It hit 87 degrees in Seattle yesterday tying a record and about 92 in my apartment, so I am begging off for the day. Summer is almost here, although we'll inevitably have one more cold, rainy weekend before our two months of sunshine begin around July 5th. Have fun.
I don't even know where to begin thanking Liz Spikol who wrote a column in this week's Philadelphia Weekly about this here blog. It's the nicest bit anyone has ever written about me and I am beyond flattered. You all know how strongly I feel about Liz's work already, so I won't even go into it. But perhaps I will soon post a cute pic of my cats in honor of Liz. Warning: article includes a pic of me--with a buzz cut no less--taken at a bar during my most recent birthday party.
Cl Psych once again goes after an academic pimp--a term that must find its way into America's lexicon--for playing fast and loose with Geodon matters and some craziness involving CMEs. Post includes pic of O Henry! bar.
John Grohol wisely notes the immigrant angle on yesterday's awful murder-suicide in Texas.
My good friends at the Treatment Advocacy Center find patients who tout outpatient commitment. I'm not sure why TAC thinks it's a "myth" that patients oppose such programs. That's just BS propagandizing on their part, likely designed to marginalize any patient who speaks up against outpatient commitment laws.
Oh, yes, and here's Britney Spears writing--who knew?--about her recent rehab and associated craziness. Like a bad kid with ADHD? Hm, how about like a bad singer with serious post-partum issues who's indulged by celebrity culture? (Thanks to Stephany for passing it along.) I mean who wouldn't have post-partum issues after having K-Fed's babies? I would.
I'll just quote from the New York Times and then go vomit:
"A woman who was said to be struggling with depression apparently hanged her four young daughters in their North Texas mobile home early Tuesday morning before hanging herself, the authorities said."
And:
"[T]here was no evidence that Ms. Estrada suffered from serious mental illness other than her recent depression. No medications used to treat mental illness were found in the home."
Enough said.
If you caught the news yesterday, you saw or read that Sen. Barak Obama (D-Ill.), campaigning for the Democrat presidential nomination in Iowa, proposed a new health insurance system for America, one that would cover the 45 million or so uninsured Americans, lower co-payments and so on. Good luck on that, Barak.
Far more interesting was the proposal he made on Memorial Day in New Hampshire. Here's a snip from a campaign press release:
"To address this growing mental health crisis, Senator Obama proposed critical enhancements at every stage of military service: recruitment, deployment, and reentry into civilian life."
I admire Obama--whom I don't have strong feelings for otherwise (it's early yet)--for taking up the flag on how badly soldiers are being wounded psychologically in Iraq and Afghanistan and looking to do something to address the military's culture of suck-it-up-soldier, which isn't particularly helpful to anyone who's seen combat in the urban guerilla mess we've gotten ourselves into in Iraq. I also admire his guts for saying words like "psychological injury" before a group of veterans on Memorial Day. Saying, in essence, that war breaks the minds and souls of big, tough soldiers and that we've got to be serious and thorough in our response or we're disrespecting their sacrifices as a nation isn't exactly going to get you on A-1 of too many papers, so I admire his candor all the more.
Many of the older vets in the crowd likely had a good idea of how such injuries play out across a veteran's life. I've seen this sort of thing first hand in my own life--in disabled vets I have interviewed over the years and in my own father, who I know was troubled for a time with bad memories of his own experiences in the Korean Conflict where, among other things, he flew ground support missions in the days when ground support was done more with machine guns and Napalm than with precision-guided munitions.
I'm glad someone in national politics is willing to put an issue like this front and center before another generation of young men (and women this time out) has no way to address the voodoo that's played out in front of them and said voodoo's aftereffects. A veteran I once interviewed who'd turned to drugs post-Vietnam told me, as I loosely remember: I killed the enemy and the innocent. It's what I had to do. I saw buddies killed right in front of me. When I came home I had all this hollowness in me that I couldn't find a cure for, so of course I took up smoking crack. (It was one of those rare moments when you almost stop taking notes because what is coming out of another human's mouth is so amazing.)
But I'm still disappointed in the Senator.
Obama's proposal operates on the assumption that we have a mental health treatment paradigm in this country that is working well and that troops can benefit from it. What we have is a mental health treatment paradigm that works poorly for civilian and veteran alike. Anti-depressants that work 30 percent of the time, anti-psychotics that barely quell the symptoms of schizophrenia and trash the human being in the process while pharma companies and researchers rush around proclaiming these treatments so useful for adults that they have got to be perfect for misbehaving children as well. Doctors who are little more than pimps for pharma companies. Taxpayers who are footing the bill. And so on.
When I hear Obama talk realistically about how crappy the current paradigm is for all parties and how, maybe, we need to be pursuing other approaches to America's weird age of psychological illness--because we are all mentally ill now, aren't we?--then I'll be truly impressed. Obama is promising the nation a "new politics," which sounds suspiciously like Bill Clinton's political sloganeering "Third Way." So when Obama--or someone else with guts--wants to acknowledge just how bad things are for everyone and how rotten many of the principal actors are in America's mental health paradigm, then I'll vote for him. But I'm not holding my breath.
Cynical side note: Obama's campaign has already received donations from people working for pharma companies albeit small ones to date. Go here if you are interested in such things.
Hi. I am mostly back in action this week, barring anything unforeseen.
John Grohol at Psych Central has an amazing/jaw-dropping post on just how ineffective anti-depressants are in teens and children. According to a study, only 1 out of 9 kids treated with an anti-depressant will see a response stronger than that achieved with a placebo. That's simply staggering. I wonder what the ratio is in adults.
Speaking of ineffective anti-depressants, CL Psych questions Pfizer's honesty in studies using Zoloft to treat PTSD.
Another patient is having trouble coming off Cymbalta. Sad. I've said it before, so here it comes again: Cymbalta is going to turn into a disaster for Eli Lilly.
Someone over at Cafe Pharma asks why J&J essentially stopped efforts to market Risperdal for bipolar disorder. Maybe 'cuz it's coming off patent soon? I'd love to know more about this.
Meanwhile, a man with schizophrenia muses on Zyprexa and deceptive feelings of being cured.
I recently took a look at the Wikipedia entry on Zyprexa and it struck me as being a bit thin and unbalanced. For example, the entry makes the PRIME study almost sound like it was a success. I'm wondering if we cannot all get together and come up with some additions and/or changes for the Zyprexa entry. Leave your thoughts in comments.
As I've noted before, the largest Army base in the US is 30 miles south of Seattle--Fort Lewis, home to the Stryker Brigade. The two dailies in Seattle have been tracking mental health issues among Fort Lewis troops fairly aggressively lately, documenting a health care system that is grossly understaffed and a military culture that's loathe to admit problems. Here's a good article on this from the Seattle Times.
"Adams, the highest-ranking enlisted soldier in his brigade, started taking tranquilizers to help him sleep. In an unusual step, he shared his struggles with the homeward-bound troops.At a dusty desert base in Kuwait, Adams went from unit to unit, telling his fellow soldiers that he was not OK and would seek counseling when he returned. He urged others to do the same.
In the Army, where soldiers often mask the traumas of war, this was an unsettling confession from a leader who had unflinchingly tackled the grimmest of tasks -- even washing out the insides of armored Stryker vehicles bloodied by human remains."
Of course, Adams, a Sgt. Major, ran into all kinds of problems with the military bureaucracy. And that's my big concern.
According to various reports, as much as 40 percent of returning troops are reporting some kind of mental health concerns and perhaps 15 percent are suffering from PTSD. The military is doing a lousy job of addressing this and they sure aren't helped by a treatment paradigm that isn't producing good results. When the Iraq War ends in...well, who really know when we are pulling out...we will be looking at 100,000 or so troops who've got some serious problems and we've simply got to do a better job of addressing their needs than we did with the Vietnam generation.
The long-term psychological consequences of combat are disastrous and I have run into too many examples of the post-combat vet who's still messed up by what he saw when he was 20 years old to not be really concerned about what we'll be seeing in Iraq vets come 2010. Or whenever the big wave comes home.
For those of you in the Seattle area, this here blog is featured in the June issue of Seattle magazine. For those of you outside the area, the magazine doesn't put their articles online--a practice many monthly mags follow--so I have no link to offer.
Have a nice Memorial Day.
As I'm sure some have surmised, I've been taking a break most of this week--been working on an outside project and continuing to rehab my back. Besides, this has almost been a news free week in the mental health world. I should be back on Tuesday. Have a nice Memorial Day weekend.
That's how the media is framing a Finnish study of several thousand twins who were followed for 15 years--another one of those cohort studies that sounds really authoritative but has so many limitations that it's hard to call the results "science" instead of "anecdote" or "association." Not that the media understands the difference.
Anyhow, "men who are persistent smokers may be at greater risk of developing depression in comparison to people who have never smoked, a Finnish study has suggested" runs the media line on this study.
I'm sure the nanny statists in this country will have a field day with this study. For my money, this is right up there with the "smoking causes suicide" claims a few months ago. Which is to say these claims are a bit out there. Besides, if pot causes schizophrenia and smoking cigarettes causes depression, then I should be the most schizophrenic depressed guy in America. I'll go contemplate this over a Honduran cigar.
In all seriousness, depression is far too complicated a syndrome to connect with any one factor. Besides, if the Finnish researchers believe in the smoking-depression connection, then what does that say for the chemical imbalance theory of depression? What's more, given how much the smoking rate has dropped in the US--about a 75 percent decrease in 20 years--then you'd rightly expect a backing off of depression prevalence rates. Haven't noticed it. You'd also expect entire societies such as France and Vietnam--both big smoking countries--to have half their citizens under treatment for depression. Haven't noticed that either.
I generally steer clear of politics on this blog, but not today. That's because the attack dogs of conservativism in psychiatry are at it again. This time out it's Sally Satel, a psych doc in the DC-area who is also affiliated with the American Enterprise Institute (a con think tank), writing a piece in The Weekly Standard in which she takes a preemptive swing at the emerging debate in Virginia over that state's commitment laws. It's a time-honored tactic for agitators on any side of ann issue to paint their opposition as delusional and against public safety and apple pie well in advance of a legislature taking up an issue such as civil commitment. It's called planting the seed. Satel paints the two sides of the debate as:
"On one side are civil liberties lawyers and disgruntled patients who insist that lowering the "imminent" danger threshold would threaten individual rights. On the other side are psychiatrists caring for people with schizophrenia and bipolar illness and their relatives who have lived through the nightmare of not being able to get timely treatment for desperately ill loved ones."
Well it would endanger individual rights, Sally, and I'm not sure a psychiatrist is always the best person to make the call as to who is too sick to function in society. But call me a disgruntled civil libertarian if you want to.
She also uses her article as an occasion to attack SAMHSA and the state-level Protection & Advocacy systems, federally-mandated groups whose job it is to look out for the rights of the disabled in state institutions:
"Unless SAMHSA miraculously reforms itself quickly (and Congress could help things along by prohibiting P&A's from lobbying state legislatures on mental health laws), a much less overbearing federal role might be the best thing to hope for from this process. It is disgraceful that, to date, the lead federal agency on mental health care has not been able to grasp the complexity of severe mental illness and has failed to keep its watchdog component from harming the vulnerable souls it is entrusted to protect."
Based up on my own experience with P&As in the Northwest, I'd say that Satel overstates her case for how much power these groups have by, say, 100 percent. Nonetheless, my good friends at TAC jumped on Satel's column as an opportunity to call for reform of the groups, as they have linked them several times in the past to every malady in the mental health system. Such as deinstitutionalization. If anyone at TAC or Satel can prove to me just how spectacular the days of mass institutionalization were, I'd be happy to look at their evidence.
The implicit gripe of folks like Satel and TAC is that commitment standards are too low, unmedicated schizophrenics are committing mayhem in our streets and homes and it is impossible for families to force them into treatment. They generally base their arguments on distorted readings of research on links between schizophrenia and violence, on an assumption that docs and moms and dads know what's best for emancipated adults who are breaking no laws, that treatment is an absolute buffer against violence and that long-term institutionalization is the only effective way to handle such folks. There are a small number of cases where that is no doubt true, but their arguments are about as solid as cheese cloth. TAC, for example, refuses to discuss with me how it accounts for patients who were on medications yet committed violent acts in its "preventable tragedies" database. What's more, TAC and Satel know damn well that the link between violence and schizophrenia is much looser than they claim.
But then they've got an agenda to market to politicians in Virginia and elsewhere.
Pharmalot has a good rundown of the major allegations in the lawsuit filed by the Utah State AG last week. Most relate to off-label marketing of the drug. A pdf of the lawsuit is available here. Among other allegations:
"The marketing program sought to create the impression and belief by consumers and physicians (particularly primary care physicians and 'family doctors') that Zyprexa was safe for human use and had fewer side effects or adverse reactions than other antipsychotic medications. Lilly knew these representations to be false."
It goes from there, although there are none of the truly intense allegations of payoffs to docs as were in the Montana lawsuit. More to come from other states soon I bet.
Side Note: I have more than a passing interest in the Utah suit. I lived five years of my life in that gorgeous state, took my undergrad degree at the University of Utah and my family's roots in the state go back to the 1840s. No, I am not Mormon.
But it sure did get chilly in Seattle a couple of hours after NAMI-Greater Seattle gave me that little Lilly-sponsored award the other day and rained the rest of the weekend. I don't have the program in front of me so cannot list the other winners, but myself included the emphasis was clearly on people working to make recovery happen with some profoundly ill people. Not a pill pusher among them. Lilly paid for the lunch which was grilled skinless (um, that's wrong!) chicken breast, rice and a couple of spears of asparagus. I'll have to remember that I owe Lilly a similar meal someday. The award itself is a lovely wedge of glass, tastefully done. No Lilly logo on it, sadly. It'll be interesting to see how I appear in Lilly's corporate marketing materials for the award.
And, yes, the NAMI folks clearly got the irony of me getting this award. As did all of you, and I thank you for your kind comments. Special thanks to Vaughn at Mind Hacks who did a funny post on it. I, too, love the smell of irony in the morning.
Not sure how active I'll be on here early this week, as I have quite a bit of other work to do.
I haven't seen the complaint yet for myself, but Pharmalot reports that the State of Utah has filed suit against Eli Lilly over Zyprexa marketing. That makes 8 states who have now sued the drug giant, which also faces a Congressional investigation over the drug, has already settled $1.2 billion in claims from class action lawsuits and faces even more lawsuits. One wonders when a bunch of other states are going to sue Lilly as well.
More on the Utah suit when I see a copy of the complaint. If it's anything like the Montana lawsuit, it ought to be a humdinger.
This has been a remarkably news-free week in the mental health world, allowing me to take a small break even. But don't be lulled into complacency. The American Psychiatric Association begins its annual convention over the weekend and that means loads of new data sets will be coming from researchers next week and loads of inflated claims will be issued by pharma companies. "Seroquel is highly efficacious for SBD!" "Zyprexa for kids!" And so on.
Also, John Nash will be delivering the keynote address at the convention and he speaks publicly about mental illness so infrequently that I haven't the faintest what he will say.
Stay tuned.
So I found out yesterday that I am getting an award on Saturday from NAMI's Washington State affiliate. It's one of the "Heroes in the fight" awards that NAMI and MHA are doing and it's sponsored by Eli Lilly. I'm sure that the irony of this is lost on few readers of this here blog. The cool--and very flattering--bit of this is that Lilly doesn't control the awards, but they are handed out via nominations from peers in the mental health system in Washington State. Not sure who nominated me, but I'll be there on Saturday getting my award along with a few social workers and doctors, etc. Pretty cool.
I cannot wait until Lilly's PR department catches wind of this. Maybe they'll begin to return my queries on Zyprexa and the like.
Looks like me and a few other bloggers have pissed off a few other bloggers in the mental health world by saying some chippy yet necessary things about this whole subthreshold bipolar disorder business. Apparently, I've been called an ass and an idiot. Hm. Or maybe CL Psych was. Anyway, CL Psych has a roundup.
My response to all this? Yawn.
Liz Spikol quotes yours truly in her Philadelphia Weekly column on outpatient commitment in the Keystone State. Thanks, Liz.
Yesterday, a medical tracking firm reported that the use of anti-depressants and ADHD drugs by teens is down, but that the use of antipsychotics is way up. Antipsych use has doubled since 2001 to the point where 1.2 percent of boys and .75 percent of girls are popping Seroquel and Zyprexa. That works out to about 1.5 million Americans under 20 years old dosing on these drugs. And it ain't over a doubling of schizophrenia.
These meds are being prescribed for bipolar disorder, depression and ADHD. And people thought I was being a bit excessive when I started banging the drum on this a couple of years ago. Although I am sure plenty of apologists will offer various bromides that what a wonderful thing it is that all these troubled youngsters are being diagnosed and treated, I just don't see an advantage to the way we are doing things. Antipsychs don't work so swell in adults, they are barely researched in youngins, so what are we doing here exactly? You'd have a hard time convincing me that America's teens are twice as screwed up as they were in 2001.
I'm not the only one troubled by this trend. The New Scientist reports a fivefold increase in diagnoses of bipolar disorder in kids between 1996 and 2004. The mag links it the expanded definition of bipolar disorder that entered the DSM in 1994 (BP-II, cyclothymia and BP-NOS were added to classic BP-I). This doesn't trouble the fine folks at CABF.
"'I think it's down to increased recognition that the condition exists in children, which wasn't accepted until a decade ago,' says Susan Resko, executive director of the Child and Adolescent Bipolar Foundation."
Counters Michael Miller, a psychiatrist at Harvard Medical School in Boston:
"'We simply don't have all the information we need to connect the dots between behaviour, causes and symptoms. We don't know yet if kids are being under-medicated, over-medicated or mis-medicated'."
No kidding. The magazine also has an editorial but since I don't have a subscription I cannot read the whole thing. The editors note that "Something strange is going on."
Excessive? I think those of us who are asking questions are just ahead of the curve.
It was very warm in Seattle yesterday and last night--OK, we'd call it hot here this time of year--and fortunately there was no real mental health news either. That's like two days in a row. Bizarre. So nothing now. Maybe more later.
Keep submitting those suggestions for naming the new bipolar disorder!
Doctors are studying babies (!!!!) for signs of mental illness. Can we get over this watered-down eugenics game we are beginning to play in this culture? (Via The Trouble With Spikol.) Or are we going to become Spartans and hurl babies who don't meet certain behavioral standards from high cliffs?
A schizophrenic gives Zyprexa to a friend. Hm. Where I come from, friends don't give friends antipsychotics. Or is it that they don't let them drive Chevys?
A Texas man gets 10 years of probation for killing his wife. Why the insanely light sentence? The court accepted his lawyers' argument that a recently upped dose of Cymbalta made him do it.
AHRP helps Prozac celebrate its 20th birthday.
Yep, we're trying to come up with a name for "subthreshold bipolar disorder," the new ultra-light bipolar disorder. Like an ultra-light smoke, it's not much but air. Still, the docs are pushing it and since SBD is a crappy name, I call on you all to keep offering names for the new disorder. More on it here for latecomers.
It was an oddly news free day in the mental health world yesterday, which is a good thing. It gives me a chance to catch up on a few questions that have been posed to me, directly or indirectly, of late by readers. If you've been around here long enough, you already know the answers.
1. Recently, I have been dubbed pro-psychiatry and anti-psychiatry by two different bloggers, one going so far as to claim that there's no such thing as neutrality in the mental health world and that I am pro-psychiatry because I use the rhetoric of the psych industry. So, let's get something clear: mental illness is real. It's driven as much by the brain as it is by environment and behavior, and there's plenty of good--and sad--evidence that most treatments to address mental disorder don't work well and can harm patients, many of whom have little say in how they are treated due to societal pressures, legal pressures and widespread misinformation about psych meds. I am perfectly neutral on how someone chooses to address their own issues, unless they are committing crimes in which case they lose that right. Otherwise, treat it as you wish. I call that neutrality.
2. Many newish readers assume that I am anti-psych because I am deeply critical of psych meds, diagnoses, doctors, Big Pharma and the media. Well, there's a lot to be critical of amongst those actors, but the flow of information for patients is so skewed in favor of what pharma companies and psych researchers claim is true that I thought a blog like this could be a useful way to offer some transparency and accountability in the mental health world in much the same way that a city hall reporter is supposed to be telling his/her readers about how their tax dollars are being spent. If that makes me anti-psych in some peoples' minds, then I'd say they are being completely simple-minded.
3. Why is this blog so one-sided? asked one researcher no long ago. My reply: it only seems one-sided because you guys are not used to patients pushing back hard and using your own data in the process. Others do it now as well, so there must be some merit to my approach. No one in the Web 2.0 world has really figured out what blogging is supposed to be--like your local quasi-objective newspaper, like Bill O'Reilly, like a long dreary policy wonk conference? There is no one formula out there--nor should there be--but so far I'd have to say what I am trying to do is along the lines of how old school news columnists used to write. Opinionated, and afflicting the comfortable and comforting the afflicted.
4. Aren't you just insane and working out your own issues? No to the former. As for the latter, anyone who writes about mental health is working on their "issues" and questions they have about the universe and so on. So, yes. And sometimes no.
John McManamy accuses the New York Times of "misleading" readers about child bipolar disorder and other things in their recent story on pharma 'ho docs in Minnesota handing out atypicals to kids like candy. Funny that John, in another post, has little to say about the ho'-riffic docs and much to say about defending the child bipolar disorder paradigm as if he'd written a book on it. He even cites an example of a child trying to jump out of a car in about as lame a fearmongering moment as using the specter of suicides in two year olds to defend the disorder. I love intellectual schisms!
Enviros are touting "green therapy" for depression and by this I don't mean pot. They are talking being outdoors. Sounds like my various rants about nature deficit disorder.
Liz Spikol has an item about how the military may be shorting mental health care for returning vets.
Brooke Shields on post-partum depression.
Apesma's Lament on stupid claims by the Bush administration that its winning the war on homelessness.
Interesting message board exchange on old folks being doped up on Seroquel.
Now that the gods of psychiatry have handed us a new form of bipolar disorder--the so-called subthreshold bipolar disorder--I have decided that it needs a better name. None of this SBD shit. So leave your suggestions for what to call this "disorder" which is characterized by not meeting the threshold for hypomania and not having depression at all.
Over the weekend, I caught wind of one writer offering that SBD sounded a whole lot like cyclothymia to him. Not true! SBD is like so totally better! Cyclothymia includes alternating periods of low scale hypomania and low scale depression. But SBD is skipping the depression altogether, so we can focus on people who are chronically productive and medicate them until they put on 100 pounds.
Dr. X's assessment:
"My prediction: treatment will be good for pharmaceutical stocks and will cause patients to gain a lot of weight."
Which will eventually lead to a new disorder marked by obesity and flatlined moods--FFD, or fat-flat disorder.
I'll announce the winning entry for what to call SBD at the end of the week.
I'd planned to do a long post ripping apart the recent stories alleging that pot causes schizophrenia. That old saw has been around since the 1930s and still the pot haters of the world haven't been able to prove their case.
Anyhow, Robert Lindsay has come along with a lengthy post on this whole business, so I'll just send you there. Globally, he notes:
"So the evidence on permanent brain damage from long-term daily marijuana use is somewhat contradictory and is still up in the air. Nevertheless, it looks like cannabis can be used by adults for up to five years, and possibly up to 15 years, even on a daily basis, without any permanent effects on the brain."
I'm on the phone to Snoop and Dre already.
Joking aside, we are kidding ourselves as a culture if we don't appropriately study cannabis treatments for depression. Because it is clear that there is something useful about the molecule and it merits further study. As for the psychosis theory, even if it's prevalence were as high as some researchers claim (about 7 percent of cases of schizophrenia may be related to pot use), then it would be no worse that the percentage of cases of mania and suicidality induced by SSRIs. It would be worse. Besides, the rate of schizophrenia has been pretty much constant at about 1 percent for eons and with broader use of weed in American culture, you'd expect many, many more schizophrenics and run-of-the-mill psychotics in our land. Where are they?
As I have noted before, there are legitimate reasons to support proper scientific research of pot in the psych realm. It may cause new brain cells to grow and has an anti-depressant effect in mice. ("Good enough for mice, good enough for me," I often say.). It's known to have positive effects on depression and anxiety. If the feds and the medical establishment are OK with looking into medical properties of Special K, then why not check into cheeba?
All of which is a long way of trotting out one of the greatest things I've ever told an interviewee. So good, it must be repeated.
"DEA Agent: "Drugs are bad. Don't do drugs."Me: "How is medical marijuana bad?"
DEA Agent: "Marijuana causes schizophrenia."
Me: "I've read those studies and don't think it's a very strong correlation."
DEA Agent: "Well, that's what they say."
Me: "Can I tell you something?"
DEA Agent: "Sure."
Me: "I should be the most schizophrenic guy in America."
Hi. Over the weekend, I went and closed comments on almost every old entry on this site in order to keep down spam comments. There are old entries that still get comments but in the great scheme of things it was too much of a hassle keeping them open. Anyhow, let me know if this proves to be a hassle for any of you. The hope is that sometime semi-soon I can have an open, unmoderated comment system that manages to be active and spam-free. For the time being, I will close comments on an entry once it's more than five days old.
In other news, several times over the past month I have had readers ask me to either change their identity on a comment they left months ago, remove their identity completely or remove something they said of which they thought better later. There are about 3,000 comments on this site and it's a serious hassle for me each time I feel compelled to do this. So, please note: I no longer feel compelled to do this. Feel free to come up with a screen name or go anonymous (just leave a real email as those don't get posted and are sometimes of use in following up on reader questions). I just don't have time to go change comments any more. Also, please keep in mind that once you post a comment, it's your original posting identity that counts as far as the internet mirrors and cacheing machines of the universe are concerned.
First, I will be guest blogging over at To The People for the next week or so while a couple of the regular bloggers at this Libertarian site are off on vacation and, likely, violating substance control laws and the laws of Nature. My first wee post is here.
Looks like the FDA is set to approve an old-wine-in-new-bottles Seroquel next week. Namely, Seroquel XR. I cannot wait to see the press releases and studies on this one, which I have a hunch will be coming out at the APA convention which begins in about a week in San Diego.
Ah, the pharma blogosphere is alive with the sounds of anger after the Senate's passage of a new drug safety bill. Peter Rost. PharmaGossip. eDrugSearch has numerous items. (Via CL Psych.)
CL Psych has great bit on how the media is screwing up this newfangled subthreshold bipolar disorder nonsense (SBD) and how much of what Eli Lilly did in marketing Zyprexa to PCPs fit right in with SBD. Now, Mother's little helper has a DX all its own.
Liz Spikol has thoughts on the SBD business.
Depression Introspection on the right to bear arms and the mentally ill.
A British doc on looking past the medicalization of psychosis.
As I noted on Tuesday, a new study claims that 4.5 percent of the American population has bipolar disorder. Bipolar disorder in this study is understood as BP-I, BP-2 and subthreshold bipolar disorder. SBD, as I am calling it, doesn't exist in the DSM. Until recently, prevalence studies estimated bipolar disorder at about 1 percent of the adult population. NIMH bumped its estimate last year to a bit over 2 percent (which seems about right). Meanwhile, pharma companies and some researchers said it was 5 percent and I read one journal article where a researcher pegged it at 11 percent.
My reading of this is that much of that increase is linked to an expanded definition of bipolar disorder as a spectrum disorder (spectrum disorders are all the rage these days) with SBD being the catch basin for all the soft bipolar researchers claim they are detecting in America these days. And so begins the war on the weird, the productive and the agitated of America.
If this strikes you as unimportant, perhaps you don't understand how all the dots connect around bipolar disorder the last few years. Zyprexa, Rebecca Riley, the bipolar child controversy, Seroquel declared the bipolar pill, class action lawsuits, multi-billion dollar settlements, researchers cooking research, black box warnings, calls for more outpatient commitment and so on. All of those bits connect with bipolar disorder in our culture and are evidence of the weaknesses--and dangers--of current treatment paradigms for bipolar disorder. And yet we have researchers, one cabinet level department (HHS), two private foundations and many pharmaceutical companies who would like to double or triple the number of Americans who must be convinced they have bipolar disorder, be instructed that it is a lifetime illness and be pressured to take medications that have a less than 50 percent chance of doing much for you and anywhere from a 30 percent to 50 percent chance of causing you an injury (I'm done with sugar coating it by calling injuries "side effects"). Forget about the usual criticism that this is all a naked land grab by pharma companies and researchers looking to line their pockets.
It's darker than that. What we've got going on here is the norming of America--a big happy party wherein Americans are forced to have their behaviors, thoughts, impulses and expressions grouped around a carefully-controlled norm. That norm is being created--has already been created some would argue--by leading researchers such as the bipolar mafia (adult division) at Harvard and the fine folks at NIMH. Any day, I expect a study proclaiming doctors as the new behavioral norms for American society. No, I am not joking.
To take this new SBD "diagnosis" at face value, then anyone who's experienced a period of insomnia and been more productive than usual at the same time has bipolar disorder. People like artists, entrepreneurs, writers, musicians, Presidents, soldiers, grad students and 4 a.m. poets have bipolar disorder--or are at risk of succumbing to its symptoms!--and must be medicated. Tom Waits, put down that whisky bottle and Marlboros and pick up the Seroquel. We are norming you! Same goes for you, Keith Richards. (CL Psych does a much better job here of poking through the SBD diagnosis. Read it.) I am really surprised that the authors didn't insist upon horniness as an SBD symptom.
I am so not interested in living in this normed world--the one without weirdness of any kind. Because it's all been dopamined to death. And a level flat world is no place I want to live. It will be odorless, tasteless, smooth and uninspiring in the extreme. Kinda like the back wards in "Brave New World."
The press has entirely missed just how important and off-base this study is. Yetserday, the study's lead author, Kathleen Merikangas an epidemiologist
from NIMH, spoke to Reuters in an article titled "Severe impairment common in bipolar disorder:"
"Regardless of the classification, the evidence suggests that impairment is often severe and few patients with bipolar disorder receive appropriate treatment...."'One criticism we always get is that we're 'medicalizing' everything' and artificially inflating prevalence rates, Merikangas said, instead of recognizing symptoms as 'the normal ups and downs of life.' However, bipolar disorder, including subthreshold bipolar disorder, 'really does impair people,' she stated.
"Study results verify the clinical severity of the disorder, the team maintains, as reflected by the number of episodes, chronicity, symptom severity, impairment and the presence of other illnesses. The observation of increasing symptom severity from one category to the next reinforces 'the validity of the spectrum concept of bipolarity,' the researchers note."
The article doesn't even establish what this vague impairment of SBD might be much less BP-II. Nor does the journal article itself although it lays out something called "role impairment" (yes, we must all conform to our assigned roles in life or we are impaired). In the journal article the authors insist that "Subthreshold BPD is common, clinically significant and undetected in treatment settings."
Most media articles have spoken of only half of all bipolar cases being detected as their news hook. That's laziness. You cannot create a DSM diagnosis out of thin air and then say it's the same thing as the already existing DX and use that as a basis to claim that the problem is twice as bad as it was before. Why some reporters out there are not asking skeptical questions about all the inherent assumptions being made in that kind of thinking is beyond me. Except reporters are trained to always respect doctors--wow, they went to medical school!--and not to question what they say except to spell the Greco-Roman disease names properly. Maybe they are impaired.
Anyhow, I simply love that NIMH's press release on the study appears on the Medical News Today site on a page that features a vague ad about how your depression could really be bipolar disorder. Click on the link and up comes a Seroquel ad where you can take a self-assessment test.
I could go on about this all night, but my back is telling me that I mustn't. Beyond what I see as the darker--and dumber--implications of such research and the press' coverage of the same, it distresses me as an old school manic depressive (back before we got the politically correct bipolar disorder and BP-II) that instead of finding long-promised "cures" for behavioral problems in American society and instead of hammering out efficacious psychological therapies, we now have a medical model of mental illness that is far more interested in finding more patients for a paradigm of diagnosis and treatment that are weak in their conception and weaker in their technology. That's not good. Because soon any agitated, impulsive person who's never had a manic moment in their lives won't have to offer an accounting for their behaviors to themselves or to anyone else.
They'll just say, "Oh, I'm SBD."
Several bloggers picked up on today's New York Times piece on pharma 'ho docs in Minnesota dosing kids on atypicals. CL Psych has a smart, lengthy analysis of the article. Stir Crazy reports that a mom quoted in the article touting Seroquel for her teen son is actually a NAMI Minnesota "Parent Organizer and pushes their pro-medication agenda at local schools where she has even given workshops on how to 'recognize the signs and symtoms of mental illness in pre-school children' and and even state mental health committee hearings."
If the Times' reporters knew this woman worked for NAMI, then omitting that fact from their article is withholding information from readers. Anyone working for NAMI (and that generally means a 50 percent chance that some of their salary or programs are funded by a pharma company) is hardly an objective voice and their inherent subjectivity should be duly noted.
Makers of OxyContin settle with feds for $634 million in a case involving allegations of downplaying risks of the drugs in statements the company made to doctors and regulators. Any implications for Eli Lilly's Zyprexa in this? Any reason we should trust pharma to DTC market its drugs than DTP market them? Pharmalot has a great analysis.
Meanwhile, the Senate totally screwed up its new drug safety bill by dropping, late in the game, a provision that would've slapped sensible limits on DTC marketing of prescription drugs. I personally think DTC marketing should be banned. It's been 10 years and it's a failed paradigm for health care delivery. Brandweek NRx has more. The FDA though will apparently have more safety watchdogs on drugs. Want to bet they get moved over to food investigations?
An AP article on the ineffectiveness of off-label marketing rules in preventing said off-label marketing. As with environmental regulations, little enforcement and small fines do nothing to deter corporate misbehavior. I wonder why.
Soulful Sepulcher has a very interesting take on mental health advocacy. The natives are getting restless.
About six weeks ago, a reader tipped me that the New York Times was poking around on a story about Seroquel set in Minnesota. That story is out today--by Gardiner Harris, Ben Carey and Janet Roberts--and it is kick ass.
I won't summarize or quote from it much as I am limiting my writing time, but it's more about Risperdal than Seroquel, it's got all the usual off-label marketing issues afoot, including docs getting paid to pimp for the product and then prescribing it for kids and teens many more time than the average psychiatrist, some establishment psych docs make noises about how this is unacceptable, and there's quite a bit about how Risperdal screwed up the muscles in a teen's back. And even more. Like docs making around $200,000 a year whining about not making much. (Nice touch by the paper!)
I know Risperdal screwed up the muscles in my face for a time and that Seroquel made my back twitch and tighten (and I've begun to wonder what role that wonder drug's hangover may be playing in my current chronic back situation), so I am glad to see the paper treating this as an important injury caused by the drug. My hunch is that the atypicals as a whole do all sorts of things to peoples' bodies that we don't appreciate. Looking back, I swear the muscle tension I got in my body in late-2004 was an advance sign of the tardive dyskinesia later caused by Seroquel in 2005. There is weird shit up with these drugs.
As much as I appreciate the Times' reporting on atypicals and kids and teens and whatnot (and all that Zyprexa stuff as well), I think they are missing the even bigger story. That would be atypicals in adults for mild mood complaints and sleeping problems. The use and off-label marketing of atypicals for such people is just as monstrous as it is elsewhere. And really drove sales in a way that the kids didn't. They should also be taking a look at how Seroquel became a drug of abuse (it's a minor street drug these days) and problems real world patients have run into developing an apparent tolerance to the drug.
This one is a neurologist, David Perlmutter, who actually gets to go on fancy shows like Oprah and Today. Regarding last year's New York Times report that antipsychotic use amongst kids had quintupled, Perlmutter writes:
"What we are accepting for the status quo for America’s children is deplorable. So many of the “psychological problems” children suffer from are related to DHA defieciency, sensitivity to gluten, and plain old lack of parental interaction. Yes, the latter is hard to accept, but see tomorrow’s post for the science behind this statement."
I'll look forward. In the meantime, nice to have what I've been saying for the last couple of years be validated yet again.
There's been quite a stir around a post by The Last Psychiatrist wherein he stated Cho wasn't insane. I admire Alone's guts. I have made my thoughts on Cho's possible dx known elsewhere--indeed, I ran into another psych doc I know this week who agrees with me and others that Cho was likely Asperger's with psychosis NOS, but was clearly not schizophrenic based on the Virginia Tech shooter's video clips and the bits we know about his psych examination. I hope we learn a lot more in coming months about Cho's condition.
Alone had some great thoughts in a further post on Cho:
"But let's put this aside and ask a different question, about us, not him: why do so many people want him to be mentally ill? Because its an explanation that doesn't implicate society, or themselves. It means the world can be divided into "us" and "them," which is always fun. It's the easy scapegoat that seems to be so obvious as to be unassailable."And if it is mental illness, what do we intend on doing about it? My bias implies harsher sentences, societal changes, etc-- we can debate that later. But if it is all mental illness, then what? Do we lock up the "mentally ill" like we do pedophiles and terror suspects, before they even commit a crime, just on suspicion? And who decides who is suspicious? Psychiatrists? Do you trust every psychiatrist to be good at this? Or should it be the government?"
These are important questions, ones that should be considered by everyone who holds themselves out as an advocate for the mentally ill, especially those who aggressively pushing for tightened outpatient commitment laws, loosened standards for inpatient commitment and people who want guns taken away from those deemed to be "mentally ill."
How long will it be before today's schizophrenic becomes tomorrow's angry political activist whom the government deems insane, locks away and medicates into submission? Does this sound unlikely to you? It shouldn't. Psych hospitals were a routine form of punishment and coercion for political opponents in the Soviet Union.
Think about it.
For those of you who are interested (Mom? Dad?), I was interviewed last fall by Joost Nixon with an ecumenical program out of Spokane, Washington. His religious group does interesting interviews on important spiritual issues and makes them available on CDs and online under a program called "St. Anne's Public House." The new program, called "Dimming Our Wits: Psychiatric Drugging," is available online now. I haven't had a chance to listen yet, but as I recall I was interviewed about where the heck we are going as a culture with mental illness, medications and our culture of over-feeling. Peter Breggin is also interviewed.
You can access it here. I am in segment three. Let me know what you think.
Six weeks after. She was 18-years-old. The link goes right to a streaming video of a newscast. It's a tragic story. Some of you may find the description of how she ended her life to be a bit graphic, so view with caution. Her family will apparently sue, if Texas' legal system doesn't hold them back.
In deference to my back, let me quickly point you all to this article concerning about 350 lawsuits that were filed against AZ regarding allegations around its drug Seroquel. These suits are in addition to the federal class action suit based in Florida, lawsuits from some state governments and a Congressional investigation.
The gist:
"The litigation arose from a label change ordered by the U.S. Food and Drug Administration in September 2003, indicating that Seroquel users are at heightened risk of contracting diabetes. No link has been proven, but plaintiffs who took the drug before that date have claimed injury and say they were not adequately warned of this risk."
A lawyer representing AZ says:
"Michael P. Kelly, the managing partner of Newark, N.J.-based McCarter & English's Wilmington office, who leads AstraZeneca's Seroquel defense team in Delaware state court, said that the company does not plan to settle the cases. "In boxing terms, we will go toe to toe -- no 'rope a dope' here. We stand behind Seroquel, which is a great product that has helped a lot of people," said Kelly."
In patient terms, rope-a-dope is about what taking Seroquel is like.
A new article in the Archives of General Psychiatry estimates that the lifetime prevalence of bipolar disorder in the US is 4.5 percent. That's comprised of 1 percent BP-I, 1.1 percent BP-II and 2.4 percent for "subthreshold" bipolar disorder. The latter is defined as "recurrent hypomania without a major depressive episode or with fewer symptoms than required for threshold hypomania." In other words, 2.1 percent of the population has bipolar disorder of some kind and the rest are just kinda, sorta weird.
The study is following the recent fashion of trying to turn bipolar disorder into bipolar spectrum disorder, which would serve to label behavior that is weird but not clinical per se. I am against this. America has such a dicey relationship with its weird side to begin with. This will only worsen matters.
The 12-month (ie, current) prevalence of all three groups is estimated to be 2.8 percent. What's interesting is that NIMH and damn near everyone else have long hyped bipolar disorder as a lifelong condition, but it appears that this study indicates that there is some flux in that hype. Which is good.
In other news, I have mentioned before that my psychiatrist and I have been having a year-long chat about whether I should be on or off-meds. Yesterday, we decided that I'd drop my Lamictal to 100 mgs. a day over the next few weeks and hold there until I am past my traditional early-June dip in mood and, then, taper the rest of the Lamictal out of my system by August. We are doing this as an experiment and, if things don't work well, then I'll go back on meds.
After 18 years and a 98 percent compliance rate in taking meds, this feels like an achievement of some kind. It will also be a nice 45th birthday present for myself.
Of course, if I do well, then the tricky question will be whether I am bipolar anymore or if I am just weird--er, I mean subthreshold.
When Jerome Groopman authored a somewhat critical assessment of the bipolar child paradigm last month in The New Yorker, you knew it would get interesting responses. Last week, the magazine pritned three letters from psych docs in response to the article, which I cherry pick from below.
Joe Bilderman and Janet "We Work In Uncharted Waters" Wozniak, both members of the Harvard bipolar child mafia, offered:
"As potent as the side effects of treatment can be, psychiatry's greater appreciation of the occurrence of bipolar disorder in children has led to remarkable advances in diagnosis and treatment which we feel far outweigh these drawbacks."
These advances in treatment? The authors don't say. Keep in mind that Wozniak was quoted last week as saying that she makes diagnoses in kids based upon reports by parents and one brief office visit with the child.
Then Demitri Papolos, Dr. Bipolar Child himself, plays the suicide card:
"When children are not diagnosed and treated appropriately, aggressive behavior, psychosis and even suicide and not uncommon results."
Nicholas Rosenlicht, a psychiatrist at UCSF offers:
"Why are these behaviors in children called bipolar disorder? Its symptoms occur in many psychiatric disorder, and in normal children, the differences between adult and childhood bipolar disorders are striking. This seems to be a diagnosis that must be believed to be seen. But this is faith; and where faith and marketing dominate, science is excluded....Stronger evidence is needed before advocating the use of powerful and expensive drugs, and burdening children and their families with the diagnosis of a major mental illness."
I am fascinated by this East Coast/West Coast dichotomy (they like medicating the kiddos in the EST zone) and predict that one day there will be a gangster style throw down between the coasts that will make the whole Tupac/Biggie Smalls thing look like child's play.
Doctors at Johns Hopkins University are set to study magic mushrooms in treating depression, following a study last year that showed that, in addition to making people trip, psilocybin helped treat depression. OK, so in the last year or so we've seen positive results using small doses of ketamine to treat depression, as well as positive reulsts from 'shrooms, and there are all sorts of anecdotal medical "research" establishing that pot has similar effects, so I just cannot wait to see the first study that pits marijuana, say, against Prozac.
I guess there is a reason that people have been taking these and similar other compounds for eons.
I am mostly of the living today, thankfully. As usual there is much afoot.
The Washington Post reports that Cho never received outpatient treatment after his brief stay in a psych unit. Due to very unclear lines of authority and follow-up in the mental health system in Virginia. There is something very messed up about that state's system. One question: if Cho was deemed ill enough to be placed under outpatient treatment, then why was he not kept in a hospital for longer? It strikes me that someone may have dropped the ball bigtime. More on this later.
Psych Central takes on in-store clinics.
CL Psych had some great items late last week, including this on the very weird Risperdal for depression study that involved some dubious stats and contorted authorship. As well, he notes a TV ad for a Seroquel study involving youngins by the bipolar child mafia at Harvard.
The Last Psychiatrist takes on the "media causes copycat suicides by reporting on suicides" theory.
Rivers in Portland, Ore. test positive for Prozac. It's not the water supply, but damn. Can Seroquel be far behind?
I have watched with growing worry the last few weeks as a buttload of commentators have taken a swing at the Virginia Tech massacre and the question of violence among the mentally ill (this chatter always assumes of course that Cho had schizophrenia). These folks, psychiatrists in some cases, almost always get it wrong. Here's another example of that phenomenon, a lawyer with a Ph.D. (not sure in what) attached to Yale University blogging for a criminal justice think tank (often a contradiction in terms in my professional experience) and banging on John Grohol at Psych Central and myself for having the temerity to question the Treatment Advocacy Center's twisted claim that schizophrenics are 10 times more violent than the general population. The author Steven K. Erickson is in the psychiatry department at Yale.
Grohol kicks ass here. I would like to kick ass here and now, but my back is still a bit dodgy--albeit much better--and I am going to stay off the computer like a smart guy. Besides, since I am bipolar, if I kicked ass it would likely lead Erickson to calling me violent and demanding that the state detain and medicate me!
The author of the post says Grohol and myself are indicative of an "advocacy culture that has gone too far." In a recent paper, Erickson, who reads this blog on occasion, stated:
"Antipsychotic drugs do not override personal choice, intentionality, or 'control' the people who receive them. On the contrary, abundant evidence suggests otherwise."
Tell ya what, Steve: You go take 30 mgs. of Zyprexa a day for two months and get back to me on its liberating properties. Then, we can talk about whose advocacy is off-base.
Thanks to John Grohol for his fine work on this issue. It amazes me that the people stepping up for schizophrenics are psychologists--Dr. Phil included--and not psychiatrists. Which tells you something.
A nice article in the New York Times Magazine yesterday by Bruce Stutz who took Effexor, found his depression leveled out and then went through absolute hell to get off the drug. He also contemplates what many patients have to think through when their condition improves:
Stutz goes through most of the major issues around the curses and blessings associated with anti-depressants, especially the serotonin syndrome. I'm glad that particular bit gets attention. I think I experienced for quite a time both on anti-depressants (but those were gentler times so we didn't know about such things) and, later, on atypicals. I am sure I will be called both pro and anti-psychiatry for saying such things or bashed as "typical patient advocate." So be it.
I think such questions--do people have to be on meds forever? can we get some meds that don't make people sick?--have got to be asked, repeatedly, until this game becomes far more humane. I think Stutz agrees.
So my back is keeping me off the computer again, but I wanted to pass along the following bit that CBS' "The Early Show" did on kiddos with bipolar disorder. It's in two parts on the web at least. Includes quotes from one of the Harvard bipolar child mafia, Janet Wozniak, who describes her diagnostic intake as:
"She said she would rely on a parents' report and a short visit with the child to prescribe medication for a child."Because the symptoms of bipolar disorder are not always present in the office visit with the doctor," she said. "
Includes a semi-lame bit on the Rebecca Riley case. Includes no skepticism about the BP Kiddo dx. Why do TV reporters get paid so much for doing so little? Sigh.
My back is usually a bit better in the morning so I will try and bust out a post or two before noon.
Much credit to Depression Introspection for jumping on the fine folks at the Treatment Advocacy Center over recent distorted claims they'd made about violence among the mentally ill--schizophrenics are 10 times more likely to commit violence than the general population. John Grohol at Psych Central took it one step further in one of the most blistering posts I've read on a mental health issue in ages. It's epic. CL Psych has fun with it as well. Bipolar Blast is on it, too.
I knew TAC's claim was bogus when I saw it and, in fact, I went after them for misreading the CATIE violence study when it appeared last year. This time out, I held off because I was tired of being the lone voice banging on TAC and TAC's refusal to correct errors in their claims as well as in their database of "preventable tragedies." I am glad others have joined me in calling them to account. I wish the mainstream media would do its job on this front as well instead of being dazzled by Fuller Torrey's alleged celebrity and the alleged horse sense of TAC's claims (which Torrey likes to case as politically incorrect just to inoculate himself from challenges and look brave). Hey, Anderson Cooper, are you listening?
While I am open to TAC's wishes to address outpatient commitment statutes in the US--where needed--I am wholly against their desire to see state mental hospitals re-opened. We tried the Bedlam approach in this country for almost two centuries and we know how that worked out.
Last year, I had a long chat with two leading psychiatrists, one of whom told me flat out that "Fuller Torrey is evil." Wish I could name this doc.
I am going to list some of the many posts I did on TAC's obsessions and delusions--and yes I am using the terms clinically--with the mentally ill. TAC has a long track record of twisting studies to support its political agenda. I am not doing this to brag, but merely to collect them in one place in one relevant post. Many of the posts are in response to last year's shooting of two police officers by a young man with schizophrenia as well as TAC's mangling of the CATIE violence study.
"Peter Earley Now Has A Problem" In which the well-meaning Earley was duped by TAC's statistics.
"What The Washington Post Got Right And Wrong" In which TAC's claims make it into a WashPo editorial.
"More Thoughts On The DC Tragedy And Mental Illness In America"
"While We're Talking About Honesty"
"A TAC-y Move" In which I call out TAC for refusing to answer sensible questions and get into the dark claims of one of its board members.
"Another Day, Another Post Article"
"Yet Another Day, Yet Another Post Article"
"TAC On Crack" TAC assails anyone who fights to get the mentally ill out of state hospitals.
"What TAC Won't Correct, I Will" In which I issue a correction of TAC's claims.
"Fuller Torrey In Seattle" In which the great one makes a weird appearance in my hometown.
Long in the consideration phase, the FDA yesterday ordered drug makers to amend current black box warnings to include language that the drugs may cause suicidal thinking in young adults up to 24 years of age, no suicidality in adults, and a decrease in suicidal thinking in seniors. I'm pleased that the FDA has taken this step, but am a bit incredulous at the idea that an SSRI, say, can produce suicidal thinking in you when you are 24 but not when you are 25.
Anyhow, the warning doesn't just apply to SSRIs/SNRIs, but to anything approved for treating depression including MAOIs and Seroquel.
I've been having a bit of trouble with my lovely chronic sciatica and tight low back, so I had to be away from the computer last night. More soon. Have fun.
Yet another STAR*D paper is out in this month's American Journal of Psychiatry, this one examining two groups of patients--one receiving cognitive therapy alone, the other receiving CT plus Celexa. The paper itself is not online yet, so I only have one press account to go from and can't really dig into the study much.
If I recall the general STAR*D structure, these two groups of patients would be in the second round of the study--i.e., after Celexa alone failed them in the first round (as it did for about 70 percent of study patients).
"The rates of remission over 12 weeks were 25 percent for the patients who switched to cognitive therapy and 23 percent for those who received it as augmentation. These rates were not significantly different from those for the comparison groups assigned to medication. Cognitive therapy produced remission more slowly than medication, but it produced fewer side effects."
With almost equal results, it's hard to tease out which modality won--not that the study was structured to pick a winner--but it is discouraging to me that CT didn't perform better. We've all seen studies where it blew an SSRI out of the water. I wonder why it didn't happen this time out. More when I get the entire paper.
Hi. Happy May Day. Oodles of interesting stuff out there.
Virginia's governor closes loophole that allowed Cho to buy guns.
Psych Central raises questions about the slippery slope that lawmakers may be on with regards to people deemed to be mentally ill. You take away someone's Second Amendment rights today and what's next tomorrow? And is psych hospitalization--which can result from overwork and exhaustion in milder cases annd can also be as a result of med-induced mania--the appropriate test for withholding Constitutional rights? Given that police officers can force a short-term commitment of anyone they consider acting out-of-bounds, then how long will it be before we hear of a cop using commitment powers in order to fuck with someone they don't like? How long before the federal government uses it to deny rights to political activists (a la ye olde Soviet Union)?
In Washington State, a right-to-carry and shall-issue state, we have a law that precludes anyone who's been in a psych unit from buying a gun, but it allows that right to be restored later by a judge. It's still a fairly new law here, but seems like a decent tradeoff of protections and rights.
Pharmalot has a great item on how much money Lilly hands out in grants to, among others, NAMI. It gave NAMI $544,000 in the first quarter of the year. In recent years, NAMI has clocked about $6 million a year in "grants" from Big Pharma, roughly half of the group's total revenues.
Several fabulous items from CL Psych. An amazing post on researchers pimpin' for Paxil/Seroxat. Lilly is apparently going to go after Zyprexa document leaker David Egilman big time. Punster Pharma Giles is calling it quits. NO!!!!!
The always-excellent Health Care Renewal on the fog around Lilly's hyperglycemia data regarding Zyprexa.
The fine folks at TAC wrap up media coverage--if you can call it that--of the Virginia Tech tragedy and a failed mental health system. Fuller Torrey says basically that the mentally ill don't have civil rights. BTW, how is it that the mental health system in Virginia failed when Cho had only one contact with the system and presented with only "flat affect?" How the hell is a system supposed to tease out a character like that? I ask that in as innocent a manner as possible.
A trial of Seroquel used to treat insomnia in recovering alcoholics. The target dose is 400 mgs a day, so I'll just go out on a limb here: These folks will definitely sleep. Bet they have bad dreams though. Bet the study doesn't measure that.
An interesting piece on Zyprexa lawsuits and docs outraged at medicating kiddos.
The editor of Current Psychiatry calls for limits on product liability for manufacturers of psych meds, among other things, as a way to spur research innovation. I'm not sure I buy the connection, especially since the companies have liability insurance and the real innovation needed is in drug safety. Given said editor's publishing record, I'd say he should be a bit more concerned about product safety.
Or maybe you didn't. Or you already knew. But yesterday I ran across the following on the main page of MySpace:
Sponsored Links Bipolar DisorderLearn About Symptoms & Treatment Options: Find Information
managebipolardisorder.comSymptoms of BipolarLook for Bipolar and Manic Depression Symptoms
treat-bipolar-disorder.netSymptoms Of DepressionTop 6 Websites For Symptoms Of Depression
www.Top6picks.comBipolar DisorderI got my life back. It just takes a plan to manage bipolar disorder.
www.BipolarHappens.com/Hope
MySpace's main page holds only four text ads, and while I have seen one or two be bipolar-related at any one time, never have I seen all four at once. This tells you something. Or not.
Treat-bipolar-disorder.net takes you to more text ads. Managebipolardisorder.com is a Lamictal website. The third is an odd web portal of no interest. The last, a patient offering advice and a book on managing bipolar, which she claims affect more than 17 million Americans. OK, that's not even possible.
I'd say we are a pretty big market for someone out there. Maybe MySpace. Which means Tom.
A new study is out claiming to show how the brain responds to chemicals contained in marijuana and that pot causes psychoses. I'll wait until I have accessed the study itself before saying much, because the media often gets the ideas of "links" and "causes" tangled up. To whit, two headlines on the study:
"Doctors: Pot Triggers Psychotic Symptoms"
"Cannabis chemical 'helps' schizophrenia"
Anyhow, the pot causes schizophrenia stories are back out there. High times indeed.