder lately--its intellectual, medical and commercial constructs--because I have gotten very skeptical about this rush to diagnose and label and stick fairly benign cases of people with bipolar disorder on aggressive medications, when there is limited/no evidence that these meds, the atypical antipsychotics, are particularly beneficial to patients. Such a situation forces someone like me, who has been in the game over 17 years, to rethink how we are doing mental health treatment as a culture and who we as a cultural are becoming as a result.
I will post more about this soon, as well as more on stealth marketing, but I am trying to be as cautious and deliberate about this as possible. Still, there is something weird afoot in America and I have a hunch it may take us all somewhere we'd really rather not be.
And, as for the MySpace groups, I think they have drifted in a bad direction.
Thoughts anyone?
Each time I see an article on mental health that's datelined Indianapolis I get suspicious. That's where Eli Lilly is headquartered. The company makes and markets famous or infamous, depending on your view, psych meds such as Prozac, Zyprexa ("opening the door to possibility"), Cymbalta and Symbyax (a combination of Prozac and Zyprexa "because not all depression is the same"). Personally, I don't think there's a good one in the bunch.
Anyhow, my suspicions kicked in overtime this past weekend when I saw a mountain climbing story, written by an Associated Press reporter and datelined Indy. Odd, I thought. Not too many mountains in Indiana. But the story, reprinted in papers around the country, concerned Joe Lawson, whose father committed suicide in 1986. The son wants to raise awareness about depression and is out to climb the highest peak on each continent in an effort to educate the public about the nasty illness. Mountain climbing is, of course, something of a metaphor. So far, so good.
But when you go to the Expedition Hope website and poke around, you'll find that Eli Lilly is a major sponsor of the educational/awareness raising effort. And when you click on the about depression link (the presumed educational component), you go to a page which then offers even more "educational" linkage. These links take you directly to Cymbalta's website. Nice work, Lilly.
I won't even bang on Cymbalta--I'd given up on anti-depressants by the time it hit the marketplace--but I know there are readers of this site and friends of mine who have suddenly gotten suicidal and uncontrollably depressed soon after beginning to take the drug. Joe doesn't have anything on his website about that.
More importantly, I wonder why this trip is even news. People climb mountains every day, after all. But, then, I can almost guarantee that the AP got put onto this story by a PR person at Eli Lilly and some editor went "interesting human interest angle" and dispatched some poor reporter to cover this drek. Why the AP isn't more discriminating when corporations pitch stories to them is beyond me. I've been a journalist for 10 years and not once has a flack's pitch resulted in a story under my byline. It confuses me that it did for the supposedly-mighty AP.
Why would any journalist worth their salt want to participate in this kind of stealth marketing? An article of this kind is great for Eli Lilly--it's positive press about a sympathetic figure and makes the company look magnanimous for helping out. And, I'm sure it gets people to click on Cymbalta's website and rush off to their doctor with the site's self-assessment for depression test where their doc will have a ten-minute appointment with them and, then, they'll march off to the pharmacist with a script for, um, Cymbalta.
Having been a successful sales rep for a pharma company when I was younger, I can assure you that's how the game is played. Some of you may recall that exactly one year ago (OK, no one remembers) I linked to a New York Times article detailing how pharma companies favored hiring former college cheerleaders for their, um, ability to educate doctors about their products. Here's the reductio ad absurdum--two Philadelphia Eagles cheerleaders are pharma sales reps in their non-cheerleading hours. They are also damn hot. If they promise to love me in the morning, I will take Prozac. Maybe even Viagra.
Thanks to the wonderful PharmaGossip blog for putting me onto this. Sadly, my Seattle Seahawks don't detail the Sea Gals' lives quite so exhaustively, but I am sure there is a budding pharma rep or two bumping and grinding down at Qwest Field. And, if they promise to love me in the morning....
Back in my day, pharma companies regularly hired hot nurses to become sales reps. But civilization must march forward!
More on all this stealth marketing of psych meds to consumers in future posts. Meanwhile, I'll be thinking of Joe Lawson, who doesn't suffer from depression himself, as he takes a crack at Antarctica's tallest peak. If he ever gets around to scaling Mount Everest, I promise to take Cymbalta for a week. Even if he doesn't love me in the morning.
Think that rates of diagnosis of bipolar disorder have gotten out of hand? Here's an old article from The Onion, which I'd forgotten until running into it on My Back Pages. "God Diagnosed With Bipolar Disorder" starts with:
"In a diagnosis that helps explain the confusing and contradictory aspects of the cosmos that have baffled philosophers, theologians, and other students of the human condition for millennia, God, creator of the universe and longtime deity to billions of followers, was found Monday to suffer from bipolar disorder."
And ends with:
"'One of the major 'heresies' of Christian history is the Gnostic belief that the Creator, or 'demiurge,' of this troubled world is a blind, idiot god who is insane,' Jurgens said. 'This idea surfaces in many religious traditions around the globe. As it turns out, they were only half right: God has His problems like anyone else, but He is essentially trying His best. He just has a condition that makes His emotions fly out of control at times'."
Classic shit.
As I mentioned on Friday, the British press was alive with news of a study in the Archives of General Psychiatry in which British researchers claim that there is fundamentally no difference in patient outcomes between patients with schizophrenia who took either a first-generation antipsychotic or a second-generation antipsychotic (the atypicals). Why the Brit press just caught on to all of this when the study was published 7 weeks ago is beyond me. Not that the American media has done such a grand job with reporting this study.
I need to caution that I have not seen the paper in full yet (anyone want to send it to me?), so it is difficult for me to know exactly how they measured quality of life for patients and so on. But from the abstract and press accounts of the study (also here), it is clear to me that even the researchers were surprised by this outcome. In fact, they went back and ran their data again just to be sure.
I am not entirely sure which second-generation meds were used, but I know that Seroquel was among them (sulpiride was the first-generation drug used). This is now the third study in about a year to knockdown the prevailing orthodoxy that atypicals reduce symptoms better than first-generation antipsychotics and that the atypicals are so kinder and gentler with the side effects. I have discussed the CATIE study here and here.
All of these studies combined raise serious questions. Here are a few:
Why do pharma companies continue to charge anywhere from 8 to 20 times as much for atypicals as they do for older antipsychotics? Because they can and no one will question them on it.
Why do doctors continue to insist, in the face of compelling data, that atypicals are great? Because they can and no one will question them on it.
Why did NAMI National put out a press release and organize a teleconference for reporters soon after this Archives of General Psychiatry study called the status of atypicals into account? Because they can and no one will question them on it. And, NAMI National gets a lot of money each year from pharma companies. Any connection?
Why have these same atypicals suddenly become frontline treatments in treating bipolar disorder, despite a profound lack of independent evidence showing that these meds are good for schizophrenics and that those poor folks can barely tolerate taking them? Why would they suddenly become so "good" for bipolars? Hell, they don't even reduce re-hospitalization rates compared to only taking a mood stabilizer. Bipolars don't particularly fancy these meds, either, as I pointed out last year.
Why are we now giving them to children? Why are their parents going along for the ride?
Why has this gone down with such little public questioning or accountability among federal regulators, mental health advocates, the entire psychiatric profession and the media?
Why is there so much silence on this matter?
Well, fuck this silence. It's time for bullshit to be called on using atypicals in schizophrenia and bipolar disorder and all the other maladies of the mind and soul that the pharma companies want them to be used for. Bullshit. There I said it. (Actually, I've been saying it for over a year, for example in this post and in this long-winded article I wrote in my former employer's paper.)
Here, the head of the British research team, Shon Lewis, offers some thoughts to the BBC:
"Despite modern prescribing patterns, second-generation anti-psychotics are not the great breakthrough they were once thought to be--and certainly may not justify their 10-times higher price tag."
Change that "may" to "can." Still, Lewis gets points for honesty.
British advocacy groups are taking the same stance NAMI National took in October. From the BBC:
"Marjorie Wallace, chief executive of the mental health charity SANE, warned it would be wrong to limit accessibility to news anti-psychotics. 'What we hope is that the study will flag up the importance of patients being able to look at the risks and benefits of different drugs, matched to their own biochemistry, and that it will encourage the pharmaceutical companies in their current research to develop third-generation medications'."
Um, whatever. NAMI National's medical director, Ken Duckworth, said this back then:
"General findings cannot be substituted for specific choices made in treating individuals with schizophrenia. One size does not fit all. It is critical that the study's limitations be recognized."
Why do groups like NAMI never recognize the limitations of pharma-funded studies that are used to justify using atypicals and licensing in the first place? Why is it that in many of those studies, you'll find huge dropout rates among participants and that for those who stick out the entire study that only about half the patients see any real benefit? Sounds pretty limited to me.
And why aren't the NAMIs of the world bothered by the fact that in the US 90 percent of the antipsychotics prescribed are atypicals? Who does this group really represent?
In October, NAMI National criticized the British study for not being useful in American medical circles because:
"The British study relies heavily on an older drug, sulpiride that has never been approved by the Food & Drug Administration (FDA) and is unavailable in the United States."
At the time, I let that assessment slip, but now it bugs me. Why? Because sulpiride is off-patent, so why would any pharma comapny go to the expense of getting it licensed in the States? And, because sulpiride is a kissing cousin of other antipsychotics like amisulpride. For all I know, it's like Haldol, too.
But, then, there's plenty of truth evasion going on outthere. A reporter at The Guardian called AstraZeneca for comment on the British study. Here's what the reporter got:
"A spokesman for AstraZeneca, which manufactures the second generation drug quetiapine, said the study did not measure the effectiveness of individual drugs and that quality of life in schizophrenic patients was difficult to measure."
Quality of life is hard to measure? Oh, please. That's about as bad as last year when, soon after the CATIE study came out, a couple of researchers at Eli Lilly published a paper claiming that the patients were at fault for not taking their Zyprexa properly. (Sadly, I cannot find that Eli Lilly paper at the moment. But I will. :))
So I wonder if this chap at AZ could go check his calendar, find an afternoon when he's free, and then go fuck himself.
God knows that first generation antipsychotics are nasty drugs, chock-full of zombieism-inducing side-effects. I am not against using atypicals and I am not in favor of restricting their access to patients, provided that said patient actually benefits from the drug. I am against the American public being ripped off for their cost. And, I am decidedly against their use as a long-term maintenance medication in bipolar disorder. I have noted before that I have no problem using them to address short-term crises. But using them day-in, day-out for years and years is without justification, in children, teens and adults.
I think this British study is a huge wake-up call for patients, doctors, the media and advocates. Are they listening? (OK, the New York Times seems to be waking up.)
Yesterday's New York Times has an article by Gardiner Harris, the third in the series on troubled children, establishing what I have been saying on this blog for the last year--that there is poor evidence for the use of atypicals and polypharmacy in children. From where I sit, it's a major article given who he's quoting in the piece, including Tom Insel who is the head of NIMH.
Hell, I don't think the evidence is so great in adults.
In addition, a new British study is out which backs another of my main points on this blog--namely, that atypicals perform poorly in adults (sometimes worse than older antipsychotics) and that their side effects are such that they provide no quality of life benefit to patients, long the aytpicals' alleged trump card.
Nice to have my ramblings confirmed again. I'll have much more to say about these studies on Monday. For now, I am going to enjoy the weekend.
I've long bitched about how costly psych meds are, especially the atypical antipsychotics, which are used in treating schizophrenia, bipolar disorder and, should AstraZeneca get its way, every other DSM category under the sun. Now, CL Psych has a post on his blog about how vast the cost difference is between older and newer antipsychotiocs. The media commonly reports that this difference is 10 times, basing that upon claims that were floated last year about the time the CATIE study came out.
What he's found is that the difference is anywhere from about 8 times to 20 times the cost of older atypicals for comparable doses. That's an outrage. In no way are the newer meds so much better than the older meds as to justify such a price differential. I guess patients and taxpayers are to pay for pharma companies' research costs. Why haven't MHA and NAMI made this an issue at all? Could this have anything to do with the funding they receive from pharma companies? And, if the fine folks at the Treatment Advocacy Center truly believe in their forced medication ideology, then why aren't they making this an issue? Psych patients are in no position to force a free market for antipsychotics.
It's time that the advocacy groups woke up and started doing work that will impact the life of millions of schizophrenics and bipolars.
One of the two main mental health advocacy groups has changed its name to Mental Health America from its old National Mental Health Association. Although they do recieve pharma money, they are much less likely to get on their knees for pharma companies than is NAMI, which also renamed itself not so long ago, going from the National Alliance for the Mentally Ill to the National Alliance on Mental Illness. Not that name changes are that big of a deal, but there ya' go.
For the record, MHA has been incredibly kind to me over the years, for which I thank them. NAMI National hasn't returned a phone call of mine in like two years.
An hour ago, I submitted an op-ed to the New York Times in response to Andrew Solomon's op-ed on depression centers, which was published in the Times on November 17. I was kind to Solomon in what I wrote, but did openly question whether federally-funded centers can improve the workplace discrimination that the mentally-ill routinely bump up against and whether whatever research advances might come from these proposed centers can do much to fix the lives of the average person with mental illness in the next 10 to 20 years.
It'll be interesting to see if the paper of record bites on my submission. I expect them not to.
I am going to pass along this link to the Szasz Blog--so named for the controversial "Myth of Mental Illness" psychiatrist--and note that this British study might reignite the long-running debate about whether schizophrenia is caused by bad parenting or is it all in the brain. It's beyond my expertise to say anything intelligent. So I link and you decide.
I should note, however, that Szasz and some of his disciples have linked themselves quite publicly with the Church of Scientology's Citizen's Commission for Human Rights. CCHR is where Tom Cruise learned his "history of psychiatry."
How reader traffic dies right before a holiday, so I'll do a couple of little posts tomorrow and go enjoy Thanksgiving.
In recent posts, I have noted that AstraZeneca is pushing hard to turn Seroquel into the equivalent of Lithium--the go-to, gold standard, front line monotherapy treatment for bipolar disorder. Some readers have wondered whether I wasn't jumping to conclusions and, of course, I wondered myself.
After spending a few hours with a government database over the weekend, I can assure you that I was understating the case: AstraZeneca is now using the term monotherapy in titles of its clinical trials and is even trialing Seroquel directly against Lithium. The Rubicon has definitely been crossed.
What's more, the company is now testing Seroquel on children as young as 4-years-old. And it's conducting studies of the drug not just for bipolar disorder and schizophrenia, as you might expect, but for post-combat PTSD, anxiety disorders, ADHD, cocaine and meth use, alcohol abuse, smoking behavior among schizophrenics and obsessive compulsive disorder.
It's truly breathtaking what the fine folks at AstraZeneca are up to and what so many researchers are willing to do at their behest. Click on the extended entry link for more on these studies, which are so numerous that I'd clutter up the main page.
All of the following data comes directly from ClinicalTrials.gov. Feel free to visit the site and do a search under the term Seroquel (the database includes studies under both brand and generic names). AstraZeneca currently has about 30 of the approximately 180 studies currently underway or recently completed for bipolar disorder. The company also has another 38 studies of Seroquel ongoing, trialing it for other conditions.
Here are some highlights of Seroquel trials:
"Bipolar Maintenance Monotherapy"
The researchers note "This is an exploratory, pilot study, seeking to determine whether Quetiapine is efficacious and well tolerated in the treatment of preschoolers with pediatric bipolar and bipolar spectrum disorder in this age group. The study results will be used to generate hypotheses for a larger randomized controlled clinical trial with explicit hypotheses and sufficient statistical power."
Awesome. Can't wait.
In kids as young as 12-years-old. So much for the wonder years.
"A Study of Quetiapine for the Treatment of Mood Disorders in Adolescents"
"Seroquel in Bipolar Depression Versus Lithium"
Last time I checked, no one claimed that good old Li had strong anti-depressant qualities, so this strikes me as little more than creating a paper AZ can waive in front of doctors and say, "Told ya' it was better than Lithium."
"Phase III Study of Efficacy and Safety Quetiapine Fumarate as Monotherapy"
"Bipolar Maintenance Monotherapy"
A two-year study.
"EMBOLDEN II - Seroquel in Bipolar Depression Versus SSRI"
Seroquel v. Paxil. Which will prove the lesser of two evils?
"Seroquel in the Treatment of Dysphoric Hypomania in Bipolar II"
There are loads of docs who use Seroquel on BPII patients. Efficacy is overkill.
Waking up from Seroquel is like waking up from a fifth of whiskey the night before, so this ought to be fun.
Patients will get up to 1,200 mgs a day for treatment of schizophrenia and schizoaffective disorder. Sounds like the metaphorical equivalent of Thorazine to me.
"Quetiapine for Cocaine Use and Cravings"
A recently completely study right here in the Seattle-Tacoma area.
Reason enough to quit doing coke and meth.
"Quetiapine Augmentation for Treatment-Resistant PTSD"
Welcome back from Iraq, soldier. Do VA benefits cover diabetes?
"Seroquel on Glucose Metabolism"
Methinks, a certain pharma company is nervous. Good.
"Quetiapine Decreases Smoking in Patients With Chronic Schizophrenia"
Yes, but can I have Seroquel after sex? And will you love me in the morning?
"Quetiapine Augmentation in Severe Obsessive Compulsive Disorder"
I can see it now: patient unable to wake up or focus. Their OCD is cured.
An Eli Lilly study measuring Zyprexa versus Seroquel. A study made for sales reps.
All of the above is but a sample of hte trials of Seroquel.
There were several comments on my post on Andrew Solomon's op-ed piece in Friday's New York Times and they are so good, in both directions, that I am posting them here for one and all.
From Lily:
"I hated the Noonday Demon from the start because of the introduction in which Solomon acknowledges that his Daddy's pharmaceutical company, Forest, started making anti-depressants in response to his battle with depression at Yale. The anti-depressant they produced was Celexa. The anti-depressant that caused me to tie shoelaces around my neck on Easter Sunday and slice up my body was Celexa. I don't want to hear about how great medical advancements are in the field of depression. I don't want to hear about how grateful I should be to Solomon's father and other wealthy, white male researchers who profit off of the misery of the downtrodden, and fail to disclose the truth when their "cures" illicit only more misery."
Depression at Yale deserves a medication all its own!
From CL Psych, who also comments on the op-ed on his blog:
"I thought that was one of the worst puff pieces I have ever laid eyes on. His main idea may have been to encourage depression centers, but he came off to me sounding a lot like a drug rep."
And from Masale, a new commenter:
"What does his being rich have to do with the merit of his book (which I found to be an excellent personal account on his struggle with the illness). I ask as that is the only reason you cite for not liking the book. Also, I have been on Celexa and it helped me more than anything else. Which is to say that anti-depressants work for some and don't for others. There must be an equal number of patients out there who are thankful that these meds exist today. I'm amazed at how the previous commentors feel they have a right to launch ad hominem attacks on Solomon solely based on what his father does for a living!"
First, I am glad Celexa helped you. Cool beans. Second, I have made the point before on this blog that I am sick and tired of the exemplars and authorized spokespeople of living with mental illnesses being rich actors and the trustafarian literary class. Why? Because not having to work for a living and having vast financial resources sure as hell isn't even close to how most people with these illnesses have to live. Seriously. Money and privilege are amazing buffers against reality. I would like to try them sometime, especially since I am currently unemployed and make do with, like, half a computer.
Mostly, though, his writing style in his book simply isn't to my taste. And I am cranky enough to have an opinion about things like that.
With the help of a friend, I was able to get the book proposal off my iBook—victim of a beer and cat-related spillage incident—without any drama yesterday. My trusty 5-year-old-plus laptop boots up fully and can drive an external VGA monitor, so whatever got toasted in the spill was neither the hard drive, the main logic board (Apple doesn't like to use WinTel terms like motherboard!!!! 'cuz that would be, like, so unJobsian), the memory nor the video card. So there is a connector between the video card and the screen itself that is out. If it's not a soldered connection, then the fix ought to be fairly affordable. If it's soldered, then it's time for a new laptop. That would suck. I've done the best writing of my life on that iBook. Writers are fairly superstitious creatures who need certain routines and habits in their daily lives—certain coffee cup, certain cigarettes, certain pens, certain keyboards—in order to function. So I would only give up my iBook—with its keys becoming non-responsive, its memory maxed at 512 MB, its processor an ancient 450 MHz G3—after trying what I could to make it run again. And, if that doesn't work, then I'm off to the store.
And, yes, I will be buying another Apple. I've been computing every day since 1983, often on a blend of PCs and Apples (I once used a Lisa at one job, no shit! and my dad owned one of the early Apple II+s. I also used the oringal PC and remember such fine chips as the 8088. I used both PC-DOS and MS-DOS). Apple, after many years, won the personal computer operating system race a couple of years ago when Mac OS X came out. It is close to flawless for most users. The forthcoming Vista release from Microsoft will be, per usual company history, buggy, will require many immediate security patches and updates, and will generally suck.
Meanwhile, many of my neighbors here in Seattle will be off all of next week and for two weeks at the end of the year, none of it counting against vacation time, because they work at Microsoft. Amazing what making shitty operating systems can get ya' in life.
Andrew Solomon, author of The Noonday Demon, not my favorite mental health book (Solomon is a pompous rich boy), offers his thoughts on the need for depression treatment centers to be located throughout the US in today's New York Times. Nice idea. Nowhere in his opinion piece does Solomon acknowledge that standard anti-depressant treatment for the illness is essentially a failure. Gee, I wonder who funded the center. From its website, I cannot tease out if any pharma money was involved. Anyone want to guess?
I am going to do a couple of posts despite losing my laptop for the time being. Our friend, CL Psy, has this post on yet another study showing no difference between atypicals and older antipsychotics in treating schizophrenia. Read it here.
Not sure where I am at with the laptop. Am looking at anything from a simple repair visit (pricey!) to a repair attempt and data recovery (pricier!) to complete data loss and replacing latop (priciest!).
No joke. I was getting ready to put up some posts about an hour ago. One of my cats jumped onto my desk and knocked an open beer all over my old iBook's keyboard, taking with it my entire book proposal and most of the documentation for this blog. I have no idea whether I can fix the computer or retrieve the data. I hope to god I can get it all fixed somehow. Perfect timing to be unemployed. In the meantime, I have an old iMac that I can post from. It just doesn't have any of my key data or the book proposal. Not good.
Anyone want to adopt a cat?
In treating bipolar disorder, my fellow BP blogger/journalist Liz Spikol, has some thoughts on my recent post about Seroquel being pushed on docs as the Bipolar Pill, aka monotherapy. She essentially agrees with me that this is troubling stuff and rightly adds that Seroquel isn't approved by the FDA as a monotherapy, but is approved separately for acute mania and bipolar depression. If I know the FDA system, I don't think they approve a drug for bipolar disorder as a monotherapy per se. Instead, the agency approves it for specific situations—ie., acute mania, depression and maintenance—and lets the Psych MDs decide whether it is a monotherapy or not.
Either way, I know Liz has had a better go of it with Seroquel than many others have, if I've read her past posts correctly (and good for her, seriously), so it's something for her to say she's bugged by what's going on out there in the world of clinical reality with Seroquel.
No, I am not referring to the classic alt-country album of the same name. Instead, yesterday morning Seattle was one-half inch away from tying the record for the wettest November since the 1850s, when the city was founded. By the end of the day, we had surpassed that record with two weeks left in the month. Which is to say that it has been dark and dreary around here on an epic scale. My point isn't the rain itself, but that mid-November is usually the tag end of my autumnal depression, often triggered by nasty weather. Mysteriously, I haven't been depressed this fall for the first time in...I don't know how long, despite some rather large outside stressors.
I think I have been too busy to let the black dog in the door. But, then, I don't even hear him pawing at the door.
I wish similar good fortune to everyone.
I am not an expert on bipolar disorder in children and I am not a parent, so it's with a lot of trepidation that I post on the subject, especially since the few times I've tried to say something substantial on the use of antipsychotics in kiddos, I have been attacked by some parents who absolutely worship Zyprexa and Risperdal and think those meds just rock for their kids. Whatever.
Anyhow, here's a link to the second in a series of fine articles in the New York Times on kids and psychology. In this article, Ben Carey covers a lot of turf, focusing especially on bipolar disorder in kids, how the kids are being given atypicals to treat it, and how the rate of diagnosis of bipolar among children is way up (and I thought it would be difficult to eclipse what was going on in the mid-1990s), as well as how the diagnosis itself is somewhat controversial. It's an informative, balanced piece and I know daily reporters have to wrestle to be fair to all concerns while managing to get a bit of skepticism into their work.
My only wish is that the article had been able to really peel back the historical lid on the diagnosis of bipolar disorder in kids as well as the use of atypicals in youths.
Personally, I am tired of handling this issue with, um, kid gloves. So let's just be honest: I am highly skeptical that bipolar disorder fully flourishes in kids, at least not to the degree some Psych MDs now claim. A few of the symptoms may be present, but for docs to diagnose bipolar disorder on the basis of kids having rampant energy, inattentiveness and the odd outburst strikes me as overreaching. I am especially troubled that they are willing to call short mood cycles in children–we're talking minutes here—full-blown bipolar, when in adults and teens they would be far less likely to slap the old bipolar label upon the same type of cycles.
To then turn around and slap these same kids with 1 mg or so of Risperdal based more on gut hunches—er, clinical judgment—than on actual research (the research is very thin on bipolar in kids much less on the use of atypicals) is really pushing the boundaries of how these meds are best used. If the docs and the parents want to use such meds for short-term symptom management, then OK. But I cannot see a case of the long-term use of these meds in kids, except for some very rare extreme cases of dangerous behavioral problems. These meds are too dicey to embrace so whole-heartedly, especially when we are seeing major problems with their use in adults.
I am not silly enough to believe that there aren't some behavioral issues with kids that need to be addressed. But to suddenly tag childhood screwiness as a full-on mental illness—an intellectual shift that has happened within the last decade—really makes me scratch my head, especially since the meds are as likely to give the kids all kinds of gnarly metabolic side effects.
Besides, the last time American medicine so dramatically embraced children's behavior and mental illness was back in the mid-1990s when, suddenly, Jack and Jill ran up the hill and were diagnosed as ADD. Remember how that little medical paradigm shift played out?
I think what we may have going on here is that we have a nation of over-worked parents who are desperate to find a solution for whatever behavioral maladies their kids might have in a society that really demands behavioral conformity and normalcy, especially in American schools. And kids are caught in a society with few stimuli outside of television, computers and video games as well as the odd soccer practice. And who offers consent for these children to take these meds? Their parents. We're talking vicious cycles here.
I don't want to claim that the 70s of my childhood were a golden age, but we had no computers, few video games and much less television. Even elementary schools still had music programs and after-school sports, both of which have gone into eclipse for kids in the last decade or so. And the kids were generally alright. Now they apparently aren't alright. Something happened here.
Anyone got any thoughts? Or want to point me to any research in any direction? Or, perhaps, challenge me to duel?
The State of Florida and various state judges down there are at-odds over state law requiring severly mentally-ill alleged criminals to be housed in state mental hospitals as opposed to being warehoused in jails. The jails are completely unsafe for them, especially if they are in the general population, and is not fair to the corrections officers, who are not trained to deal with the mentally ill and sure don't get paid enough to do so. Trouble is that the state's mental hospitals are at capacity, so Gov. Jeb Bush is blowing off the state law and judges are firing back. Read this fine report in the New York Times.
The whole matter of the mentally ill, especially the severly mentally ill, in America's jails and prisons is not limited to Florida. It's everywhere. Here in Seattle, the King County Jail has 200-plus people sitting in the medical ward of the jail, some convicted of crimes, some awaiting trial, as well as several hundred more in the general jail population. Around the country, roughly 30 percent of jail and prison populations are mentally ill. A recent Department of Justice study pegged it at a higher percent, although it seemed to me that that particular study also included many prisoners who were depressed as a result of being in the joint. Let's face it, being in jail would depress the hell out of anyone and I've been in enough jails, in a professional capacity, to assess that.
No matter what the status of the mentally ill in our jails and prisons is an unacceptable situation. We treat drug addicts better in the criminal justice system. I don't even pretend to know what the answer is to all of this. Building special jails for the mentally ill seems like a poor solution, one that was proposed for Washington State and was swiftly beaten to the ground by several law enforcement officials, including, ironically, King County Sheriff Sue Rahr, whose department fired Dep. Angela Holland for revealing that she had bipolar disorder. The congnitive dissonance is deafening on that count.
Building more forensic units in state hospitals—in effect jails for the mentally ill deemed incapable of standing trial—isn't a solution that excites me either. But I do know that if people with mental illnesses are to be incorporated into the American mainstream and the American workplace then they do need to face penalties when they commit crimes, albeit with some kind of legal mechanism in place to take into account their particular situations—same as we do with drug addicts and drunk drivers—when it comes to sentencing. Crime is crime no matter who commits it.
So I ran into this Psych MD I know today and we got to talking about Seroquel and its recent approval as a monotherapy for bipolar disorder. This particular doc works at both one of the large clinics dealing with low-income, chronically mentally ill patients—mostly schizophrenics and bipolars—and in his own private practice.
He told that within days of Seroquel's approval for bipolar depression a few weeks back, he got a visit from an AstraZeneca sales rep who told him that Seroquel was now an approved monotherapy for bipolar disorder. Then, she asked him why he wasn't prescribing it very much anymore. Yes, the pharma companies can tell how much an individual doc prescribes which med! (Seriously.) He told her that he didn't think Seroquel worked benignly for patients and that the increased blood-sugar levels and cholesterol levels associated with its use were unacceptable to him. She broke out a recent paper which claimed that there were no metabolic syndrome problems with Seroquel.
The doctor told me that after reading the paper he was unconvinced by the research. Atypicals, he said, are dangerous. Interestingly, he's gone back to use the older antipsychotics on chronically-ill schizophrenics, albeit at much lower doses than before. He says he's seeing good results, too.
Ah, this whole Seroquel is the Bipolar Pill business is getting interesting.
I've joked before on this site about how researchers are in a race to link depression with absolutely every malady known to humankind. Now, we have reached the bottom. A researcher in New Zealand reports that acne in teens and depression are strongly linked, and that teens with acne must be screened for depression. I cannot wait to see the television ads for this one.
Perhaps Eli Lilly can come up with another magical med combo—a la Symbax—one that will treat acne and depression in a handy pill.
Speaking of Eli Lilly, a friend of mine who was going through a rough divorce was given free samples of Cymbalta by a doctor friend of his. Within days, my friend was unable to sleep and was having suicidal thoughts. He'd never had suicidal thoughts in his life. He stopped taking the med, thank god, and bitched out his doctor friend.
There are some really disturbing, documented evidence concerning Cymbalta and suicidality. Meanwhile, Cymbalta is slyly being marketed as a treatment for chronic pain and has some television ads pointing out that depression hurts—the kids, the family, hell, even the family dog.
Hurts who might be the right question.
Angela Holland, the King County Sheriff's Deputy, who was shitcanned in 2004 for revealing that she has bipolar disorder, is a principal character in the short documentary "Stigmanity." The doc's director was kind enough to credit the article I wrote about Holland in his doc, which has been entered in the Berlin Film Festival and may be entered in other film competitions as well. You can view it here.
Angie looks fabulous in the doc and isn't quite as tongue-tied as she thinks she is on camera. More to come on all of this, you can be sure of that.
I originally wanted to entitle this post "Booty Call," but nah. Instead, let me point you to this fine article in today's Philadelphia Inquirer, concerning the dating website for the mentally-ill called No Longer Lonely and the fact that some therapists and Psych MDs now realize that they actually need to discuss sex and relationships with even the most profoundly ill of their patients.
It's 2006 and they are just realizing this? Maybe their friendly pharma sales reps didn't tell the docs that such discussions were essential. Sigh. I'll return to this topic another day.
Meanwhile, I want to praise to the skies the work of No Longer Lonely's creator, James Leftwich. The man, who has schziophrenia, provides an important public service for his brothers and sisters.
Sex and relationships aren't the only essentials of living that psych docs do a poor job of addressing with their patients. Another is food. I once fired a psychiatrist after I'd gone through a very bad patch and noticed that I had been unable to eat much during the ordeal. When I raised this as a concern with my doc, he didn't even act as if it were important. It's 2006 and.... Nevermind.
Not mine, I've gotten past those, but a unique way of looking at psychosis and mental illness in a blog called Spiritual Emergency. It's good reading (anytime someone cracks out the Tibetan Book of the Dead, it's music to my ears), and authored by a frequent commenter here.
From me, right here and right now. The fine folks at the Treatment Advocacy Center, whom I bang on from time to time, deserve credit for pointing out that a nurse in New Hampshire has been busted for allegedly trying to get an ex of hers involuntarily committed without justification. TAC wants accountability for her alleged actions and so do I, especially since the nurse had reportedly made such an atempt with another ex previously. The news account of her case states that she'll only be charged with filing a false complaint to the police.
Um, how about super-sizing that to attempted kidnapping? Where I come from, working to deny another citizen their freedom goes down as a serious felony.
While TAC is busy on the accountability beat, it'd also be swell if TAC joined me in calling for pharma companies to be held accountable for, among many other things, grossly over-pricing atypical antipsychotics far out of proportion to the actual benefits of these meds (they ain't the silver bullets some docs and pharma companies claim). Such a move would be in keeping with TAC's outpatient commitment agenda, which mostly impacts schizophrenics and bipolars, the major markets for the atypicals. If TAC believes in the core humanity of its rhetoric as strongly as they profess, then those fine humane folks should be very interested in seeing these meds become far less costly and, as a result, less of a drain on the public purse for the patients whom TAC wishes to be in a forced medication program.
Sounds like a plan to me.
A frequent commenter here left a comment yesterday that pisses me off and not at her:
"For once I will keep this short. My doctor DID tell me Seroquel was equal to Lithium."
Fucking-a, could we get some sense of proportion out there amongst some of the MDs who appear to be going for Seroquel as if it were some kind of brain Viagra? Hell, hearing that such talk is out there in the mental health world brings me to one of those "that's when I reach for my revolver moments." (I refer to the Mission of Burma song, nothing more.) Let these same docs take 600 mgs. of Seroquel a day for a few weeks and, then, possibly re-evaluate their thinking.
And now: thanks to many of you readers who have sent me kind thoughts recently. I appreciate it.
Hi. Looks like I am actually back now, after a few days of trying to disconnect from all the work drama. Which means I have some catching up to do.
One of those things is to introduce you all to a fairly new blog, authored by an anonymous doctor, that is just as skeptical as I am about the current state of the mental health world. It's called Clinical Psychology and Psychiatry: A Closer Look and is a damn good read. Already Dr. X is going after the notion that everyone is bipolar all of a sudden and that AstraZeneca trying to expand its market for Seroquel by targeting anxiety disorders, as well as offering some wise comments about the fact that several states are subpoenaing various documents from the makers of Seroquel and Zyprexa, etc. Read Dr. X's work, which is ridiculously knowledgeable, and add his blog to your newsreader/feedburner/etc. Dr. X also had nice things to say about this here blog today.
A couple of thoughts: Using Seroquel to treat anxiety disorders is a bit like using a nuclear bomb to clear a field of stumps. It's efficacious as hell, but....well, you know. Two, like Dr. X, I am thrilled to see California and other states going after atypical makers for their marketing and pricing practices, especially as they relate to each state's drug formulary and MedicAid programs. As I have mentioned several times in the last year or so, the fact that these atypicals are not proving out as being much better for treating schizophrenia than first-generation antipsychotics argues that the pharma companies should be forced by market pressures to slash the prices of these drugs. Why NAMI and NMHA have not even floated that idea is beyond me.
The big selling points for atypicals in treating schizophrenia is that they are better at treating symptoms of the illness than older meds and that their side effects are much more tolerable than, say, Haldol. But as the CATIE study and other studies have established, the atypicals aren't any better than the older meds and they have their own set of troubling side effects. Bottom line: the Eli Lillys of the world are ripping off their customer base, which is a bad way to do business.
And, now, they think they can justify giving these meds to every bipolar as if they were the equivalent of Lithium or Lamictal? Please.
I spoke with John McManamy yesterday and just wanted to update you all on how well his book is doing. The answer is quite well. According to John, it's sold out of its first printing of 7,500 copies and the publisher is ordering another print run of 1,500 books, which I suspect they will add to very soon. Usually the measure of a new book—assuming the rules of the biz haven't changed that much since the mid-90s—is how quickly it sells its first 10,000 copies. John will get very close to that inside of one month. So if you haven't looked at Living Well with Depression and Bipolar Disorder and bought it, then go right here.
As I've noted before, it thrills me no end to see a patient write a book like his and step into the province that has long been dominated by doctors.
So I will go into my office at Seattle Weekly for the final time this morning. Although my new boss told me last Friday that he was fine with me doing work for them for another two weeks, he told me yesterday that he wanted me out of the building promptly. After four and a half years of doing some pretty decent work there, that's just damn disrespectful. But I'll get over it.
Thanks to the many of you who have expressed their concern after I quit my job on Friday. I don't want to belabor matters, but it is one of the most difficult things I have ever had to do in my life. I hope to be back to regular posting in the next couple of days.
My job that is. At Seattle Weekly, where I have been a staff writer for four and a half years. I resigned under duress, but don't feel like sharing details. No, I don't have another job awaiting me. For the first time in forever, I am winging it.
Today. Much drama in my personal world, including dealing with a dear friend who had a former partner kill himself. Not good. Hope your worlds are better than mine.