Washoe, the world's most important chimpanzee and the first non-human to acquire sign language, died on Tuesday in Ellensburg, Wash. aged 42. That's almost youthful by chimp standards in captivity. Washoe was proof, argued some, that chimps could reason, think and communicate much the same as humans. Fascinating creature.
Bob Burnett at The Smirking Chimp offered a fascinating take on depression and the American malaise yesterday. For those readers who don't follow the political blogosphere, The Smirking Chimp is one of the primary lefty blogs out there, dedicated to banging on the GOP and President Bush. Apparently, depression in America can be traced to the man in the White House.
Burnett puts it thus:
"The depression epidemic explains why Americans have been so passive in the face of the continuing outrages of the Bush Administration: It's the reason why our fellow citizens didn't protest the stolen election of 2000; or the invasion of Iraq; or Bush's subversion of the constitution - to name only three misdeeds."
Americans didn't protest the 2000 election and the Iraq invasion? That's news to me. For Burnett, it's part of a post-60s historical arc:
"[W]e became a nation of depressives. It's not only that one in four of us has a diagnosed mental disorder, but also that millions of Americans self medicate: we take prescription drugs for depression - antidepressants are now the most frequently prescribed drugs -- or use daily palliatives such as alcohol or marijuana. There are millions more who suffer from the symptoms of depression - chronic anxiety or fatigue, eating disorders, or irritability - and never seek help, who stagger through each day in a funk. And there are millions of Americans who feel chronic helplessness in the face of an Administration that doesn't listen to the cries of the average person and seems determined to implement their evil agenda regardless of the consequences."
Um, maybe I'm a bit young to remember the 60s, but weren't lots of folks drinking booze, smoking weed, taking pills and Mother's little helpers back then? I just don't think you can prove that Americans feel any more or less crappy about themselves now than in some other epoch, regardless of whether the Ds or Rs were in charge.
But there's hope on the horizon:
"The next President must preach a message of hope and invite us to make a shared sacrifice for the good of the country. And, to help cure our national depression."
So does this mean a vote for Hillary will make you feel like you just took some Ecstasy? Or will voting for Mitt cure one's foul moods? I have a hunch that our next President will be as big a downer as the current one, but perhaps in different ways. No matter what, the pharma companies will do just fine, I predict.
Election Day is only a year off, so stay tuned.
Two psychologists offered responses to yesterday's posting and commentary on Bruce Levine's bashing of the psychiatric profession.
First up is John Grohol of Psych Central.
"I feel profession bashing is too easy to do, and you have to take as good as you give. For instance, psychologists shouldn’t be proud of their own professional association’s tortured stance on, well, torture, flip-flopping like a fish out of water over the past year. Which has been heatedly opposed by many of its own members (resulting in Sharon Brehm’s (PDF) and Beth Shinn’s resignations, among many others)."Nor should they be proud of their continued push away from their roots in psychology and behavior to wanting to prescribe all those wonderful psychiatric medications. The same medications Bruce Levine says has corrupted the field of psychiatry.
"I hope he and other psychologists see the irony here, because we, as a profession, are sadly doomed to repeat the mistakes of other professions if we learn nothing from them."
Those are fabulous points. Like John, I am fairly dubious of psychologists and therapists prescribing meds. I'm sure they'd do no worse than psychiatrists and PCPs already are--and that's just the problem.
And Cheryl Fuller, who writes the excellent Jung At Heart blog (one of the best blog names ever) offered this in comments on this site:
"Levine's critique is good as far as it goes, but he seems to overlook some of the pressures within psychiatry to move so dramatically to a biological model. Surely the fact that they lost exclusive control over the therapy field as other disciplines such as psychology, social work, counseling and nursing developed license-eligible clinical training programs is a piece of it. Plus psychiatrists have been on the low end incomes for physicians. Other physicians have often viewed them as not "real" doctors. Likely these pressures laid the groundwork that Big Pharma has been so able to build on."And sadly, we psychologists are not innocents in all of this either. In our haste to make ourselves "scientists" we have become captive to outcomes studies, neuroscience and the like just as much as psychiatrists have been -- there's just not as much money in it for us as for them."
Great points by both, for which I thank them.
Thats a claim being made by researchers at the Buck Institute. A press release states: "Nematode worms treated with lithium show a 46 percent increase in lifespan, raising the tantalizing question of whether humans taking the mood affecting drug are also taking an anti-aging medication."
That kind of makes me wonder if nematodes--c. elegans in formal parlance--have anything resembling kidneys in their simple bodies. God knows, long term Lithium use isn't especially friendly to human kidneys. Does anyone know what the scientific evidence is--or isn't--on how Lithium affects lifespans in humans?
All the same, an interesting and suggestive study. Perhaps, the researchers will next try some Zyprexa on those little worms. Anyone want to bet we don't end up seeing an "Olanzapine extends life" press release as a result?
Kerry Katona, a star of some type in the UK, claims that some odd behavior on her part on TV a few weeks ago--slurring words for example--was related to her use of the anti-depressant Effexor. She takes it for bipolar disorder. Do the Effexor horror stories ever end?
Also, why is a bipolar taking an anti-depressant alone--much less an anti-depressant at all, given all the recent STEP-BD findings that anti-depressants aren't efficacious for the disorder? Some good doctoring going on there!
OK, I simply must find something nice to say about anti-depressants. Anyone have any suggestions?
I don't really know how to explain this piece in today's New York Times, except that it involves a scientist who suffered from major depression who got no relief from meds or therapy, underwent ECT, and, then, learned that her depression was connected with a physical ailment--a thyroid condition. Fascinating piece.
Bruce Levine, a clinical psychologist and author, has been hammering away at psychiatry and some of its central tenets on The Huffington Post of late.
Earlier this month, he went after the dubious SSRIs and suicide study from the September American Journal of Psychiatry. He properly credits the New York Times and others in the mainstream media for busting the AJP, but fails to note the noise on the 'Net that erupted right after that study came out.
Anyhow, then Levine goes after the serotonin-causes-depression, which he sees as one of the chief evils of our time (you expected different from a psychologist?) and how it works to the advantage of some powerful folks:
" While all personal-defect explanations for despair distract the depressed from considering how the structure of society may be contributing to their malaise, biochemical-defect explanations have the added benefit of creating a boatload of easy profits for drug companies. And biochemical-defect explanations are also quite useful for authoritarians who prefer that people look up to authorities-- in this case, to biotech corporations and drug-prescribers-- for solutions to their problems, rather than looking toward themselves, their family, friends, and community."
Levine's new book, Surviving America's Depression Epidemic: How to Find Morale, Energy, and Community in a World Gone Crazy, likely offers an interesting critique of how to address depression in our society to judge by:
"While researchers have not found depression to be associated with any kind of biochemical marker, they have found it to be associated with several variables that we as a society actually can do something about."In 2000, sociologist Robert Putnam reported: 'Low levels of social support directly predict depression.' Several studies show that people who have close friends, friendly neighbors, and supportive coworkers are less likely to experience symptoms of depression. In 2004, BMJ (formerly known as the British Medical Journal) reported that postpartum depression occurs in 10 to 20 percent of women in the United Kingdom and the United States but is considered rare in societies such as Fiji and many African populations. BMJ concluded, 'Structured social supports after childbirth are described in groups of women with low rates of postpartum depression.'"
And so on.
Levine's central thrust is about dishonesty in the psych world, particularly on the part of the American Psychiatric Association and pharma companies. For example, this from yesterday:
"When the serotonin-enhancer Prozac first hit the market in the late 1980s, Americans heard from the APA and psychiatry officialdom that depression is caused by a deficiency of serotonin. There was no proof of this, and by the mid-1990s the serotonin-deficiency theory of depression had been scientifically tested and rejected. But antidepressant manufactures knew that more people would take Prozac, Paxil, Zoloft and other antidepressants if they believed these drugs worked by correcting a deficiency (analogous to insulin) rather than by "taking the edge off" (analogous to alcohol and illegal drugs). So drug companies and their partners in psychiatry kept quiet. Psychiatry also kept quiet about antidepressant tolerance (the need for an increasingly higher dosage), dependency, and nightmarish withdrawal--all of which was well-known in the scientific community several years before word got out to the general public."
Levine is dead right about this, and as I have noted recently even thought leaders in the psych world are backing off claims they've made about depression for the last 20 to 30 years. And, no, I am not being hyperbolic. There's a shift going on out there that I don't have a name for yet.
I find it curious that Levine isn't pounding on the atypicals. Based upon deaths and injuries caused, the atypicals may be worse than anti-depressants. But that's nitpicking.
"In the past, those who have confronted Big Pharma's corruption of psychiatry have been accused by psychiatry apologists of belittling emotional suffering. But Americans increasingly understand that such smearing is as ridiculous as accusing critics of the Bush administration's invasion and occupation of Iraq of disloyalty to American soldiers."
Yeah, that about captures it.
Yesterday was a record day for hits on this site, for which I thank all of you. I'm not sure what to attribute all these hits to since I'm not getting linked anywhere out of the ordinary and there's no earth-shattering news events in the mental health world. Still, I expect to reach and slightly surpass 16,000 hits for the month of October, roughly double August's hits.
Thanks. I am very gratified.
On the update front, I am pleased to announce that I will be delivering a guest lecture at the New College of Florida in Sarasota, Fla. on November 27. I'll have more details on this later.
On another front, posting will be fairly light after tomorrow as I will be out of town for a job interview at the end of the week.
That's the view of Alicia Sparks, a blogger in West Virginia and a leader of the local NAMI affiliate, who has run into horrible problems trying to come off Cymbalta. She's written about it all quite well. I feel for her, since it's clear Cymbalta is turning out to be a very dicey drug that is also heavily-advertised. Lilly spent almost $700 million in ads on the anti-depressant in 2006.
Of course, I've been posting on this drug--which I've never taken--for about 18 months (here's a collection of Cymbalta posts), after stories began trickling forth from the patient world about the drug and especially reports of suicides and suicidal ideation linked to the drug. I wonder when the mainstream media will begin to pay attention to reported problems with this drug, because a drug that ought to generate about $2 billion in sales this year (its third full year on the market) that is having such problems is news in and of itself.
Johnson & Johnson today announced it's filed a new drug application with the FDA for an injectable form of Invega called paliperidone palmitate. I assume it might be renamed Indabutt, if approved. The drug is a riff on Invega, itself a riff on Risperdal, an antypical antipsychotic that has caught the attention of a new anonymous blogger who's begun a blog called Atypical Antipsychotics. The blog appears to be written by someone with much knowledge of the pharma world. Should be interesting. (Via CL Psych.)
Over the weekend, a few people had suggestions for what med they thought Owen WIlson was taking when he was interviewed recently on MySpace. If you want to watch the video again, in which Wilson looks pretty drowsy, go here. And then take the poll below.
Writing in response to a recent Florida newspaper article, which effectively linked Effexor to the suicide of a promising artist, Angela Vickers, an attorney and advocate for the mentally ill, offers this:
"The harsher tragedy is that both of these common mental illnesses have an 80 percent to 90 percent recovery rate when the patient is promptly and properly diagnosed and properly treated. Medication brings recovery."
Eighty percent to 90 percent recovery rate? Say what? Even pharma companies don't make that claim. In fact, an NIMH report put it like this a few years ago:
"Even when they do receive treatment, only slightly more than half of all of them respond well to therapy, defined as experiencing a 50 percent or greater reduction from baseline symptom severity. If complete symptom remission or restoration of function is the outcome, then the proportion is even lower."
Yep. Sure sounds like 90 percent to me.
By now you are most probably aware that a study came out last week showing that a synthesized version of cannabis--which is to say, one of marijuana's core molecules--was found to be have an anti-depressant effect in lab rats at low doses. At high doses, the reverse was true. No idea how all of that correlates to real world marijuana (and the study was done by Canadian researchers), but it's at least suggestive of what I've been saying for a long time--that pot seems to have some anti-depressant effects. Given how well the legal anti-depressants are working out, this country would be wise to spend some research dollars on investigating all of this. Not that it will ever happen in a formal way in the US, at least not soon.
For the inevitable newbie reader who wants to inform me that pot causes schizophrenia and ask me who do I think I am saying we ought to research pot's potentially beneficial effects, please note that the pot-causes-schizophrenia link is fairly weak (obviously there are known cases) and hardly what you might call proof of a 1:1 association. And if you still want to get wound up about psychosis-causing agents, then go after alcohol.
Or at least that's the contention of some Wilson fans who've emailed me to say he looks nice and doped on meds in his recent MySpace interview with Wes Anderson. You watch, you decide.
Artist on Artist: Owen Wilson and Wes Anderson
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How I missed this story earlier is beyond me, but thanks to Liz Spikol for highlighting this outrageous situation with immigration detainees in Southern California. Seems that the wonderful folks at ICE are jabbing some detainees with drugs like Haldol, even though the detainees are not diagnosed with schizophrenia, in order to make the more troublesome of them nice and compliant for their deportation flights. This is beyond unethical, given the dangers with these drugs, and I'm glad to see that the ACLU is going into court on their behalf. The Los Angeles Times has much more on this.
Well, those annoying TV ads must be paying off. Yesterday, Bristol MyersSquibb, makers of Abilify, announced third quarter sales of the drug hit $420 million, a 34 percent increase over the same quarter of 2006.
I continue to be stunned by the sales growth of Abilify and the other atypicals. These are known to be dangerous drugs with limited efficacy and yet America is popping them like candy. Or maybe I just don't get something about American culture these days.
I cringed when i read about this story two years ago: Jeanette Sliwinski, apparently in the act of trying to commit suicide, crashed her car into another car containing three men and killed the men. She's charged with murder and her trial is underway. This happened near Chicago.
What came out in trial the other day was this:
"In the weeks before Jeanette Sliwinski drove her car into another vehicle -- killing three men on a Skokie street -- her psychiatrist committed a series of errors, possibly worsening Sliwinski's acute mental illness, a doctor testified Tuesday."
Errors by a psychiatrist? Oh my.
"Two psychiatrists testified Tuesday: Dr. Lucyna Puszkarska, who treated Sliwinski beginning in May 2005, and Dr. Lisa Rone, hired by defense lawyers after the crash."She never got appropriate treatment. She never got stabilized," Rone testified.
"According to Rone, Sliwinski suffered from "severe" bipolar disorder and "was in a manic psychosis" the day of the crash. Puszkarska testified she diagnosed Sliwinski with attention deficit-hyperactivity disorder, major depression and anxiety.
"Puszkarska prescribed Adderall, a stimulant, for Sliwinski's ADHD. But when taken by a bipolar patient, Adderral can make their manic symptoms worse, according to Rone.
"They can be off to the races at that point," she said."
No kidding.
Apparently the woman was on as many as five meds at the time. Further proof, sadly, that polypharmacy is very dangerous. Why do doctors continue to send people home with multiple Rxs when they know how unpredictable the results can be? And giving stimulants to a bipolar? That's malpractice.
It'll be interesting to see what a jury makes of this case. A doctor testifying for the prosecution claims that the woman was not psychotic. Personally, I think the prosecutors may have the wrong person on trial.
OK, this is so classic, I'll just quote the first few grafs of the New York Times article and let you read the rest.
"The two prominent psychiatrists clashed frequently over small details and big money, over research priorities and ethics, and in the end Columbia University’s child psychiatry department was not big enough to hold both of them, colleagues said."Now, one psychiatrist is suing the university for wrongful termination and charging that the other engineered his ouster in a Machiavellian plot that went on for years.
"In the suit, filed last week in State Supreme Court in Manhattan, Dr. Peter Jensen, formerly the director of the Ruane Center for the Advancement of Children’s Mental Health at Columbia, contends that after he was hired by the university in 1999, Dr. David Shaffer, director of the university’s child psychiatry division, continually undermined his work. By making derogatory comments and subjecting Dr. Jensen’s work to unfair scrutiny, the lawsuit says, Dr. Shaffer helped force Dr. Jensen out of his job.
"Dr. Jensen — who said that, among other things, Dr. Shaffer had called him “the Brad Pitt of psychiatry” — is seeking about $15 million in damages from the university."
Absolutely wonderful. And these are the babies who are putting together the new DSM and reshaping child psychiatry?
BTW, Shaffer is the head of the famous, or infamous, TeenScreen project.
Here's the now-infamous Pharmed Out video of former Eli Lilly sales rep Shahram Ahari explaining how he was told to shade the truth about problems with Zyprexa. Fascinating entre into the dark side of Big Pharma. (Via Kmarek.) I'm getting it onto my site now for archival purposes.
I've been tracking that Abilify TV ad lately, and all of a sudden there is a new entrant in the antipsychotic ads derby: Geodon, Pfizer's atypical antipsychotic. I ran across a Flash ad for it on HealthCentral.com, where a self-congratulatory blogger blogs about bipolar disorder.
The ad can be viewed here (if it's still active) or the basic imagery can be seen here on Pfizer's site. Yep, a woman in yoga top on a yoga mat. She's seated atop a boulder and stares out at the sun.
The ad copy I saw noted that Geodon is for mixed moods and scrolled symptoms such as "irritability" past my eyes. What's a mixed epsiode like the ad asks? "Happy, sad, hyper, lethargic." In other words, this is total bipolar disorder 2 country--dubbed mixed episode here--and you can "discover what's possible with Geodon." I tried Geodon for a few weeks once. What was possible? A complete inability to sleep, and akathesia. I lost weight though which was nice for a change from a psych med. Anyone I've spoken with about this drug has had decidedly mixed experiences, but sure hasn't seen much of a calming Yoga feeling from it. The idea of meditating on this drug is hilarious.
Thirty years ago, these same symptoms wouldn't be dubbed bipolar and would've been treated with Valium and the like. That didn't work out too well, of course, but I am not convinced that America's love affair with antipsychotics is working any better. Keep in mind Geodon carries two black box warnings.
Between Abilify and Geodon, the pharma companies are really targeting women with the new mood marketing. Irritable and depressed? We'll get you back to the Yoga studio soon. Please. Pfizer and BMS, Abilify's maker, are praying on every woman's perceived weaknesses and insecurities like a pick up artist at a bar.
Marketing like this makes me want to barf.
I wonder how female readers feel about this ad and about being in the cross hairs of all this new bipolar "awareness" in ways that men aren't (even though the gender split on the disorder is 50/50). So tell me.
And speaking of weird, check this quote from that blogger from that same page: "We may be the ones with mental illness, but our families are the ones who suffer from it."
Breathtaking. Written like someone who has never had a med--such as an antipsychotic--go bad on him. Get back to me on that suffering, John.
Recently, I've run into a string of fellow bipolars who are winding up on four and five medications at a time. Two mood stabilizers plus two antipsychotics plus an anti-depressant or two plus a benzo or maybe some Lunesta. I've even run into people on three antipsychotics when they've not had a genuine psychotic episode in their lives. It's like docs have lost their minds--someone is supposed to live and thrive on these things long-term how exactly?
I usually suggest to these folks--at least when they complain of getting poor results--that they ought to really get a second opinion from a different doctor, preferably one working independently of doc A. It may or may not help you, but it likely won't worsen your situation--and you could just end up on fewer meds and doing much better. This seems to work for depressives and people with anxiety as well. Not so clear what kind of results schizophrenics might see.
The sad thing is that anytime I've made the suggestion I've been met with blank stares. Yes, people, you really can go to a different doctor--and you can do it without your current doctor's permission.
Just an idea.
I've been catching stray references to allegations of Zyprexa-induced suicides. I already know that there are similar accusations involving Seroquel, an atypical antipsychotic, but was less clear about Zyprexa. Some of the problem with Zyprexa seems to stem from its use not in schizophrenia, but in off-label treatment:
"A major problem with Zyprexa is that it is often prescribed for conditions for which it was never approved. One woman notes that her husband committed suicide after taking Zyprexa, despite never being diagnosed with bipolar disorder or any other long-term mental illness. She writes that he was only diagnosed with depression and anxiety but was still given Zyprexa."
And:
"At least one doctor, Dr. David Healy, is concerned about the risk of suicide in patients taking Zyprexa. He has gone on record as saying that Zyprexa has the highest suicide rate of any antipsychotic in clinical history. The research he based his claim on involved five pre-marketing clinical trials conducted by Lilly. In the trials 12 patients taking Zyprexa committed suicide. However, information on how many unsuccessful suicide attempts occurred during the trials is not known."
As Healy noted in 2002 (via AHRP):
"At much the same time Lilly began studies on Zyprexa in children. There are parallel problems to Pfizer's studies. The studies in adults with Zyprexa that Lilly submitted to the FDA demonstrate, as far as I can establish, a higher death rate on Zyprexa than on any other anti-psychotic ever recorded. In addition to this Lilly have suppressed data on suicidal acts on Zyprexa from these trials. The data are not available in the scientific literature, nor from FOI requests to the FDA, nor from enquiries to the company."Despite this Lilly are engaged in trials with this agent in children. These trials will underpin vigorous company promotion for this drug in a wide swathe of children with hyperactivity, neurosis, bipolar and psychotic disorders - they won't enable clinicians to use the drug if needed."
Here's one study sponsored by NIMH of Zyprexa used long-term in kiddos. Kids as young as 3-years-old may enroll.
The question of medication-induced akathesia (aka extreme internal agitation) has long been a dirty little secret of anti-depressant treatment, and has led to hundreds of suicides and likely thousands of more cases of suicide attempts and suicidal ideation. Why shouldn't the atypicals get in on the fun?
If anyone thinks this is wild speculation, consider a schizophrenic friend of mine who recently made a med switch to the new atypical Invega ("Son of Risperdal") and was also taking Lexapro. This person ended up so wound up on the Invega/Lexapro combo that they wound up fully manic, a new experience for this particular person with schizophrenia.
I know many in the mental health advocacy world and mental health blogging world don't like it when people like me point out this sort of information, but these are powerful drugs and the public has aright to know what's going on, so they can make their own decisions.
MSN Health/MSNBC.com had an interesting feature concerning the current generation of children, who seem to have more illnesses than any other batch of kids in human history.
"More kids are getting diagnosed with bipolar, ADHD, allergies, and asthma in this decade than in previous decades. Some attribute this increase to improved diagnosing, others to over-diagnosing. Still others view the sick-kid trend as the proverbial canary in the coalmine: More children are getting sick because they are fragile and affected by an increasingly industrialized world."
Diagnosis of bipolar disorder in children is up 4,000 percent, ADHD is up 400 percent and it seems like every third kid has a food allergy of some kind or is wandering around school with an inhaler (depending on the school).
The article makes a game attempt at explaining what's going on--toxins, industrial society, etc.--but when it comes to mental disorder I'm afraid we are talking over-diagnosis. One huge slip up is when the writer quotes a psych doc stating:
"The study of serious mental illness in children and adolescence is more recent. 'Twenty-five years ago people would even debate whether the diagnosis [for bipolar disorder in children] existed,' [Gonzalo] Laje says. 'Symptoms of serious mental illness in children and adolescents are now recognized. Today nobody argues that this diagnosis exists.'"
That's a lie. Laje is a psych researcher at NIMH and he'd have to be ignorant to not know what's up in his own field. There is much debate within the psych world as to whether bipolar disorder exists in children and, if it does, to what extent it exists. I find it ironic that the writer din't even challenge the notion since MSN/MSNBC.com is located about 10 miles from Children's Hospital in Seattle where John McClellan, a child psychiatrist and UW prof, has emerged as one of the leading critics of the bipolar child paradigm.
Perhaps they need to make more use of the MSN search engine over in Redmond.
Only The Onion can get away with stuff like this: a TV panel discusses whether the government is doing enough to spy on paranoid schizophrenics. I turn you now to The Onion's "In The Know," the finest news analysis program on the 'Net.
In The Know: Is The Government Spying On Paranoid Schizophrenics Enough?
Two interesting and discouraging articles about depression and depression treatment in the media today.
In the first, a Florida artist has a doc put him on Effexor after years of grappling with depression and seeing limited results from Zoloft and Lamictal. The Effexor completely screwed him up, and he goes off the med and soon after kills himself. His grieving widow is particularly critical of Effexor. Joseph Glenmullen, a Harvard psych doc, says, "I won't start anybody on Effexor....It's a very nasty drug. It's by far the worst of the antidepressants."
It's nasty, but I'm not sure that it's the worst of the anti-depressants. Wouldn't that be Paxil? Anyone have any Effexor stories to share?
Good work by the reporter, for what my opinion is worth. Only a few years ago, the media would blow off such stories as not worth doing. Now, they are doing them. I wonder what changed.
Second, a review of a documentary looking at the aftermath of Japan's sudden adoption of anti-depressants and depression awareness in the early years of this decade. Short story: Japanese being treated for depression with anti-depressants are still depressed. The reviewer doesn't care for the documentary very much either.
Why is it that 20 years after the introduction of Prozac we are still at the fingerpainting stage in treating depression? Why do we spend so much money and time on treatments that have very unpredictable results?
So I was talking to a friend of mine on the phone in between the sixth and seventh innings of Sunday's Redsox-Indians ALCS game seven. On comes the Abilify for bipolar disorder TV ad which I've written about previously. It looked to be an ad that was shown nationally, as opposed to being something my local cable system (Comcast) was running in the Seattle market. The ad also included a budge for viewers to go to abilifyinfo.com. I also understand others have seen the ad pointing people to bipolaroptions.com.
The ad is clearly targeting women for the drug, but you've got to wonder why it would air during prime time and during a decisive baseball game, when I assume the audience would skew heavily male. Lots of youngsters watching too I bet.
So now we've had an ad for an antipsychotic on during the playoffs. We have sure reached a pretty pass in our cultural history and an interesting moment in new mood marketing. After all, the drug's maker, Bristol Myers-Squibb recently entered a settlement with the feds over a host of accusations about off-label marketing, alleged payoffs to doctors and more to the tune of $515 million. And warnings about potential problems with the drug occupy about half of the ad time.
What a country.
I almost couldn't believe my eyes: Charles Nemeroff, a professor of psychiatry at Emory University, had this to say the other day in connection with a visit by the Dalai Lama to campus to talk about meditation and depression (article here):
"'With other diseases, we can measure things and predict what treatment we should us,' said Dr. Charles Nemeroff, head of the Emory School of Medicine's department of psychiatry and behavioral sciences. 'But in the disease state of depression, it could be mindfulness, cognitive behavior therapy or medicine.'"
That's some pretty interesting talk from a leading psychiatrist, especially one who has been rung up for having his name attached to ghost-authored studies, studies with cooked stats and so on (CL Psych busts him here). In other words, Nemeroff is one of the big boys in the meds-for-all, pharma-does-no-wrong club. Interestingly, Nemeroff backed off from the serotonin hypothesis of depression earlier this year.
His statement is correct of course. I know people who swear that meditation saved them. As with vitamins, if it works for you, go for it because there's obviously something to it. As there is with CBT.
A quick note to let regulars know that I am taking the day off to focus on some outside work, so nothing new here today. Besides, it has been a remarkably news free week in the mental health world. That won't last.
Have a fine Friday and weekend.
Here's an interesting claim from the Royal College of Psychiatrists: 1 in 4 cases of depression is actually a case of bipolar disorder, according to a recent study. That's a very high ratio (higher than I've seen claimed elsewhere), and is based upon a survey of almost 300 patients diagnosed with depression, so I'm not sure how much faith to put in the numbers. So I pass it along for what it's worth--and I bet it's worth a lot to the pharma companies.
Eli Lilly, makers of Zyprexa, today announced its third quarter financials. Despite reams of bad publicity about its top-selling drug over the last year and reports of eroding market share, the company says its Zyprexa revenues are up 8 percent to $1.67 billion for the quarter.
The company's newish anti-depressant Cymbalta saw its sales jump 47 percent to $513 million for the quarter, putting the drug in line to be a $2 billion a year blockbuster.
So do doctors even read press coverage of the problems with these drugs?
Sometimes you run into a bit of news that you know is a huge symbol of where we are as a culture, but you just don't know what to say about it except "Wow, that's messed up." So it is this time.
The FDA is marching ahead at record speed to create and construct a drug researcher center that will be funded and partly controlled by the very pharma companies the agency is supposed to regulate. It's all part of something called the Reagan-Udall Foundation, and so far press coverage of this public-private partnership has been scant.
Read about it right here, while I go vomit.
Yesterday, AstraZeneca released results of a long-term study using Seroquel plus Lithium or Depakote as a maintenance drug. In a press release the company claimed:
"A large-scale, international, double-blind study (Study 126) investigated the time to recurrence of a mood event (manic, mixed, or depressed) in 1461 patients with bipolar I disorder initially stabilised with SEROQUEL (400-800 mg/day) plus lithium or divalproex.1 After stabilisation for a minimum of 12 weeks, 703 patients were randomised to maintenance treatment with SEROQUEL in combination with lithium or divalproex, or placebo in combination with lithium or divalproex for up to 104 weeks. Compared with placebo, fewer patients in the SEROQUEL group had a mood event, defined as a manic, mixed or depressed episode (49.0% versus 18.5%). SEROQUEL combination treatment also significantly reduced the risk of recurrence of a mood event in comparison with placebo plus lithium or divalproex (hazard ratio 0.28; p<0.0001). When examined according to mood event type, this reduction in risk was similar for both manic and depressed events."
The study itself is not yet available, so it's a bit hard to pick at this data especially since I don't know how many patients in the Seroquel arm of the study made it to the end of two years. One thing makes me a bit skeptical of this study, however:
"Long-term treatment with SEROQUEL was generally well tolerated - the most commonly reported (³5%) adverse events in patients treated with SEROQUEL plus a mood stabilizer during the randomized treatment phase were somnolence (5.7%), nasopharyngititis (5.4%) and headache (5.1%). Additional tolerability results were presented which included combined results from Study 126 and a second similarly designed, large-scale, double-blind study (Study 127). Pooled data showed a greater incidence of blood glucose increases to hyperglycemic levels in patients randomised to Seroquel and mood stabiliser (10.7%, 18.0 patients per 100 patient-years) than in patients randomised to placebo and mood stabiliser (4.6%, 9.5 patients per 100-patient years)."
The hyperglycemia data speaks for itself. But only 5 percent of patients reported somnolence? Based upon what I've seen in the real world, I don't trust that number at all. And weight gain? None reported. That ought to make everyone suspicious. Has anyone ever seen a Seroquel patient who hasn't packed on the pounds? I've met none during the three or four years that Seroquel has been the hot new drug in the psych world.
Although the press release doesn't mention it, it's clear to me that AstraZeneca will likely file with the FDA to have Seroquel approved as a long-term maintenance drug used in conjunction with either Lithium or Depakote. Otherwise, they would have no incentive to do a very costly study with 1,461 patients. What's interesting is that this study comes as AstraZeneca is in the midst of facing legal action by about 10,000 plaintiffs in a federal class action lawsuit along with lawsuits by several states and a Congressional investigation.
Ah, what a tangled world we live in. Stay tuned.
Yesterday, I mentioned that The Icarus Project and the Freedom Center had teamed up to publish a guide to coming off psych meds entitled the "Harm Reduction Guide To Coming Off Psychiatric Drugs." You can read the guide for yourself here (it even has very nice illustrations). In response a reader asked me the following:
"I want your opinion related to the central question of this piece: Do you think anyone should be able to stop taking meds against the wishes of the doctor? This document suggests 1) making a case to your doctor as to why you should go off and if that doesn't work, 2) either switch doctors or go ahead without telling the doctor."What do you think?"
In general, the answer is yes. Only under a few circumstances--involuntary commitment and outpatient commitment being two--does a doctor have the legal and medical authority to compel someone to stay on a given medication, or any medication whatsoever. Other than those exceptions, you are boss of your own body and captain of your soul, a free-willed actor in the universe. (Unless you are running around violating the law, in which case you'll likely wind up in involuntary commitment, outpatient commitment or jail.)
But the corollary to the question is whether the doctor's judgment might not be better than the patient's as to what makes sense for a patient. There really is not a clean way to resolve that question absent a patient going off med X and seeing what there is to see. Getting a second opinion from another doctor might also be another way to test the first doctor's judgment. Second opinions are something that people don't tend to avail themselves of enough in the pysch world, and I am usually stunned by how often psych docs will contradict one another on treatment.
I do think that it's generally a good idea to have your own doctor be supportive of going off-meds, and of encouraging a patient to seek alternative answers to psychological questions. Any doc who thinks he or she is the lawgiver for a particular patient, or who is convinced that he or she has the Answer to the riddle at the middle of the universe is as destructive in their way as a schizophrenic who just flushed his meds down the toilet, took a few hits off a crack pipe and set off into the night with a Glock.
No matter direction a patient or their doc goes in, it's probably wisest to proceed slowly and cautiously.
That's startling news, given that part of the hype around the use of atypical antipsyhcotics in schizophrenia and other ailments has been that the SGAs help patients' cognitive functioning, but it is the contention of a paper in this month's Archives of General Psychiatry that, in fact, cognitive gains are the result of so-called practice effect. Meaning that patients who have their cognition improve are seeing such results because they are accustomed to taking the tests used to measure cognition.
From the paper:
"The cognitive improvements observed in the trial were consistent in magnitude with practice effects observed in healthy controls, suggesting that some of the improvements in cognition in the first-episode schizophrenia group may have been due to practice effects (ie, exposure, familiarity, and/or procedural learning). Our results also indicated that differential medication effects on cognition were small."
From one of the study authors in a press account (second item):
"The study’s lead author, Terry Goldberg, said: 'It is a sobering finding (since) the field has just accepted that these medicines enhance cognition. But it may be that (patients are just) getting better at doing the same test over time."'If it's just a practice effect, it is a big problem,' he added."
Indeed.
Forest Labs--makers of Celexa and Lexapro--today announced that a new antipsychotic compound designed to treat schizophrenia failed to outperform placebo in a recent clinical trial. Known as RGH-188, the drug targets D3 receptors instead of D2 receptors, as do most atypicals.
Janssen/J&J recently released a study showing that Invega outperforms Seroquel in treating schizophrenia. CL Psych dubs Invega "Son of Risperdal" and tosses cold water on the study.
In response to a recent post in which I beat up on atypicals for not doing a thing to improve mortality rates among schizophrenics, a reader commented:
"Exactly what would you prescribe for schizophrenics? The older drugs had a host of side effects and long term problems that were horrific. Are you suggesting that there are no treatment options that are acceptable for people with schizophrenia? You are at war with the entire class of atypicals but what is your answer? There are people who have been helped by these drugs. I have been."
Since I'm not in charge of a mental health system and am not a doctor, I'm not sure it's incumbent upon me to provide an option. That's one of the frustrations of being a critic--it's also one of the benefits.
But the question is one I wrestle with.
Of course, the first generation antipsychotics are awful, worse in some respects than the second generation antipsychotics. But the sad truth here is that we are spending tens of billions of dollars a year on SGAs--and allowing them to be used for a host of ailments that have nothing to do with schizophrenia--that don't have a clinically superior profile, costs 10 to 20 times as much as FGAs and are in fact killing people. All while pharma companies, the FDA and researchers stand by and call them good. And taxpayers foot much of the bill.
Current treatment paradigms for schizophrenia and bipolar disorder are built upon a house of lies. My answer is that it is time for the mental health industry to stop lying about these drugs and their ill effects in long-term use.
Also, I think that it's high time this country--if not the world--starting spending research money on examining alternative treatments for schizophrenia. There is a reason that long-term outcomes for schizophrenics in countries like India is much better than it is for their brothers and sisters in the US. We should be very interested in whatever answers we can glean from other cultures.
Sadly, I don't have a thorough answer for what should be used to treat schizophrenia in light of the flaws of the SGAs. What I hear through the grapevine is that some clinicians have reverted to treating schizophrenics with FGAs but at lower doses than in the past. I have no idea how that's working out clinically. It's far too early to say.
But I do know that it's time for this country to stop allowing researchers and pharma companies to apply a failed technology to long-term use in bipolar disorder in adults and children where, classically, there is no indication whatsoever for the long-term use of antipsychotics. It's become a disaster for patients. People have died as a result where, in my opinion, they wouldn't have died in the past.
The Icarus Project and the Freedom Center have just released a guide to coming off meds, based upon harm reduction principles. Here's a link to the guide. I haven't had a chance to review it myself, so let me know what you all think of it. And, yes, it was created in consultation with doctors.
The company's quarterly numbers aren't due until later this week, but here's a sign that the Zyprexa scandal isn't affecting Lilly's bottom line: the company just declared a dividend of 42.5 cents a share, the same as prior recent quarters (press release here). This despite a reported erosion of market share for Zyprexa.
More later this week.
Update: I know this posting is getting a lot of attention through web searches. I guess people have a lot of questions about this drug. As a result and because crazymeds.org has disappeared, I've created a guide for people looking for information about Lamictal. It's right here.
A reader left a comment regarding problems she's having getting off Lamictal in advance of getting pregnant:
"More withdrawal symptoms....as I mentioned above, I am TRYING to come off of Lamictal and have decreased my dosage a little at a time. I have been taking 75mg, down from 150, then 100, for the past two weeks and tried going down to 50mg over the weekend. I became incredibly moody, impatient, and hostile towards my husband and felt completely out of control. Yesterday I popped another 25mg in the afternoon when I felt the rage building and it seemed to calm me down. Should I wait a little while before I try reducing to 50mg again or do you think this will pass in a few days? I got so depressed thinking that I can't get off this drug without turning into a bitch...we really want a baby and in order to do so, I've got to get off this medication. I'm scared and hate to think I'm really this moody without medication!"
You likely aren't that moody. My own experience coming off Lamictal this summer was that, as you get to lower doses, it does tend to make you really bitchy and snappy. What I also found is that you've got to just accept that this is going to happen for a while and deal for a few weeks in order to get off the med. Not fun, I know, but essential.
I'm really beginning to wonder when the nice folks at GlaxoSmithKline are going to put information in their package inserts about withdrawing from this drug, so that doctors and patients will actually know what they are dealing with instead of guessing in the dark.
For the record, I actually happen to think that Lamictal is one of the more useful psych meds on the market for bipolar disorder. But its withdrawal problems are unacceptable to me.
Over the years I've met several bipolars who claim they were cured through diet and vitamins. They are always very passionate when talking about their cure and, as dubious as I tend to be of any claims of a "cure," I usually walked away partly jealous of the people who claim themselves cured and wondering if there wasn't something to their approach. Such a question isn't exactly asked by researchers and advocates for the mentally ill, even though they often pay lip service to such notions as nutrition and physical health. At the same time, psych docs do a poor job of monitoring whether their patients are even eating at all, much less what they are eating. The proportion of folks with depression and schizophrenia, for example, whom I've watched literally starve themselves is astounding. It's a phenomenon that the mental health industry would do well to pay more attention to.
Here's an article on a woman named Autumn Stringham from Alberta, Canada, who was seriously doped upon five meds. Her father and others started a nutritional treatment company--Truehope--and she was "cured." The company and its products have been the source of much friction involving researchers and the Canadian government, which eventually went after the company for making claims it felt were unsupportable.
I'm a bit dubious about claims that diet and nutrition can cure bipolar disorder or other mental illnesses, but I am just as dubious that Seroquel or Effexor can do the same. But I've run into enough cases over the years of people reforming their behavior through the vitamin cure that I'd be a fool to discount their claims too much.
Hi. I took a few days off, partly to finish some outside work and partly to get some time away from writing. I'll be back with regular posts later today.
Hi. I am mostly taking today off to finish some outside work, but wanted to thank you all for contributions which reached $2,000 yesterday. I expect to see a bit more come in through the mail over the next few days, so I'll let you know the grand total when I can compute it. So if you haven't mailed your check yet, please do.
And thanks very much.
Another $100 came in via PayPal overnight, bringing the fundraiser total to $1,725, not counting various checks that the USPS hasn't stuffed in my mailbox yet. It'd be great if another $275 could come in today, so that the fundraiser could make it to $2,000. I'll update the total after the mail comes later today. And, then, I will generally shut up about money--aside from letting you all know the final tally in a few days--until I give this another shot.
I truly appreciate all the contributions, especially given how difficult the media economy has become in this country and how difficult it is to find decent-paying freelance work (it's next to impossible when you primarily write about mental health issues especially from as provocative an angle as I do). But, then, perhaps the media in this country knows exactly what it's doing on mental health issues, and I am out of touch.
To whit, I offer this piece from Fox News' web site, which was posted yesterday. Headline: "New Medications More Effective for Treating Bipolar Disorder." What medications? The entire class of atypicals including Clozaril. Apparently, Marrecca Fiore, who writes health articles for the network, didn't even do a Google search about these drugs (and they are so in the news that it's difficult to believe she couldn't have known of their problems), which are touted in her piece by actual working doctors, who probably don't listen to their patients very much or pick up a journal article very often. Nice reporting there, News Corp!
Isn't it amusing that someone so clueless is employed as a journalist while folks like me are barely employed? OK, maybe amusing was the wrong term.
I've had a surge of interest--if interest is the word for it--in my writing from pharma companies and their lawyers recently. Not that they weren't around before. Yesterday, BMS came by looking for info on whistleblowers. Someone from Roche. And so on.
What's intriguing is that someone at Lilly and, separately, someone at one of its outside law firms were on this site within minutes of each other and both of them were accessing the same Zyprexa document at roughly the same time.
The document in question is this one. It is dated Jan. 15, 2004 and is a directive to the sales force entitled "Unsolicted Questions of Off-Label Information or Unapproved Products." In other words, it's a how-to guide for sales reps concerning how to handle a doctor or a nurse asking unprompted questions concerning off-label uses of a drug. Nowhere in the document is Zyprexa or any other drug mentioned by name.
The instructions are fairly straightforward. Read it for yourself.
I wonder why Lilly and its lawyers are so interested in this document, and why they are visiting this site for copies. Don't they have legal assistants at the office who can just print it off of a disk?
This bit from a Wall Street Journal article yesterday says it all:
"Chinese drug companies are the main suppliers of the raw ingredients needed to make AstraZeneca's Seroquel, an blockbuster that is used to treat schizophrenia and other mental disorders, according to Mr. Yin."
Why does this make me nervous?
Another $125 came in via PayPal today which I greatly appreciate. I know there are several checks in transit, but the holiday yesterday seems to have slowed them and I got nothing today in the mail. So I'm not sure of the exact total of the fundraiser to date, but estimate it be about $1,625. I appreciate all of your contributions.
My hope is that another $375 or so will come in so I can make it to $2,000 for this fundraiser, which officially ends at the close of Wednesday. As usual the PayPal button is on the right, or if you prefer a snail mail address, send me an email and I'll give it to you.
Some readers offered feedback to today's earlier post on continuing evidence of rotten outcomes for schizophrenics, despite many alleged medical advances in the last two decades or so.
"Just have to point out that the "diagnosis" of schizophrenia can ruin a persons life. Once stigmatized by doctor,family and friends what is there to live for? So to say the (bad)way schizos take care of themselves has no reason/reference is somewhat shortsighted - not looking at the big picture."
Good point.
"[H]aving the label of schizophrenic is what causes the harm. And it's hard to know what to do about it. Are we part of the beginning of a backlash against the biopsychiatric holocaust that has been going on? (sorry here's my obligatory I'm not a scientologist) It's terrible that with this information widely known at least in the "mental health professional community" people are still being legally forced to take these drugs and are being legally forced in more places and more numbers."
Good point as well.
Yes, the amount of silence in the mental health community--especially among doctors and advocacy groups--on these issues is staggering to me. It's like there is an intellectual delusional disorder on the matter. I don't know how to address it aside from continuing to put information like this out there into the public realm. But it does give me cause for concern.
Can I share for a moment?
I worry a great deal about the "labeling" and "misdiagnosis" that goes on in the mental health world, particularly as it relates to schizophrenia and bipolar disorder, and understand that both of those terms are at the core of the radical wing of the mental health movement (I almost wrote anti-psychiatry) in this country and elsewhere. I respect and understand where people are coming from on these matters.
To date, I have been very careful about handling the labeling controversy, because the minute you start throwing those terms around, you get written off as a nutjob, ill-informed and an anti-psychiatrist whom no one with brains should read. If you think I am joking, consider that in some quarters in the mental health world I am now dubbed anti-psychiatry simply for pushing hard on the bipolar child controversy and for pointing out the dangers of atypical antipsychotics and anti-depressants and how thought leaders and advocates in the mental health world are pining for expanded definitions of bipolar disorder in the next DSM and how that is bad for us as a culture. I've even gotten emails in the past accusing me of being a Scientologist.
Recently, my blog came up at a grand rounds at Harborview Medical Center. HMC is part of the University of Washington School of Medicine, and during a presentation a resident in psychiatry dubbed my work an example of anti-psychiatry. At least, that's what my sources tell me. My hunch is that the doctor had likely read one or two posts on this blog--not understanding just how episodic blogs can be and should be--and went from there. Also, when I railed in print two years ago against the atypicals-for-everything paradigm that has emerged in America, I received numerous letters from patients telling me that their doctors said I was dead wrong and kind of crazy. One doctor wrote to tell me that he thought I had issues that needed to be resolved and I should come see him. (I'd say that based upon what we've seen in the two years since that everything I asserted in the article was prescient.)
My frustration is that I am not anti-psychiatry, at least not as someone like Foucault would understand the term. What I am is someone who is against bad treatments, dangerous medications and lies. We have a lot of bad treatments, dangerous medications and lies in the mental health world these days and I began this site two years ago (and have invested many hundreds of hours of my own time since) in an attempt to counteract the flood of stupidity in mental health care. Fundamentally, the split in the mental health world is over those who see how bad things are and speak up and those who see that but remain silent.
Doing this is dangerous for someone's career as a writer and street intellectual, and it's why I tip-toe very carefully around terms like "labeling" and avoid terms such as "Holocaust."
But here I sit, a commentator on mental health issues who has simply reached the boiling point (once again) on the mental health industry's unwillingness to be honest and skeptical about the kinds of results we are seeing after two decades of a national embrace of the psychophamraceutical revolution and a decade after pharma companies and doctors began touting atypicals for every mood malady under the sun and clouds. And, once again, I am wrestling with the English language. And I don't like that.
There was an upsetting study in this month's Archives of General Psychiatry stating that schizophrenics are two to three times more likely to die than is someone in the general population, based upon a review of dozens of studies from countries around the world. The mortality picture for people with schizophrenia has not improved in decades and has not been been helped by the adoption of the atypical antipsychotics.
It's not clear how much this mortality is driven by injuries caused by meds or by the way schizophrenics take care of themselves. Some of the mortality was related to suicide. But as the authors noted:
"In light of the potential for second-generation antipsychotic medications to further adversely influence mortality rates in the decades to come, optimizing the general health of people with schizophrenia warrants urgent attention."
I'm glad the authors said it so I have some cover for this: the atypical antipsychotics have been a multi-billion scam that has resulted in early deaths for schizophrenics and bipolars (and others), and much of the expense has been footed by American taxpayers (a third to one half of monies spent on atypicals in the US comes from Medicaid) and insurance companies, and of course by individual patients themselves. We have not improved outcomes from these patients despite dumping about $13 billion a year into these alleged silver bullets that have crept into every corner of America's mood management paradigm. I am no fan of the first-generation antipsychotics--they are very nasty and fit only for short term use--but given that they cost 10 percent or less the cost of the atypicals, one has to wonder exactly how this deal went down.
(Psych Central has written about the study here.)
This runs completely counter to the hype when the atypicals came out in the 1990s. From a NAMI press release of the time, NAMI's then-executive director noted:
"'The introduction of atypical antipsychotics as first-line medications represents an unrivaled turning point for the more than five million Americans suffering from the most debilitating brain disorders,' said NAMI Executive Director Laurie Flynn. 'The new drugs offer these individuals renewed hope and exciting new possibilities for full and productive lives. Unfortunately, however, far too many people with chronic mental illnesses are denied access to these life-changing remedies.'"
Life-changing? Oh my.
I feel especially hosed by this outcome since I did write articles touting the atypicals as kinder and gentler treatments for patients. I was relying on the judgment of my sources, who clearly did not know what they were talking about. I regret the error.
Clearly, the atypicals have huge problems in long-term use, so can someone please explain to me why we are using these drugs on children, pressing women to take them to settle their agitation, and forcing people with bipolar disorder and schizophrenia to take them for a lifetime when it is clear that these drugs are big expensive problems?
Thoughts?
"'The time is ripe for FDA, the health care industry, and the medical community to collaborate on a reform of our nation's pharmacovigilance system,' said Taurel. 'Such reform will allow us to speed up the recognition of safety signals and understand the true efficacy of new medicines more quickly.'"
This from a company that only last week updated its label on Zyprexa to reflect heightened hyperglycemia problems associated with the drug? This from a company whose lawyers continually monitor this site because it has documents that clearly indicate how long ago Lilly knew of these problems?
Count me unimpressed.
Some more money came in through PayPal over the weekend bringing the total for this fundraiser to $1,275. There are also some checks on the way, but since it's Columbus Day for letter carriers and banks (and not much else in Seattle), I have no precise idea where the fundraiser is at. I do know that one of them will put me at $1,500, which is great. My hope is that with your help we can get this to about $2,000--or another $500 or so--come the end of Wednesday, so please give what you can. You can either use the PayPal button the right or email me and I'll give you a snail mail address.
And thanks to all of you who've given already. Enjoy the holiday for those of you who have a holiday today.
Fascinating piece in yesterday's Boston Globe about how the Commonwealth of Massachusetts is combing records from its state Medicaid program, plucking out all the kids on a certain unnamed antipsychotic (I assume it's Zyprexa) and the kids on more than three psych meds. The justification is that the state is footing the bill for this and there have been some bad outcomes for youngsters on these drugs, so it's time for the state to have a look-see. So far the cases of about three dozen kids have led to the state asking questions of the doctors involved out of about 500 kids the state found on some serious psych meds. This is a first in the nation experiment, which I hope spreads, especially since the state may in some cases measure the diagnosis of bipolar disorder in some kids by interviewing school teachers and such and seeing if the diagnosis dovetails with emotional and behavioral reality.
Gee, I wonder how many patients from Biederman and Wozniak's practice they might ask about. The Globe which is doing smart work on these issues should ask for the data and get the doctors names, and ask some questions of its own. Stephany at soulful sepulcher also has some questions to ask.
Sam Schiffman, a pharmacist in New Jersey, wrote a letter to the Asbury Park Press in response to another letter to the paper's editor claiming that the pharma industry was well-regulated. That first letter was written by Ken Johnson, a senior vice-president with PhRMA, the pharma industry's powerful lobbying group. Here's what the pharmacist wrote:
"Time after time, I read reports in pharmacy journals and the news media of medical professionals receiving kickbacks for using a certain company's product. Recent reports indicating higher doses of certain drugs pushed by the companies for higher profits caused cardiac problems that in some cases proved to be fatal. Sales representatives never knew, or were not told by the company, that a drug called Zyprexa had a side effect that had patients gaining 20 to 100 pounds and greatly increased the chance of these patients becoming diabetic."Many years ago, sales representatives were all pharmacists. Now most are young, attractive men and women who may not have a medical background. They are given crash courses on the company's drugs and parrot whatever the company wants them to say. Studies they show physicians are designed by the company.
"The pharmaceutical companies spend billions on advertisements that create an unnecessary demand for their drugs. The marketing costs are passed on to the consumer.
"Drug companies help support the FDA financially. Their lobbyists are among the most powerful in Washington. Their efforts made sure that drugs could not be bought from Canada, nor could there be contract bidding by the U.S. government to lower the prices of drugs as the VA can do."
Yes, the Zyprexa scandal is Exhibit A in showing just how screwed up the pharma biz and its regulatory overseers are. I hope various governmental types who read this site get that.
I have personal experience with being a pharma rep with no medical background. I was a sales rep for one of Abbott Labs' many divisions in the late-80s. I sold critical care monitoring equipment not drugs, but the racket and the training are the same. Within one week of completing my sales training, I was a 24-year-old hustling catheters on cardiovascular surgeons and others. Why was I hired for this task? "You look good in a suit," one of my bosses told me one day when I asked why they'd hired me as a sales rep instead of as a financial analyst (I had just gotten an MBA in finance).
Maybe this is why I don't even own a suit anymore.
I just wanted to update readers on where the fundraiser is at the moment. To date, it has raised $1,100 in contributions, which I appreciate greatly. The overall goal is $6,000 by the end of Oct. 10, so I'll post a few more reminders during the week and then shut up.
Thanks to all of you for your contributions so far. If you haven't given yet, it'd be great if you would. You can use the PayPal button on the right, or if you prefer sending a check, shoot me an email and I'll give you a snail mail address.
BTW, a couple of people have told me they've had problems using PayPal. (Apparently, this has to do with a browser setting or something.) Let me know if you have problems with PayPal.
As did Newsweek earlier this year, a freelancer writing a piece for the Los Angeles Times claims that the federally funded STAR-D study of anti-depressants proves that 67 percent of people have their depression improved through drug therapy. The only problem with that claim is that it's only true if you are very naive.
The STAR-D trial saw various responses rates for various anti-depressants--anywhere from about 30 percent to 12 percent, depending on the drug and what phase in the trial someone was. But as I understand things, you cannot add together the response rates from each discrete step of the trial, and then claim at the end that 67 percent did better. Additive probabilities don't apply to real life like that. Or do they?
Well, perhaps not everywhere, but this evening I saw it on live TV--as opposed to on BMS' website--and I just sat there and shook my head as I watched history being made. You see, this ad is the first time an antipsychotic has been advertised in this country--and anywhere else, as far as I know--on TV. I've also had readers tell me they've seen the same ad, which clearly targets women, on MTV and VH1, as well as CNN. (I've also babbled about the ad here.)
The ad is of course all about bipolar disorder, although the symptomology described in the commercial (irritability and racing thoughts) hardly counts as full-blown, old-school bipolar disorder 1 (aka, manic-depression) but instead is far more typical of bipolar disorder 2--or the newly-minted bipolar disorder 3, if the makers of the new DSM get their way. There is no mention of depressive symptoms.
The imagery is of a 30s/40s woman walking on a lonely path in the country. At the end of the path, she is greeted by another 30s/40s woman. They smile and walk off into the country and conversation, as the voiceover notes the many endless side effects and injuries Abilify is known to cause in some patients. There are no men in the ad I saw aired (about 30 minutes after a playoff baseball game), although the longer version on BMS' website has a stern looking father figure at the ad's beginning (as the woman begins her walk down the path no less).
Take Abilify. Go from stern looking daddy-o to receptive female friendship. You'll feel better for the journey.
We have really reached a weird place and time as a culture when ads for a class of drugs that are known to be dangerous appear on TV. But then BMS has been advertising the hell out of Abilify--in newspapers, women's magazines and on phone booths near college campuses. No other antipsychotic has been so aggressively advertised--I've never seen a Zyprexa or Risperdal ad on TV or in other consumer publications, although AstraZeneca pushed Seroquel on MySpace ads at one point. The imagery is predominantly of women in all the Abilify ads I've seen. It's not hard to understand why BMS is targeting women. Women are far more likely than men to go to a doctor, and the recent doubling of bipolar disorder diagnoses among adults is predominantly among women, even though the illness is supposedly evenly distributed between men and women. (Among kiddos, it's the boys who are being diagnosed with bipolar disorder more than the girls.)
Of course, the big ad push could have a whole lot to do with BMS' recent $515 million settlement with federal government over all manner of hinkey-dinkey committed by the company to get doctors to prescribe Abilify and other BMS drugs.
I wonder how that makes the women who read this site feel. Guys, you chime in too, please.
I cannot put this any better or get at the irony--if irony is possible when it comes to Eli Lilly--any more acutely than does Pharmalot:
"Interesting timing. The drugmaker will include new warnings for weight gain, elevated cholesterol and hyperglycemia. This comes just as Lilly is seeking FDA approval to market the antipsychotic to teens. Then there are those mounting lawsuits filed by various states that accuse the drugmaker of improperly marketing Zyprexa because side effects--weight gain and diabetes--allegedy weren’t disclosed properly."
Isn't this move by Lilly 10 years and at least 1,000 deaths too late?
Alex Berenson at the New York Times has all manner of fun with Lilly's announcement as well.
The following is an interview with Ellen Liversidge, mother of Rob. He was a 39-year-old with bipolar disorder who died in 2002 after taking Zyprexa. Today is the fifth anniversary of his death.
Tell us about your son.
Rob grew up in Burlington, Vermont, Western Massachusetts, and Philadelphia. He was precocious, kind, and read at age 3. He became manic/psychotic at age twenty after going off to Cornell and having a hard time getting going every day. For the first three years, he was misdiagnosed as schizophrenic and took every possible "old" antipsychotic. He bounced in and out of the hospital like a rubber ball and was unable to accomplish much of anything. Finally, with his agreement, we found a very skilled psychiatrist who, in addition to diagnosing him correctly with manic depression, helped him get back up on his feet. He finished college and got a Master's at Cornell. He stayed on lithium all this time - for thirteen years - and although the symptoms broke through three or so times, he was able to get back up again.
How did he happen to start taking Zyprexa? What was he told about the drug?
It was during a rough period in Maryland when he was jobless that he signed on for the first time to Medicaid. The psychiatrist pushed him onto Zyprexa, saying that he needed a "stronger" drug and also saying that it was very safe.
We were very naive and trusting (this was the year 2000) and never thought of not believing the doctor. The doctor told us that the illness got worse the longer you had it (another reason to switch to "stronger" Zyprexa) but I have since found out that this is not true.
How long did he take Zyprexa for and what happened?
Rob gained almost 100 pounds. Two years later, he said one day that he felt "strange". Though he wanted to go to the hospital, I, to my eternal sorrow, didn't take him. Two days later, on September 30, 2000, he fell into a coma and never came out. He died on October 5, 2002, at Shady Grove Adventist Hospital in Rockville , Maryland.
He was a much-loved, thirty nine year old man. The Medicaid care was lousy in addition to the fact that he died from it. He needed and got therapy but I think he felt very poorly while on the drug and this prevented him from getting, again, back on his feet.
We both fought hard, for a long time, but in the end were defeated by a poison drug. I miss him as if it were yesterday. Despite feeling poorly, and being "fat", and having his life not going so well due to the drug, he maintained a sharp intellect, a great sense of humor, and the ability to love.
After Rob died, how did you learn there might be a connection to Zyprexa?
The doctors knew Rob died of profound hyperglycemia but they didn't know why. They tested him for West Nile virus, AIDS, and a couple of other things. I found out what it was from an article written by Syd Wolfe of Public Citizen who, earlier that year, wrote of concern over the drug. He also said that two other countries, Japan and UK, had required Lilly to place warnings on the labels for diabetes, hyperglycemia, and death. This happened in Spring 2002. The FDA only acted in late 2003 partly due to huge frontpage articles in the Baltimore Sun, Wall St. Journal, and NYTimes and the label didn't only go on the worst drug, Zyprexa, but the FDA made all the atypicals put it on so as not to single out Lilly. But Lilly was scared so I think this is why they came up with Viva Zyprexa.
Did you sue Lilly and what was the outcome?
No discussion of lawsuit possible.
What should other people learn from your family's experience with Zyprexa, the mental health system and the courts?
If I had it to do again, I would definitely have investigated orthomolecular and other kinds of non prescription drug therapy. These areas have everything going against them, including the insurance companies. Right now I am reading a book about alternative therapies - however this should be attempted with a good guide and there are only but so many of these available. I would also listen closely to Syd Wolfe's advice :"Do NOT take a drug until it has been out on the market for seven years. It often takes this long to shake the truth out, to learn of the lethal side effects." I can understand someone who is dying of cancer trying something new, but people with mental illness are used as guinea pigs and their average life expectancy is shorter because of it. I have two friends who lost their only sons - in their twenties - from Zyprexa. Dying at such an early age will surely bring the average age of death down for people with mental illness.
Be very wary of Medicaid and Medicare. Many scams have turned up in these programs, such as bribing state officials to get a drug on the formulary. People who are poor are much more at risk. Beware of front groups such as NAMI. Who do you think pays for their offices in every state?
If something awful does happen to a family member, consider it a memorial to that person to battle back so as to save the lives of others. Not that many people take this stance but it is the stance I took from the start and I will remain that way for the rest of my life.
Help other people with mental illness in whatever way you find that is right for you.
Don't believe what you hear just because a doctor says it is so. Many doctors are on the take; psychiatrists have nothing left to do but prescribe pills now that they are no longer a "talking" profession.
Robert Passmore Liversidge III, May 15, 1963 to October 5, 2002
Yesterday, a 30-year-old man jumped to his death from a bridge in Seattle. As I've noted recently, we have an awful suicide problem on the Aurora Bridge here. It's one of the worst bridges in the world for suicide in one of the worst cities for suicide in America, and an effort is now underway to get a barrier on the bridge because people keep jumping right in front of office workers in Seattle's Fremont neighborhood.
But this man didn't jump from the Aurora Bridge. He jumped from the West Seattle Bridge, which generally sees maybe one jumper a year as opposed to the four or more who jump from the Aurora Bridge each year. The man who jumped yesterday was the third jumper from that span in a year, and the second in a week (thanks to West Seattle Blog for pointing out what the rest of the media missed). He didn't hit the water.
No one has any speculation as to why the West Seattle Bridge is getting this kind of attention from would-be jumpers. Yesterday's death did get a good amount of media coverage locally, but mostly because of what the man did before he took his life. Late in the morning, he appeared at his psychiatrist's office in Lower Queen Anne--not far from the Space Needle--and, according to various press accounts, was arguing with the doctor and demanding medication. Then he pulled out a gun. A receptionist called 911, and the man went flying around the office building with the gun, leaving shaken bystanders in his wake. He got to his car and drove to the bridge. Police found his body later.
I don't even have a guess as to why the West Seattle Bridge is a bit of a lure recently, or what was going on with this particular man. Why someone so troubled had easy access to a gun is beyond me. But there will be the inevitable common tangle of someone not getting care, or of getting care that doesn't work, or of letting himself unwind to the point where running around with a gun, endangering dozens of innocent people in the process and jumping from a bridge somehow seems logical. Even when it's not.
I often struggle to find something wise to say when I write about this subject, but the tank is empty tonight. I do know one thing, however.
Someday, well after this is posted, someone in a bad way will happen upon this post. Despondent people look up all sorts of things on the 'Net the same as us less despondent sorts do. So if you are that person and this is that day, do me a favor: Don't do it. There are a bunch of ways to get out of a bad fix, and they all start with you. Or a friend. Or 1-800-SUICIDE. Or, maybe, with this bit from Samuel Beckett's The Unnamable:
"Perhaps it's done already, perhaps they have said me already, perhaps they have carried me to the threshold of my story, before the door that opens on my story, that would surprise me, if it opens, it will be I, it will be the silence, where I am, I don't know, I'll never know, in the silence you don't know, you must go on, I can't go on, I'll go on."
Read it twice. It's like armor.
Yesterday, the FDA sent Eli Lilly, makers of Cymbalta, a letter concerning a mailer the company had sent to doctors touting the drug for diabetic nerve pain treatment, an approved indication for the drug.
From a press account:
"The mailer claimed Cymbalta could help patients 'experience less pain interference with overall functioning.' It used a series of bar charts to show how Cymbalta could ease pain that interferes with walking, sleeping, mood, enjoyment of life and other functions. However, the FDA said that claim 'had not been demonstrated by substantial evidence or substantial clinical experience.'"In addition, the FDA said the mailer failed to reveal risks for patients with certain conditions, including a form of glaucoma, and did not give precautions about liver toxicity or side effects connected with abrupt discontinuation of the drug.
"'Although the mailer presents numerous efficacy claims, it fails to communicate some of the most serious risks,' the letter said."
A Lilly spokesman told a reporter the company was working to understand the FDA's concerns and would act once it had greater clarity. I'd say the FDA's concerns are pretty clear.
To date, the fundraiser for this site, which began on Monday, has raised $475 through PayPal and $150 through snail mail. That brings the total to $625. The goal for the fundraiser is to raise $6,000 by the end of Oct. 10. So please consider contributing what you can through the PayPal button on the right. If you prefer snail mail, let me know by email and I'll send you a mailing address.
As many of you know, the fundraiser's purpose is to raise enough money so that I can devote myself full time to mental health reporting for readers of this site. I wrote about this goal in greater detail here.
Thanks to the Seattle Times' David Postman and Crosscut.com for publicizing the fundraiser.
And, thanks to all of you who've contributed so far.
The "60 Minutes" piece on bipolar disorder in children and the Rebecca Riley case continues to generate responses, including one by John McManamy, whom most of you know authored a book on living well with bipolar disorder and depression. McManamy felt the CBS piece maligned parents of bipolar children and he said so on his blog. He called Katie Couric as dumb as Oprah and so on. Coming from someone of McManamy's stature in mental health circles, that's interesting. Couric's piece was far from perfect but it was also far from stupid.
But the good times waited until a few people commented on his blog post on Couric. It appears that McManamy thinks anyone criticizing the bipolar child paradigm is an antipsychiatrist, a baseless slur he uses to try and discredit others such as myself and, as you'll see in a second, another blogger on these issues.
First, McManamy had to dispense with someone who left a mildly critical comment on his post:
"Incidentally, the loudest voices against treating kids come from the same people who are against treating adults. Everything to them is a drug company conspiracy. Maybe we should do nothing and let these kids jump out of moving cars (and practically every mom I've talked to has a jumping-out-of-car story). The news media has bought into the anti-psychiatry party line, hook, line, and sinker."
That sort of speaks for itself. Then, Stephany who authors the soulful sepulcher blog and lives in the Seattle area left McManamy a response, which in part reads:
"My daughter was misdiagnosed at age 11 with bipolar disorder, and at age 18 and after several experts at leading hospitals, the diagnoses was removed. After 6 years of being medicated with dozens of drugs, many changing with what new drug was on the market, she is one unique example of why it is important to medicate children with caution. In no way am I judging any parent, and the Rebecca story is heartbreaking. Her story is unique as well. I am glad that the parents in 2007 have information at hand to make informed choices, and understand medications that I did not have in 1999. My daughter was on Zyprexa in 1999-2005 and we had no way to know about the weight gain or diabetes connection[she gained 50 pounds by age 13] because Eli Lilly buried the data. This is a very difficult road to be on as a parent, I've walked it for 8 years, saw medications activate my daughter into violent aggressive behaviors, and saw it change with removal of medications. Now at age 19, she has "psychosis NOS" as a primary dx and no one knows if she has brain damage from all of the medications trialed on her, because I listened and trusted a doctor. Her illness whatever it is, may have emerged on its own, or not. She was fine until age11 and took a bed wetting pill, an anti depressant. From there it became immediate dx of OCD to Bipolar to Austism and now psychosis."I felt the Couric show was evenly balanced, and to medicate a 2 year old with these chemicals is something I must say is frightening, after seeing first hand side effects with my daughter."
She went on, but that's the gist. McManamy responded:
"Hi, Stephany. Were we watching the same 60 Minutes? Balanced? Was there any segment showing kids successfully diagnosed and treated with the illness? Was there any segment showing what it's like when a kid is not treated? Was there any segment explaining how to distinguish BP from ADHD? Was there any segment with a panel of parents of bipolar kids? Was there any segment with a spokesperson from the Child and Bipolar Foundation. Sorry, the 60 Minutes I saw was two-thirds sensationalist Rebecca Riley shock-horror, and fraught with serious factual errors."For that matter, was there any segment with you in it, explaining how your daughter's idiot psychiatrist misdiagnosed her and over-medicated her?
Did 60 Minutes make any attempt to educate its viewers?"I am looking forward to a reasoned response from you, not the ad hominem remarks you have posted about me on your own blog and Furious Seasons."
I was not the only reader flabbergasted by his handling of Stephany. You see, McManamy is not only a pompous ass for attacking a single mother who has clearly seen the dark side of the bipolar kiddos paradigm, but he's single-handedly gone after the one parent who has fought harder for her kid than any single parent I have ever seen in my 18 years in mental health circles in three different states and my seven years or so of reporting on these issues in two states. I have seen dozens and dozens of cases of patients rotting in state hospitals and residential facilities whose families have simply given up on them and left them in the hands of the state. I know they've all fought fights similar and different to Stephany's, but eventually they give up. It's understandable, except to Stephany.
Stephany doesn't want her daughter to be jammed into some ward in Western State Hospital--where Frances Farmer was once a patient--because when her daughter was briefly at the same hospital a year or so ago, another patient tried to sexually assault her. Stephany's daughter is about as defenseless and innocent as a 10-year-old and one of the most profound cases of psychosis that I know of. Guess what? The State of Washington is currently trying to send her daughter back to Western and Stephany is fighting them tooth and nail in court. She wants her daughter at home.
That's who McManamy attacked and he owes her an apology--publicly. Besides, Stephany knows all the kids trying to jump out of cars stories--and has several daughter running into traffic stories and daughter trying to jump into Puget Sound stories to go along with those.
It's always discouraging to watch an alleged big shot pound on someone else, especially someone else in the patient community. I don't understand that sort of thing, but then I don't understand how McManamy could idly sit by and not say word one on his blog or website about the on-going scandal around the atypical antipsychotics. You don't need to be an anti-psychiatrist to appreciate that there are huge problems on that front--I'm merely critical of the psych establishment and I get it. And as for his "drug company conspiracy" jibe, perhaps he might want to ask himself why companies like Lilly and BMS are settling legal claims involving their drugs, and why several other states are suing AstraZeneca and Janssen/J&J, and why Congress is investigating Lilly and AZ, and then perh
