MindFreedom has another alert out on yet another New York State patient whom the state is lining up to force into undergoing ECT against his will. Read about it here. I've said it before: if someone consents to ECT, go ahead and do it. But to force ECT on someone who does not give their consent is the grossest invasion of human privacy by the state that I can think of these days. It's fascism and against almost every principle upon which this country was founded.
On another front, I chatted over the weekend with a fellow bipolar I've known for three years from the MySpace bipolar groups. She's tired literally every anti-depressant and antipsychotic on the planet, but she cannot shake her depression. She is going into the hospital at the end of August for 30 days worth of treatment including several rounds of ECT. She is consenting to the procedure.
I didn't push much in the conversation, but simply asked if she'd read the pros and cons of ECT. She said she had. I asked if she didn't think it wise to get a second opinion. She said she'd been with the same psych doc for seven years and trusted her doctor implicitly, so she wouldn't seek a second opinion. I left it at that. I hope to God it works for her.
Over the weekend, the St. Petersburg Times had a fine article on just how much atypicals are being used on children in the state's public mental health system. Over 1,000 children under 6-years-old are on them. And so on. Treatments back there have gotten so crazy that one kiddo was on 16 meds at once. The reporter does a good job of scoping out the range of opinions and concerns (the usual hamfisted "We don't need no research" defenses are uttered) on using these meds in kids and teens. Gee, I wonder what they'll find when they look into how they are being used in adults.
Hi. This is a bit of a kitchen sink post, as I am trying to catch up on a few things. I think my posting will be more active this week as well.
First, Mr. B., whom I've chronicled in the past, was mugged the other night while walking home. I knew the new neighborhood his social worker moved him to--after he got kicked out of his old apartment because he smokes--would prove to be a problem for Mr. B. Basically, three men intercepted him on a street not far from where I live. They started punching him and demanding his money. Like many schizophrenics who manage to get out and about, Mr. B. looks like he's got victim on his forehead. He's been set upon by assholes like these guys many times in his life. Mr. B. coughed up $30 and they demanded the keys to his apartment. About that time, a private security patrol drove by and saw what was going on. The rent-a-cop chased off the bad guys and took some kind of report from Mr. B. Mr. B. doesn't know if a report was made to the police or not. It's a bit unusual for someone to be openly mugged in that part of the city. Mr. B. is 62, gets 300 mg. injections of Haldol every few weeks and can barely walk. It annoys me deeply that some criminals would set upon him. Guess that's why they are criminals.
Anyhow, Mr. B. is basically OK. He won't tell his social worker about what happened because he doesn't like his social worker. Getting mugged near the housing said social worker moved him to isn't going to improve their therapeutic alliance too much. More later.
Second, Mary Zdanowicz, the Treatment Advocacy Center's executive director, resigned the other day. You can read about it here. Despite my many differences with TAC, I appreciate Mary's work all the same. We are all trying to make things work better for people like Mr. B., after all. I wish her much luck and success.
Third, today I filed an adverse event report with the FDA over my withdrawal experience with Lamictal. I don't really expect any action, but these sorts of reports need to be brought to the attention of the proper authorities in case a pattern of patient experiences turns up. From recent comments on this blog, I'd say there is a pattern of withdrawal problems for Lamictal users.
I think patients should always file these reports. It's the only way the system will change.
Thanks for the many kind thoughts, comments and emails in response to my post yesterday on some Lamictal withdrawal issues I've been experiencing. Here's one comment:
"Lamictal withdrawal was by far my easiest, but I did it over about 5 months and stopped after every drop in dose until I felt no ill effects. From what I recall, withdrawal symptoms took the form irritability and difficulty concentrating, but I don't remember any extreme fatigue."
I hadn't mentioned the irritability yesterday. A few weeks ago when I got into the 50 mgs. a day range, I noticed that I'd begun getting very snappy with my friends. Which is to say, words were coming out of my piehole much faster than usual and I felt pissed off much more than usual. I was irritable as hell and actually had to take Ativan on a couple of occasions just to chill out. The irritability part seems to have disappeared in the last week since I've been off Lamictal altogether. The extreme fatigue and difficulty in concentrating seem to have drifted away for the most part. Then again, today is young. I've slept like crazy the last several days. Oddly enough, my mood is fine.
Except for my frustration that my doc didn't tip me off that this might happen. But that's OK. I'm pondering putting in a call to GSK's press office next week and asking them why it is so difficult to find info on Lamictal withdrawal on their site. I am also pondering filing an adverse event report with the FDA.
All in all, I'm trying to remain positive about the whole experience. I mean, I've taken Lamictal for three years, so what did I expect?
First, I've been very light on the blogging this week as I am trying to buy myself a bit of time off. Second, I needed to buy myself some down time as, after discontinuing Lamictal over the weekend, I experienced what I'd have to call withdrawal symptoms. I cannot find much information about such things, but what I ran into was utter exhaustion the last few days and difficulties focusing and a weird feeling of ennui. I'm not talking about being scatter-brained, but about whatever I was thinking at a particular moment washing out of my head within minutes. Very odd. I'm a bit surprised by this since I went through a very slow, gradual tapering process over six weeks.
I feel back to normal today. I was beginning to worry.
Anyone else ever run into odd experiences coming off Lamictal?
I apologize to regular readers for being light on posts the last few days. I was busy over the weekend and am playing catch up on some other work as a result and will be through tomorrow. Today is also the first day in a week that we've had sun in Seattle. It's only partly cloudy right now. The way the weather goes around here, we'll be into fall by early September, so we may not get much of a summer at all this year. OK, random observation.
Thanks for the many emails asking about how my Lamictal tapering has gone. I took my last 25 mg. dose on Friday, so I am essentially in the clear today. Things seem to be fairly level, especially given the amount of financial, career and personal stress I am under. A friend of mine told me last week that she couldn't believe that I was handling going off meds so well at such a tricky time in my life. I believe it, but I knocked on wood all the same.
I am trying to not make a big deal out of what's going on. But I do recognize that I am crossing into a bit of the promised land for psych patients. And that's not a small deal. Neither is the fact that each night I've had to stop myself from reaching into my medicine cabinet for a pill of some sort. Talk about breaking behavior patterns.
Speaking of not small deals, I find it very, very interesting that Lilly employees have been poking very hard on some old Zyprexa and Cymbalta posts on this site the last few days. In addition, quite a few law firms who do plaintiff's work in class action lawsuits have been spending time reading old Zyprexa posts. I know the search terms they are looking for, but I'll keep those to myself. Something is going on, however. I'd love to know what it is, so if anyone feels like dropping a little old anonymous tip my way, the email is in the top left of this page.
Here's a BBC item on anti-depressant use going up fourfold since the mid-1990s. The figures were unearthed by a cranky MP and concern kids and teens up to 16-years-old.
The BBC item continues:
"But there is also some debate as to whether mental health disorders really are rising within the young.In its last major report on the prevalence of such problems in 2004, the Office of National Statistics found the figures were broadly unchanged from a previous survey in 1999.
One in 10 were found to have some form of disorder, ranging from the very minor to the very serious.
These latest figures on child prescriptions follow others which suggest that that the rate of anti-depressant prescriptions for the population as a whole has hit a record high.
More than 31m prescriptions for these drugs were issued in 2006 - a 6% rise on the year before.
The Royal College of General Practitioners accepted that depression could nt be cured by pills alone, and that better access to alternative therapies was essential.
However its chairman, Professor Mayur Lakhani, has rejected the suggestion that family doctors prescribe anti-depressants too readily.
"GPs consider the need for anti-depressants only after a careful assessment of the patient's clinical condition," he said.
Marjorie Wallace, chief executive of the mental health charity Sane, said: "While in some cases there may be a need for medication as part of a treatment plan, drugs should not be seen as the only solution."
Geez, and people thought we were crazy for meds over here.
As most of you have no doubt heard, Atlanta Falcons QB Michael Vick was recently indicted on federal charges related to dog fighting, wherein he participated, perhaps indirectly, in torturing and killing pit bulls. The NFL has suspended players such as Ricky Williams for smoking pot and Pacman Jones for being involved in a club melee in Vegas. Neither were convicted of anything. Vick deserves similar treatment.
If you want to sign a petition calling for Vick's suspension, do so here. Or you can go to PETA's site and use their handy-dandy letter writing application and shoot a note to the NFL itself.
I have zero tolerance for animal cruelty and pieces of shit like Vick.
Earlier this month, a former psych patient wrote to the Treatment Advocacy Center asking it all manner of questions about how the political action group accounted for the consequences of misdiagnosis. This person got no answer. Now, this person has written the group again. In my mind, these are legitimate questions--regardless of where you stand on the pro/anti-psych line--and deserve answers.
"I'll keep this short, as you guys never seem to find the time to respond. My questions are pretty simple:(1) What system do you have in place or do you propose to have in place to
protect the wrongfully diagnosed?- and -
(2) Now that you claim to have irrefutable proof of the neurobiological
nature of mental illness, why don't you have scans OR ANY OTHER PHYSICAL
TEST available that can prove an alleged diagnosis?- and -
(3) When are we going to have some discussion about the assault suffered BY
patients BY their families?That's all for now.
Still waiting for answers,"
What kinds of answer do readers have?
I haven't written about Mr. B. in a while. He's the Vietnam-era vet who's schizophrenic and was kicked out of his housing recently because he smokes. He has new housing now in a dicier part of town, but is still often in my part of Capitol Hill. He misses living up here. Anyhow, Mr. B. loves to poke around in dumspters, looking for knick-knacks he can sell for cash. It's his job, he once told me, although his VA benefits are a damn sight better than what most mentally-disabled folks get each month.
Those of us around here who know Mr. B. know that he will occasionally find a knife or a sword in a dumpster. The problem is that we're all a bit uptight for the guy until he gets rid of it at a pawn shop the next day. If the cops found a knife on him or saw him walking around with a sword, it'd be an interesting time for Mr. B. Every cop in this precinct knows that he's harmless--he truly is and I've run his name through court records once just to check--but he's also a schizophrenic, so everyone is pretty suspicious because of the propaganda spread around by the likes of the Treatment Advocacy Center. You know the talk: all schizophrenics are violent and axe-murderers.
Over the years, Mr. B. has tried to sell me CDs, fishing rods, a creel, a nice sports coat and the occasional knife. I bought an Al Green CD off him once. Tonight, as I was having coffee and a smoke outside a local coffeehouse--the cig was illegal by the way under our state's bizarre 25-foot rule smoking ban--Mr. B. walked up and tried to sell me, in his sheepish way, a Janet Jackson CD, a claw hammer and a three-inch knife, a Buck knockoff. I talked to him about the knife--where did he find it? on what street?--and listened to him tell me he'd keep it until he sold it the next day. Mr. B. was released to the streets of Baltimore when he developed schizophrenia in the mid-1960s and he's told me how he regularly had the crap kick out of him by street folks until he learned how to defend himself. He has so much PTSD over those days that I cannot even get into it.
A couple of months ago, Mr. B. found a sword and a local shopkeeper bought it off him for $10. He told me later it was the fastest way to make sure Mr. B. had no troubles that day.
I decided I wasn't going to let Mr. B. hang onto the knife, so I asked him what he wanted for it. "Three dollars," Mr. B. answered. I had no cash on me, so I told him I'd pay him later. I looked the knife over--it's made in Taiwan and the compass embedded in the handle's butt doesn't work. When I looked up, I noticed a few people staring a bit uneasily and I put the knife back in its scabbard and slid it into my coat pocket. People are so easily spooked in Seattle. As it is, I've seen much more interesting items sold on the streets over the years.
And, then, I walked home and along the way it hit me: I'm a soon-to-be unmedicated bipolar who'd just bought a big old knife. What would Fuller Torrey say? What about NAMI? Would they recommend Zyprexa and outpatient commitment?
I put the knife in a kitchen drawer where it now sits with my prized Wustoffs--some of the few nice things I own--and, if I go camping this year, maybe I'll take it along.
I appreciate the many comments in response to the families and therapy posts of the last two days. Yesterday, I had something like 25 comments, almost as many as during the height of the Zyprexa days. I also appreciate the personal stories people have passed along recently. They make for great reading and give me a bit of a much-needed break. Today, a anonymous reader passed along some thoughts on a recent encounter with the police.
Last week, I had a shopping day that involved several stores on the same block on both sides of a busy highway. As I try to avoid left turns at uncontrolled intersections, I parked my car at the grocery store and crossed the highway on foot to get some of my other chores done.
I was very careful and, when the time was right, dashed to the island in the centre. I was so busy watching oncoming traffic from the left, I completely failed to notice the motorcycle cop coming from the right (on the other side of the centre island). Whoops. He stopped and barked at me “Are you suicidal?” As is the case for so many other ex-mental patients, I have a deep and justified fear of the police. I probably hesitated a second before stuttering “No, not at all.” After listening to a condescending and ill-advised speech about how I was crossing the road incorrectly (there are no crosswalks there and the cop said I would be safer crossing at the corner, which is manifestly incorrect), he let me go on my merry way.
No big deal, right? Wrong. I was terrified. Had this cop not liked the look of me, he easily could have hauled me to the nearest emergency room for a mental health assessment. I would have to hand over my medical card. The hospital’s computer would indicate my formidable psychiatric history. I would be questioned by a doctor. The truth would come out: I’m bipolar and I don’t take meds. Had they felt like it, I could have been held for 72 hours for assessment. During that assessment, I could have gone crazy
from fear and rage at being confined again. Then a second doctor could rubber-stamp the first doctor’s recommendation and, whammo, I’d be in the loony bin again. While it got sorted out, I’d be at the mercy of the medical system and most likely given drugs (probably by injection, if history is any guide).
None of this happened, of course, but it easily could have. And the fear I felt at being questioned by a cop was entirely due to my past experiences. This is why I say that a psychiatric label is forever. And although my psychiatric assault is over, these fears will never leave me.
Today is an off-day for me, so I wanted to share two of the many interesting comments left in response to yesterday's post on bringing families into treatment and therapy for psych patients.
First:
"As someone who was stymied at every turn in her effort to help her adult daughter during a manic episode and who even now can't engage in "help" for surviving siblings without incredible hassle, I frankly applaud this concept of family therapy. I know privacy rights are a thorny thing but common sense needs to enter into these therapeutic relationships too. Furthermore being completely excluded can make it easy for therapists to label other family members the "problem" when they really don't have a clue if this is the case or not."
And, then, a startling comment which I had to edit down:
"My father is a lawyer specializing in involuntary civil committment....He had the probate judge in the small town where I grew up sign committment papers saying there had been a hearing at which I was present and represented by a lawyer. No hearing took place....All of this because my family, knowing I didn't meet the criteria for committment, broke the law to get me committed. Luckily they lied and told the hospital and pshrinks I had previously been diagnosed as bipolar when I had not been. And yet, any psych evaluation of me will involve interviews with them in spite of the fact that we live in different states and I am financially independent."Families should be investigated as contributors, either intentionally or unintentionally, to a persons psychic distress, but should never have power to intervene."
My own view is that if a patient wants family involved in their health care, fine go ahead. If not, then the family should stay away. There is some point at which we must as a society grant free will even to our most-cherished and most-coddled family members, regardless of their condition. Life and liberty are rough that.
The Wall Street Journal, soon to become part of Rupert Murdoch's publishing empire, has an interesting piece on a new movement among therapists and psych docs to have families become intimately involved in a patient's care. Proponents claim all sorts of wonderful results. While I support whatever the hell works for someone, it is a bit troubling to see this trend. No doubt the fine folks over at TAC are cheering this on because we are all such big babies who need Mommy to care for us permanently.
One odd thing from the piece's lede:
"When Tony Fama worries about recurring sadness or has questions about antidepressants, he calls a psychiatrist -- his wife's."Mr. Fama's wife, Helen Kraljic, suffers from bipolar disorder, and he calls her doctor frequently if she seems to be manic or having side effects from her medication."
Um, wasn't there a landmark study a few months back identifying that anti-depressants are no more effective than placebo in bipolar disorder? Why, yes there was. So perhaps Fama's wife is having side effects because she's taking meds that aren't particularly good for her or efficacious for her disorder.
Marissa from depression introspection posed the following to me in comments following a post of mine yesterday:
"Maybe it's possible for some people that as they get older, their symptoms become few and far between. So did any of the meds REALLY help you then? :)"
It's a good question, an essential one, but I don't really know the answer. Maybe the best way to address this is to list each med I've taken and offer some of my experiences on it and readers can tell me what they think helped and didn't help.
1. Lithium: 1989 to 1997. Worked fine on manic/hypomanic symptoms most of the time. Made me fat as hell on higher doses--I hit 235 pounds at one point and I am six-foot-one--but it was loseable weight and I eventually got back down to 195. Made my hands shake and tore up my stomach. Eventually washed out.
2. Prozac: 1990 to 1993. I began taking Prozac weeks before the infamous Newsweek cover of the pill came out in the Spring of 1990. Initially, Prozac felt like the greatest medical technology I had ever encountered. I felt "better than good. The depression came back and my doc at the time, unaware of the problems swirling around the drug, began upping my doses to 80 mgs. a day. I experienced severe akathesia--although I didn't know what it was or that I should tell my doc--and suicidality. I was so scrambled on this drug that I was unable to do my accounting job.
3. Tegretol: 1993. It did nothing for me good or bad.
4. Paxil: 1993 to 1994. This was my replacement for Prozac. Since these were still pretty pre-Net days, I had no idea of the problems with this med either. It didn't do squat for depression and, again, I had problems with akathesia and suicidality on higher doses.
5. Zoloft: 1994 to early 1995. This drug just made me feel stony. And cleansed in a weird way. I got off it when I lost my health insurance. By now, I was on Lithium only and, living in San Diego at the time, was going across into Tijuana to buy it cheap--scared each time that I crossed the border that I would have to explain the bag of pills to US Customs.
6. Depakote: 1997 to 2004. Like Lithium, good for manic/hypomanic stuff but kind of rough on my body. I didn't put on too much weight from the drug. It galled me that I was taking a drug made by Abbott Labs, which had fired me in 1988.
7. Luvox: 1997. I literally took this drug for two days before stopping it. I was so agitated that I feared another Paxil go-round.
8. Ativan: 1997 to present. I've taken this drug very intermittently, a day or two every once in while when it makes sense. Apparently, it's highly addictive and you cannot take it long-term, and I never have. Good dope though.
9. Xanax: No particular year. I've been given this by friends, not docs, a few times. It makes me sleep like a log.
10. Wellbutrin: 1998 to 2004 over three separate trials. A benign, ineffective med which likely agitated the hell out of me.
11. Risperdal: 2000 to 2003. Initially, a good med that seemed to really make me focus. Also calmed the Bad-butrin agitation. This was the first of the atypicals I had pushed on me for long-term, every day use. Over time, it made me sleep a lot, packed on the pounds, made my heart take on odd beats and puffed up my face. Garbage as a long-term drug.
12. Lexapro: 2002 to 2004. Not a particularly strong anti-depressant. Gave me cracking headaches and lightning bolts in the head when I went off it. When I went back on it briefly, it made my heart race and gave me akathesia. I went off it immediately.
13. Seroquel: 2004 to 2005. My thoughts on Seroquel are already well-known. It's an OK drug for very short-term use rather as first-generation antipsychotics used to be used with bipolar. For anything else, this drug is very bad. I was in a constant fog and it made me fat as hell. In addition, it gave me horrific nightmares--such as I had never experienced before or since--and made my muscles tighten. Also, puffed up my face. I would still use it in a short-term emergency, however, should the need arise.
14. Lamictal: 2004 to 2007. Pretty good at addressing both manic/hypomanic symptoms and depression. Not perfect at it, however. Almost zero side effects on this drug.
15. Mellaril: no particular year. In the 1990s, docs used to still hand this out as a get to sleep drug. You'd take it for a couple of days and stop it. While on it, you slept like a drugged log and were impotent. Nasty stuff.
16. Celexa: no particular year. I took it for a short time twice and it did nothing for me or to me.
17. Geodon: 2005. I took this for three weeks in 2005. Caused akathesia worse than any SSRI. Lost weight on it though!
I am missing a med here, since the last time I did a hard count of what I've taken over the last 18 years, I got to 18 drugs. I'll figure that out another day.
So what do you all think worked? Me or the meds?
I have my hunches.
For the last 18 months or so, my psych doc and I have discussed the prospect of my coming off meds altogether. His opinion has been that I've done remarkably well since getting the low-dose, long-term atypicals out of my life two years ago. So why leave me on Lamictal alone? He's told me that I may be one of those bipolars who does just fine without medication.
After 18 years of playing by the rules 98 percent-plus of the time, I've earned the right to find out the answer. I should stress that I've had no problems with Lamictal aside from the cost. It's one of very few meds I would openly recommend to people. Obviously, I am aware that others have had different experiences on the drug.
Anyhow, I've tapered from 200 mgs. a day down to 25 mgs. a day and will be on 0 mgs. a day come this weekend. So far, so good.
Of course, if this works out long-term, I then have to ask myself if I am even bipolar. For several years, I've met none of the criteria for bipolar disorder I, my original diagnosis from 1989 (although it was called manic-depression then). But then I have been mania free for many years. I haven't met the criteria for Bipolar Disorder II for the required time period in ages. I've not even met the standards for unipolar depression.
Forget about whether those facts are even clinically interesting. What interests me is what do I call myself in the future? Formerly bipolar? A bipolar off-meds? A psychiatric survivor? A bipolar survivor? Or, as the fine folks at TAC might have it, lacking insight into my serious debilitating disorder?
Maybe I'll just call myself by my name and leave it at that. I've earned that right, too.
Last week, I posted the thoughts of SS, a regular reader of this blog, concerning her experiences with ECT. She passed along something else over the weekend. Read on.
When I was in 7th grade, the big movie was “One Flew Over the Cuckoo’s Nest”. I knew this movie was rated R but somehow all the kids in school had seen it and I had to fit in. So I begged my mom to take me one weekend.
So the whole family went one Saturday afternoon. Me, my mother, my father, and my sister, who was given a big bowl of buttered popcorn and was told it’s OK if she fell asleep.
The movie scared me. A bit earlier one of my friends and I snuck into “The Exorcist” and that scared me. But this was different scary, although I couldn’t pin it down in my 11-year old mind. Maybe it was the men, shuffling around and looking vacant that scared me. Or maybe it was a feeling in my stomach, a foretelling.
Years later, in college, I took psych classes. The professor, who was very respected in the field, made some disparaging comments about bipolar and schizophrenics, saying that they wouldn’t be able to do much with their lives and end up pretty much in locked mental wards. He treated sociopaths much kinder.
I was petrified, because as I studied, I realized this definition for this new thing- manic- depression, was I. And my professor was saying it’s easier to be a sociopath and fit in society than what I had. I cried, and it bruised my struggling self esteem.
Oh the indignity.
Maybe that is why in the real world, I do not tell people I am bipolar. My actual diagnosis is Bipolar 1, but I keep this under my hat.
I hate being bipolar, but it’s me. I hate the fact that I cannot seem to attract a normal guy. When I am dating and eventually it comes out that I am bipolar, they run away like I have a terminal case of gonorrhea and their privates will fall off if they are with me. If they don’t run then, they run like hell when they find out I am a suicide survivor.
I hate the fact when I write I cannot be “Out” and use a pseudonym.
I was in a relationship with a lovely man, who would always introduce himself to whomever he met by saying “Hi, I’m (blank) and I’m bipolar”. I could never do that.
But why?
I wish I had the courage to out myself. I can do it at a DBSA meeting, I have no problem at an AA meeting, but in my normal life, I try to just appear normal and not say anything.
But Normal- that’s a setting on a washing machine. No one is 100 percent normal.
What is it about Bipolar that scares us like we are the boogeyman or Freddie Kruger?
It could be ideas like my well-meaning professor. After all, he read Kesey and saw “The Snake Pit”, and based his ideas on that. He probably read papers from the 50s where mentally ill patients were rounded up and placed in mental hospitals and forgotten about. Lobotomies were common, even JFK had a sister who had one.
I am embarrassed and I shouldn’t be. Part of me loves being bipolar; I have touched Mt. Olympus in Mania, and visited Hades in depression.
And part of me hates it. I feel like damaged goods. I don’t feel human. I don’t feel accepted, or loved. I look at all the houses where I live, all the houses made of little ticky tacky, with children playing in the yard and dogs and cats and I want the normalcy of it all. I want the comfort of it all. And that is denied to me, because like attracts like and even though I may fuck like a demon in the sack when I’m manic, when I am depressed I totally embrace abstinence. You can’t run hot and cold- said my last boyfriend. But I do. And when your meds change to something that takes away your libido and your appetite, you have to wonder, HOW MUCH DO I WANT THIS?
I want to have a life. I want to have a job again, and not live on disability. I want to be a productive member of society again. I want to go out with my friends and club, and date and go to movies and concerts. I don’t want to be treated like Mrs. Rochester in the Attic.
Right now, as I write my libido is back for the first time since October. I am so horny I could fuck a doorknob. Hell, I probably have, in the search to get off by any means possible. My kingdom for a cucumber. But when I went to the store, I wasn’t in the mood for salad, instead I bought lovely blueberries, strawberries, oranges, and a new fruit I was just introduced to, a mango. Add cottage cheese and voila! Dinner!
A few nights ago there was a female cat outside my apartment, clearly in heat, meowing. “Oh baby girl”, I thought to myself, I too wish some boy cat would just flip me on the backside and get it over with. If I could meow like that I would join her.
My biggest problem with my wellness is thinking that all happy families are alike, and everyone is happy all the time. I know this is not true. Nothing in this world is an absolute, except maybe a brand of Vodka.
Normal people – I don’t understand them, yet I long to be one. It’s like high school where you look at the popular clique and long to fit in there. And you know you won’t. And maybe that is why, even though I admire those in the blogosphere who can use their real names without qualms, while I write under a fake name or my initials because I haven’t had the strength to further my recovery.
And the only way to erase the prejudices towards mental illness, is by doing that. In the 60s society had a revolution and racial and sexual barriers were broken. Maybe this is the decade to do the same for mental illnesses.
Maybe this essay is a baby step towards it. My baby step.
Or so says this Wall Street Journal article. And we're talking about chiropractic treatments, acupuncture, massage, naturopathy and so on. While I don't buy the reporter's assertion that there's been a culture-wide backlash against SSRIs and the like (sales have leveled off after years of spectacular growth), it's nice to see the paper pay attention to alternative treatments.
Interesting bits: The article asserts that 80 percent of anti-depressants are prescribed by primary care docs, which is just wacko.
And:
"Using herbal supplements with conventional medicine can be dangerous, psychiatrists say. 'There are always snake oil salesmen,' says Carolyn Rabinowitz, president of the American Psychiatric Association."
That's some brave talk coming from the head of the APA.
Someone over on a MySpace blog recounts the crushing fatigue they're running into on Cymbalta. Along with suicidality, it's one of the more prominent injuries--ooops, I mean side effects!--of the anti-depressant. Less well-known are other injuries such as liver damage.
I mentioned recently that there was some concern among Lilly reps that Cymbalta could wind up with a black box warning over liver damage. Last week, I ran into a musician I know, one of Seattle's rock royalty, at a supermarket. He'd had a lot of physical pain issues in recent years and a doc had put him on Cymbalta. Lame doctor.
Then, my friend suffered actual liver damage and immediately went off Cymbalta. Re-diagnosed as bipolar, he's now on Lithium, which is processed in the kidneys, and it is ripping up his stomach. I shook his hand and said, "Welcome to the party."
Before it's all over, I suspect that Cymbalta will turn out to be a disaster for patients on the order of Paxil. If anyone thinks I am kidding, go read the comments on this post from last year.
The following was sent to me by SS, a reader, who wanted me to post it. I'll let it speak for itself.
In the evening, the place I was in took a rhythm of it’s own. People fell asleep on chairs, and games of checkers and chess sat on the table, half played, like a lone sandwich sitting next to them.
It was nighttime. The patients had all been fed, and medicated, and were left in front of the TV while something as insipid as the Home Shopping Channel droned on providing white noise.
I had been in this locked ward for approx 20 days. My insurance, though I did not know it at the time, pooped out at 30.
And I hadn’t gotten better, I had gotten worse.
My doctor, who ran the hospital had unbeknownst to me called in my parents for a meeting, as well as the three doctors under him. All I knew was tonight I didn’t have my supper; instead one of the nurses helped me in the shower and bathed me because I was too catatonic to do so. She helped me get dressed and finally put on those slipper socks that all the inmates wear because our shoes had all been stripped of their laces.
She walked me out of the locked ward, stopping at the Christmas tree by the Nurses station in the main part, and let me touch an ornament. I smiled. We went into the doctor’s office and there was my mom, and dad sitting on a plushy bluish purple sofa, and three doctors I never saw before.
“Mr. and Mrs. S” went my doctor – “We’ve tried everything on your daughter but she is extremely depressed and still suicidal. We’ve tried several different drug therapies and nothing is working, and we are left with two things. She has ten days left on her insurance and if she is still like the way she is now, we will be forced to put her in a state hospital. Or we can try ECT”.
ECT was then explained to my parents, and they saw a video. And with the State’s leading expert on ECT who told them he would be personally administering it, papers were signed, I was convinced by mom and dad “ do this to make your mother happy”, and the next day woken up at 5 am to be driven to the local teaching hospital for my first round.
This isn’t the time or place to get into the fine details. Suffice it to say I was strapped down to a gurney and got poked prodded, IV’ed and what not. I saw monitors and a little contraption by my bedside that looked like R2D2. When the good doctor got to me, I had my treatment, later waking up and changing back to my street clothes and out of those hospital garbs that show your ass to the universe.
What was unusual was when they asked me who the President was; I thought it was Bill Clinton. But I got the other questions correct and maybe it’s a good thing to forget a few years of history.
But as the treatments went on, I noticed several things. I had a photographic memory prior. I could not recall huge events in my life. I would look at family pictures and know something happened but couldn’t recall it. Huge chunks of my adolescence and childhood went Poof! I also had the ability to recall in graphic detail every book I had ever read from “Green Eggs and Ham” to the last book I had been reading in the hospital which was of all weird things “ A Noonday Demon’. I had been a contestant on Jeopardy. Now I couldn’t even name the hosts name.
I couldn’t read anymore. I couldn’t even read a newspaper. I couldn’t watch TV. I forgot how to get to places I was driving to, even though I had been driving the same routes for years.
Now this may seem trivial. To some people, thinking the last president was Clinton could be a good thing. To some people forgetting horrible adolescence is a good thing.
But when you are a writer, someone who makes their LIVING out of writing, and cannot anymore its death.
Imagine you are an Olympic athlete or a pro ball player. You are injured to such an extent that you are living, but your career is gone. All you have, as a reminder that you were once one of the best in your field are medals, trophies, articles. But it’s all gone. This is your identity. Your whole life has been building up to this career, and it’s all gone, what do you do?
Coach. What do you do if your brain able to recall things well enough to teach/coach? You are a baseball player and you can’t explain to someone the difference between a ball and a bunt?
In other words, your body is living, breathing thing. Everything is working fine, your heart, your legs, and your eyes. But what about the brain? It’s like going into a house that has just been sold and is lying vacant while the new owners wait to get in. Functional but no one home.
ECT is one of those things, which seems to have its pros and cons, each group vocal. I mentioned to a friend today I was writing something about ECT and she acted like I was writing about clubbing baby seals.
I can tell you that the man who was next to me in all my treatments did fine. His memory loss was minimal. It helped him.
But I will also tell you that those of us who have had the bad experiences are afraid to or don’t know how to write or talk about their experience.
I tell people to please make sure about ECT- it’s a procedure. Know the pros and cons and don’t let a doctor coerce you into ANY procedure. Get a second opinion. Be informed. Ask to see the facility if possible, and talk to the nurses who will be assisting.
For me, it was a mistake. Most of my memory did come back 5 years later. I no longer act like a stroke victim where I cannot string two sentences together when I talk, and point to the TV when I mean the Fridge. I can read, and I can look now at my library and recall the majority of the books I have read, albeit not in such graphic detail, hut I will settle for that.
What I cannot settle for is it destroyed my writing career. My rasion d’etre. Everything I write now seems Sophomoric, and I struggle to do that. It’s like “Flowers For Algernon”, I have been a genius, and now I am sub standard. It pains me. It’s also humbled me.
I wrote earlier had I had a gun after my treatment ended, I would have eaten it. I still feel that way now. What holds me back is the hope that if it took 5 years for my memory to right itself. Maybe my writing will come back. But to go from writing at a degree of a Hemingway- to now where most days all I can write is “Pat the Bunny” has destroyed my heart and my soul.
A post I did on ECT earlier this week was seized upon by Crazy Tracy, who writes a pretty good blog. She offered a couple of thoughts:
"ECT saved my life. Period. Plain and simple. I can't say what it's done (or not done) for Furious Season, but it certainly has saved my ass."
Good for her. And:
"We are dangerously capricious by skipping by and pointing and singing-songing, "Look what happened to Ernest Hemingway!" when pointing out the dangers of ECT. Look what happened to Sylvia Plath. Look what happened to Virginia Woolfe. Plath had it but only once....and later gassed herself. Woolfe never had it and loaded her coat down with rocks and walked into a river and drowned herself."
For the record, I've never had ECT. A doctor discussed it with me once 12 years ago when I was getting nowhere with Prozac, Paxil and Zoloft. We were talking speculatively--what treatments would I try to replace the SSRIs. It was 1995 and I'd been on SSRIs for five years and had seen some initially decent results but, over the prior two years, their effect had washed out and the more disabling of the side effects had popped up. You know, like suicidality and extreme agitation.
"No way" was my answer to ECT. I'd already met a few people by then who'd had it and all of them had experienced very bad results. A 20-something musician I knew was completely unable to play guitar for months and was still depressed, for example. Since then, I've heard from scores of readers on ECT and only a few of them have anything positive to say about the procedure.
I know that's not science, but it is evidence--and I have long been leery of the alleged science cited in support of ECT. I think some ECT practitioners have been, over the course of time, proven to be frauds and sadists. Some are no doubt also angels. Someone who knows the facts, figures and so on better than I runs a website called ECT.org.
I also think we are being dangerously capricious if we don't understand the bad outcomes from ECT and let individual patients weigh the pros and cons and figure out what to do for themselves. For one patient or one doc to argue that their own experience was fine so no one needs to hear about bad outcomes because you'll do just as well as I is silly. And worse.
As for forced ECT--meaning without a patient's active consent, the state stepping in to assert its alleged right to force treatment--I am 100 percent against it. It is one of the grossest example of doctors and the state invading an individual's body and I am a Libertarian so I am against that shit.
But if people such as Tracy want to consent to the treatment, go right ahead. Here's a comment from one reader who had ECT but prefers to remain anonymous:
"ECT was the biggest mistake I made in my adult life."And it destroyed my writing career. I wish I had known about Hemingway before I was convinced to have it by a zealous shrink and a fantastic health insurance policy which covered everything including the shrinks frappicino's."
On Monday, I spoke with the Oregon State Attorney General's Office, asking if they had undertaken any actions against Eli Lilly over Zyprexa. To date, the state is not among the eight that have filed a lawsuit against the company regarding various allegations surrounding the drug. A spokeswoman told me that the AG's office had an "open investigation" regarding Lilly and Zyprexa. I asked for more information. Yesterday, I received the following message:
"We are part of the leadership states (Executive Committee) for a multi-state case concerning Eli Lilly and Zyprexa. We opened it January 4, 2007. Although Montana and a small group of other states filed a lawsuit in March by using private lawyers, we believe we have the expertise to handle the case in-house."
Multi-state case is lawyer talk for a class action lawsuit by states attorneys general, a la the tobacco lawsuit of the mid-1990s. That Oregon is among the lead states tells me quite a bit, as the AG's office there can be quite aggressive.
Stay tuned.
It is blazing hot in Seattle today as it will be the rest of the week plus I am up to my elbows in outside work the next couple of days, so posting will be a bit erratic. However, I pass along the following.
First, I am pleased to let you all know that a letter I submitted to the editor of the Journal of Clinical Psychopharmacology, which questioned some of the statistical methodology of last year's Seroquel BOLDER II study, has been accepted for publication in the journal. The BOLDER II study was one of two studies used to gain FDA approval for Seroquel for bipolar depression. Now, the study's authors will have to reply publicly to my query and, as a patient, that makes me feel good and bad all at once. After all, aren't mental health professionals supposed to be the ones publicly asking these sorts of questions?
Remember the crazy pizza bomber case in Pennsylvania in 2003? Allegedly, someone with bipolar disorder was behind it. I seriously doubt that bipolar disorder alone could even begin to get at the level of sadism involved in this crime. This was straight-up sociopathic behavior and that's not bipolar disorder.
Reason's Ronald Bailey on the pros and cons of how the FDA has managed the SSRI/black-box warning controversy.
A New York agency with a long track record of helping the disabled--including those with mental illnesses--get jobs. Good for them. Work is recovery.
CL Psych has quite a few thoughts on Aubrey Blumsohn's amazing work on the JAACP and the infamous Paxil Study 329. It is great that academics like them are trying to force journals to be accountable for the accuracy of the scientific representations made in their pages.
An item from PsychCentral last week--so I am late, late, late!--on how many schizophrenics ditch their meds after one year of treatment. Ninety percent. Yikes. This of course tells you a lot about problems with the meds and perhaps recognition issues with patients. I'll take this issue up again soon as it is horribly complicated.
Those of you who follow mental health news know that some psychiatrists have been pushing to re-popularize ECT and, in some cases, forced ECT. New York State is particularly aggressive on this front. For example, take the case of Simone D, whom Mindfreedom has started a campaign around. A state hospital patient in New York, the state recently won an appeals court decision allowing it to force her to endure another 30 rounds of ECT. Miss D would prefer not to be shocked.
Mindfreedom urges you to write to New York State officials. You can do so by following this link here.
In other shocking news, here's a Dutch doctor defending the use of ECT and a reporter who seems to have come under the doc's spell--not even offering any counter-evidence on ECT's use. The piece is filled with enough lies to make President Bush blush.
Readers of this blog know that I am passionately against the use of forced ECT. It's torture upon innocent people, plain and simple. As for voluntary ECT, it's your brain. Go ahead have a nice day.
But keep in mind what Ernest Hemingway said of ECT: "It put me out of business."
The lede says it all in this Australian article:
"Hundreds of Australians have died and thousands more suffered gruesome side effects after taking anti-psychotic medications, official figures have revealed."Data from the nation's drug watchdog the Therapeutic Goods Administration shows 9532 adverse reports involving anti-psychotics in the past 15 years, including 399 deaths."
It's discouraging to see that patients Down Under are running into the same sorts of problems that we are in this country and elsewhere. Many of these cases involve patients with schizophrenia and bipolar disorder. Almost 400 of the adverse reports involve children.
And there's bad news in the piece for Eli Lilly, which faces lawsuits over its handling of Zyprexa in Australia.
"'We are now in the double figures with clients from Zyprexa and we are seeing a number of alleged problems,' lawyer Simon Harrison told The Daily Telegraph."'The problems vary from inadequate policing of the medication to the alleged side effects of the medication not being conveyed,' he said."
I'm no expert on the Australian legal system, but it wouldn't shock me if Lilly isn't soon looking at a class action lawsuit over there.
Add these kinds of figures to the tens of thousands of similar adverse events--I simply call them injuries--in the US, and you have to wonder why thought leaders in the psych profession aren't asking some very sharp questions about the logic of using these drugs long-term much less short-term.
Nobel Laureate John Nash is the world's most famous schizophrenic, primarily owing to the biopic A Beautiful Mind. Nash rarely speaks about his experiences although he has given public speeches a few times in recent years including this one at the APA's annual convention. I cannot even think of when the APA has ever before had a patient give a keynote address. There's an account of it here.
I find it difficult to imagine that the above article--which quotes Nash talking about how schizophrenia and other mental illnesses must have an evolutionary purpose of some kind--fully captures what Nash said. But I have been unable to find a complete transcript of his speech.
I'm a bit puzzled that world's most famous schizophrenic would have no public comments about the awful state faced by his fellow patients and that he wouldn't seek to end the small controversy around whether meds saved him or whether he saved himself or whether it was a combination of the two forces. He must know by now that the public in interested in knowing that answer.
All the same, it's great to see Nash getting some credit within the psych world. He deserves it.
I haven't been able to do one of these roundup posts in a while, primarily because of all the outside work I've been doing. Not that there aren't tons of things to link to.
For example, CL Psych goes ripshit on Drug Wonks' attack on Danny Carlat--all over whom Carlat chooses to link to on his blog. My policy here is that I link to most everyone pro or con on mental health issues with the possible exception of CCHR. Why doesn't Drug Wonks, if they truly believe in their free market arguments?
I've been impressed recently with Psych Watch, whereon an anonymous poster named Sickmind Fraud reposts or summarizes items of interest from the media. Here he has a great item on just how much antipsychotics are being used in the Vermont prison system. Answer: a helluva lot.
Stephany at Soulful Sepulcher has been documenting the Harvard bipolar child mafia's expansion of bipolar disorder in children over the last decade.
Liz Spikol beat me to this: Fox News propagating the cat shit causes schizophrenia theory anew.
My favorite Big Pharma sycophant, Drug Wonks, has a bizarre post on the recent Group Health study on depression treatment. He concludes that those who criticize pharma companies and corporate control of the mental health system are scaring people to death. My bit: I am fine with corporations as long as they don't cook research or lie about injuries caused by their drugs. When they become good actors, then I'll shut up. Because a free market of ideas is as important as a free market for commerce. Right, Drug Wonks?
AHRP on a recent FDA letter (unearthed by Bloomberg News) in which the FDA notes:
"We are concerned that the proposed labeling [for Symbyax] is deficient with regard to information about weight gain" and high levels of sugar and fat in the blood of patients who took the drug, the FDA said in the letter. "We do not feel that current labeling for either Symbyax or Zyprexa provides sufficient information on these risks."
Take that Drug Wonks.
Pharmalot has this classic item on pharma companies crying that payments by the British government, which encourage docs to prescribe generics, shouldn't be allowed because they influence prescribing. As Ed dryly notes:
"This is truly a switch: a pharma trade group saying docs should prescribe meds free from the influence of money and other incentives. Hmm…. That’s a remarkable statement. Do you think that should apply to brand-name meds, too? Or is this new insight merely a convenient legal strategy?"
Hehe.
A blogger who's generally OK with pharma-connected marketing of disorders sort of finds it troubling after all.
Vaughan at Mind Hacks has an excellent discussion of recent research pinning rates of schizophrenia and locale in South East London. Aside from all the other factors the study identifies as driving rates of psychosis, I think increased urbanization in this world of ours has profound effects on peoples' mental health. In a bad way. I cannot prove that in a scientific way--cuz I'm like not a scientist--but consider: About half of the world's population now lives in cities, really big cities, and that represents a rough doubling of urban population rates in a couple of generations. Is that connected with increased prevalence of depression, say? I bet it is.
The questions around schizophrenia are much more complex, of course.
On another front, a new paper in AJP reports a genetic susceptibility to postpartum psychosis among women with bipolar disorder. Or puerperal psychosis as the docs call it. Apparently, one in three bipolar women experience psychosis after giving birth. I've not heard the prevalence put that high before, but wow all the same. Something tells me that docs won't be slamming bp moms-to-be with Zyprexa or Seroquel as a fix. I also hope folks like those at certain advocacy groups won't use this prevalence estimate to insist that women with bipolar disorder undergo forced medication and forced sterilization.
According to Lawyersandseattlements.com, AstraZeneca could be facing upwards of $10 billion in payouts over lawsuits related to Seroquel, the company's atypical antipsychotic. I'm not sure that I buy the amount--Lilly, after all, has paid out about $1.3 billion over Zyprexa, an amount I expect to see grow--but it's clear to me that AZ will likely end up settling some lawsuits over its handling of the drug. Stay tuned.
Hope all of you in the States had a nice 4th. It was strangely sunny in Seattle--it usually isn't on the 4th.
Inevitably, we all had better days than did many civilians who've been over in Iraq--working alongside regular Army and National Guardsmen and doing many of the same jobs (an interesting tale in itself from what I hear). They are also washing up with a host of mental health problems upon their return to the States. Unlike other vets, they don't have an inadequate military/VA mental health system to turn to for help. Instead, they have to poke around for themselves in the inadequate private sector, where most mental health workers don't have any expertise in treating combat-related problems. Fabulous.
The New York Times has a fine, discouraging article on the phenomenon.
I want to caution that the following information is secondhand in the press accounts I've read. That said, WWE wrestler Chris Benoit may have been prescribed Zoloft a few days before he murdered his wife and child and then hanged himself on June 23. As I opined last week, for a successful young man to do such a crime, then something other than your typical family meltdown murder-suicide dynamic—already crazy enough of course—had to be at work.
Let's be clear that the guy was also being given steroids and I'm enough of a believer in some of these roid rage cases to where I'd be uncomfortable saying merely that "the Zoloft did it." Cable news is, predictably, all over this story. We'll know a lot more once the results of toxicology tests come in.
Turns out that getting treatment--meds, psychotherapy or both--works to eliminate suicide attempts soon after a patient begins treatment. Culled from 100,000 or so patient records by Seattle's own Group Health Cooperative, the resultant paper is not yet available on the APA's website. But in a press release, GHC's Greg Simon notes:
“Our study indicates that there’s nothing specific to antidepressant medications that would either make large populations of people with depression start trying to kill themselves—or protect them from suicidal thoughts,” said Dr. Simon. “Instead, we think that, on average, starting any type of treatment—-medication, psychotherapy, or both-—helps most people of any age have fewer symptoms of depression, including thinking about suicide and attempting it.” That said, he likened population-based studies—both observational studies such as this one and randomized controlled trials of medications—to “circumstantial evidence” about what happens to individual patients.
It's not clear whether meds-alone or therapy-alone was better than the other. Nor does the study really prove the release's PR claim that it's shedding new light on the SSRI black boxes. But the results fit my contention that treatment of any kind for depression can have positive effects--not so much because of the meds or therapy involved but because there is a kind of nurturing in medical care and patient self-care that in its initial phases is powerful.
It'd be interesting to see what results GHC--who is very handy with the numbers--would get from a study of suicide completers who were in their system and what treatment modalities they'd been using.
I'm thoroughly blessed to have readers who leave fabulous comments, often saying things I don't dare. Here are two recent examples.
One reader apparently wrote the fine folks at the Treatment Advocacy Center after that political action group's attack on the anti-psychiatry crowd:
"No reply from Torrey & Co. so I tried again...."'I have been diagnosed with bipolar disorder. I disagree with that diagnosis and, consequently, I don't take medication for it. According to your blog, you would conclude that I must therefore be suffering from 'anosognosia' or 'lack of insight.'
"My question to you is this: What if I was, in fact, misdiagnosed? Would you still contend that my refusal to accept that misdiagnosis is itself another psychiatric condition? Are there pills for anosognosia?
"As I'm sure you are aware, a psychiatric label has profound consequences on a person's life. What safeguard do you have in place to protect the wrongly diagnosed?
"Please let me know."
I'm fascinated by the bad diagnosis syndrome because I have encountered enough people over the years who were clearly misdiagnosed yet were tossed into psych hospitals, slammed with meds and held even longer when they told docs there was nothing wrong with them. I'd love to hear from more people who've had this unfortunate experience.
And in response to my recent post in which I wrote that men do a rotten job of maintaining their psychological well-being:
"It's just because men have no place in modern society. Women don't need men anymore, and even the ones that do are calling the shots. We're creatures of control and we're losing our hold on that control more and more. Don't get me wrong, I'm not saying it's wrong or bad or that something should be done. There's not much TO be done about it. Women are better and we all know it."
As I've noted before, men's traditional roles have shifted incredibly fast over the last 30 years to ill-defined positions of half-power. That's bad and good. But what interests me the most is that women just don't seem to need men as they once did--have you seen the numbers of single moms out there?--and men don't seem to need women as much either. We are in a post-family, post-relationship world and, while I cannot argue that the classical man-woman model was particularly successful, I am not sure where this brave new world is taking us. But it sure is interesting.
Yesterday, a couple of hours before the Seattle Mariners took the field against the Toronto Blue Jays, the Mariners' manager Mike Hargrove resigned effective at game's end. The M's are enjoying a renaissance currently. AFter four years in the cellar of the AL's Western Division, they are in second place, 12 games above .500 and are in a good postion to contend with the Angels for the division crown (despite the M's spotty pitching) or the lone wild card playoff berth.
No one ever resigns under such circumstances absent a dustup with the owner--not here--or a health problem with themselves or in their family. You always want to see if your team can make the World Series or win the league pennant. That's sports.
But there you have it. Hargrove resigned, saying he didn't understand his own move but offering that he has lost his ability to give the same 100 percent he asked his own players to give. The M's won the game, comepleting a three-game sweep of the Jays which comes on the heels of a three-game sweep of the Red Sox.
This is the weirdest thing I have ever witnessed in a lifetime of following sports. OK, it's the weirdest non-Yankees related incident.
So I wonder what was really at work psychologically for Grover. Speculate away.