This is certainly a fabulous Friday for pharma execs in the land. Abilify gets approved for kids this morning and this afternoon we learn that the FDA just approved Pristiq for depression. The drug is made by Wyeth and is essentially a rejiggered Effexor, only this one was originally developed to help women with hot flashes. You know Wyeth is going to give this drug a huge roll out since Effexor goes off-patent fairly soon and I'm sure that the made-for-hot-flashes-but-good-for-depression sales pitch is going to work wonders with men and women of every age.
As CL Psych and I noted last year, this smells like another episode of Celexa gets tweaked and becomes Lexapro. In other words, this is another me-too anti-depressant that will probably not have an unique features or efficacy.
One hopes that the drug proves less gnarly to take than does Effexor and that patients can actually get off the drug without going through the Effexor joneses.
Danny Carlat had these thoughts:
"And Dr. Daniel Carlat, a psychiatrist in Newburyport, Mass., who publishes the Carlat Psychiatry Report, said the release of Pristiq appeared mainly to be an effort by the company to, in effect, extend its patent for Effexor XR."That is because Pristiq is a metabolite of Effexor — meaning it is the chemical compound that results after Effexor is swallowed and processed in the body.
'"Is there a compelling public health reason for Wyeth to be releasing another antidepressant into the market, with no clear advantages over others?' Dr. Carlat said. 'Not that I can see.'"
The company continues to seek approval for the drug to treat hot flashes.
The FDA today approved the atypical antipsychotics Abilify for use in treating bipolar disorder in kids as young as 10 years old. Of course, there's much controversy in the land about what age a doctor can properly diagnose bipolar disorder at and 10 years old would sure seem to be pushing it by the FDA since most clinical literature I am aware of talks about 12 and above.
But whatever. We live in times when the needs of Big Pharma and not the needs of children are the prime concern of our society.
One psych bigshot opined:
"Abilify offers a potential advantage over other atypical antipsychotics because 'it doesn't cause to the same degree weight gain and metabolic' disorders, said Jeffrey Lieberman, chairman of psychiatry at Columbia University in New York, in a telephone interview yesterday."'The major problem with second-generation antipsychotic drugs is weight gain and diabetes,' Lieberman said. 'The younger you are, the more severe and common these side effects.'"
Gee, and here I thought schizophrenia in adults was Lieberman's thing.
Bristol Myers-Squibb said:
"'The approval is one of a series we've had for Abilify in a short amount of time,' Sonia Choi, a Bristol-Myers spokeswoman, said in a phone interview. 'This is evidence of our commitment to developing medicines to their full potential.'"
Full potential for whom? Here's a separate company statement.
Between the Seroquel XR application for depression that just hit and this approval for Abilify, we are seeing one of the biggest land grabs ever by Big Pharma for the American mind.
Meanwhile, Lilly is licking its chops:
"Lilly's request to sell Zyprexa to treat schizophrenia and bipolar disorder in teenagers was delayed by the FDA in April. Lilly received what the FDA calls an approvable letter, indicating the agency needs more time to analyze data and to determine the drug's prescribing information."'We don't have a time frame at this point,' Lilly spokeswoman Marni Lemons said in a phone interview. 'We have no intention for promoting the drug for use in adolescents. We want to add information to the label.'"
Can't wait to see that information.
Yesterday $300 came in via PayPal and another $50 in the mail. Many of the contributions were in the $10 range, proving my point of yesterday that a bunch of people making small contributions together can have an immediate impact. The total of the fundraiser to date is $550, the goal is $2,000 by the end of next Friday, so it'd be great if a bunch more people got together and made contributions of $10, $15 or $25.
I'd really appreciate your help in getting this fundraiser to $1,000 by the end of the weekend. That means lots of you giving $10 and so on, but this site does have several thousand regular readers. I'd truly appreciate your help.
Where's that $2,000 going? you wonder. It'll help keep my butt alive and housed for the next three months and help me buy food for the cats, and supplement what I bring in from outside freelance work--which is never, ever enough and never, ever gets paid on time--and allow me to devote more time to the important issues before America, the UK and elsewhere concerning mental health.
One person who's backing off from mental health commentary for a couple of months is the New York Times' Judith Warner. In her column today, she announces that she's off on book leave for two months--must be nice-- and sick of writing and thinking about children and medication. Some of us out here were getting pretty tired of it, too. Her writing and thinking were so thin on these issues that I knew I was watching the new-beat-reporter-screwing-it-up-and-trying-to-intellectualize-her-way-out-of-trouble phenomenon. I've seen the phenomenon before and it's never pretty.
That's OK that Judy's gone for a while. There are plenty of other shills for Big Pharma in the land, and I will continue to be on them like white on rice, like hammer on anvil, like...well, you get the picture.
So please contribute what you can. Thanks for your support.
UPDATE: Mere hours after I posted the following, AstraZeneca filed a supplemental new drug application for Seroquel XR, the extended release version of Seroquel, for treating depression under 3 different indications: monotherapy, adjunct therapy, and maintenance therapy in adult patients. Monotherapy and maintenance? With an anitpsychotic? That's a tectonic shift in depression treatment. If anyone thinks I was overstating the push for antipsychotics in my original post below, then think on the idea of people with depression taking an antipsychotic for life. ECT almost--almost--begins to look friendly by comparison.
The Last Psychiatrist offered his usual wise contrarian take on the British study showing that anti-depressants are essentially spendy placebos. Last's big concern is that this is a set-up for the use of antipsychotics to replace, or become add-ons to, anti-depressants. The timing of his post is delicious--Brit study comes out this week, American study saying loosely the same thing only with all 12 anti-depressants came out in January, and Abilify was approved by the FDA as an add-on treatment for depression last November. J&J/Janssen has been studying Risperdal for depression like maniacs and Seroquel is already approved for bipolar depression.
I'm not sure if Last has had a visit from a sales rep touting antipsychotics for depressed patients. But I wouldn't be shocked if it happens soon. Right now, Abilify's website doesn't even list the drug's new indication. Bet than changes soon and maybe they'll give us some TV ads too. Seroquel's is more up to date.
Anyway, Last writes:
"People are completely missing the point of this paper and all the other recent re-investigations, the true social and clinical consequences of them. For example: they're saying antidepressants are no good. Ok. What do you think doctors are going to use instead? Psychoanalysis? Nothing? They're going to prescribe antipsychotics. Are you listening to me? I'm not even saying this is clinically wrong to do, but do you not see the setup? Abre los ojos, man."
I believe you, jefe. My eyes have been open for a long time on this front, but I've kept semi-mum on this topic lately because I've spent so much time railing against how crappy antipsychotics are for schizophrenia and acute bipolar disorder and how willing their makers are to market them off-label for dementia that I wanted to back off for a while.
But, yes, depression is the big mental health market to pharma companies and they want to own it by any means necessary. It's a $20 billion market worldwide and antipsychotics are like an $18 billion market now. If I were a pharma exec, I'd be looking to marry those two markets pronto. And if they can't kick ass on depression, then they are going to get antipsychotics used for everything under the sun from social phobia (aka, shyness) to anxiety to whatever they can think of.
There at least 50 completed or ongoing trials of Seroquel and depression listed on clinicaltrials.gov. AstraZeneca isn't doing all that research for nothing. And here's one for Risperdal being used to augment Celexa in a 6-month study of recurrent depression.
Now, why would J&J/Janssen be dumping money into researching a drug for depression when that drug is about to come off-patent? Because they smell a market. There are other Risperdal for depression trials too. And if Risperdal's being trialed for depression, can its kid brother Invega be far off? Probably not.
And why would Lilly be studying Zyprexa as an add-on for depression, especially if that trial ends about 18 months before the drug comes off-patent, unless they knew something? In fact, Lilly has 52 studies of Zyprexa and depression listed in the clinical trials registry.
Yes, indeed, say hello to the new anti-depressants. Much scarier than the old anti-depressants, which can already be plenty bad. Why do I say that?
Because the atypical antipsychotics are simply not safe for long term use--why do you think Lilly and other companies are charging ahead on glutamate receptor drugs?--and it's hard to recommend them, in an ethical sense, even for schizophrenia (I'd make a different case medically and legally). Because you use these drugs long enough at whatever dose and if you don't develop diabetes, high blood sugar, strange heart beats and so on, then you can look forward to extreme weight gain, facial tics, muscle plasticity, spontaneously moving lips and maybe some nice limb rigidity. The scariest side effect of them all is how these drugs are enervating over time--they simply suck the life and soul out of patients.
I don't care if you are talking about Zyprexa, Risperdal, Seroquel, Geodon, Abilify or Invega, some of that symptomology will pop up if you take these drugs long enough. This is the nastiest class of psych meds on Earth, psychiatry's nuclear arsenal and the atypicals already have two sets of black box warnings. They make anti-depressants look like harmless placebos by comparison and make the feds' continued blocking of studies of medical marijuana for depression look downright cruel. If you think Risperdal and Seroquel are well-researched harmless drugs, then why is LAPD investigating the reported doping of Britney Spears by her manager with both of those drugs and why has Seroquel become a drug of abuse among teens?
And, the atypicals don't seem to work so swell for treating depression. Check out this slamming of the Risperdal ARISE study by CL Psych. Speaking of placebo, psychologist Bruce Levine had a nice piece on Alternet yesterday pointing out that anti-depressants are essentially faith-based medicine, given their provably large placebo effect. He's using faith in the sense that it was used by William James and I largely agree with his point.
I unfortunately speak from first hand experience when it comes to the problems with the atypicals. I was one of the guinea pigs in the first half of this decade when docs were giving these to patients off-label to treat depression and bipolar depression. The experience was not a pretty one (ever had TD or EPS folks?), but I prided myself on being a good, compliant patient because everyone told me that non-compliant patients always got in trouble--that is until I realized that being compliant was getting my body and mind in trouble and wasn't doing squat to address depression.
Over time, I walked away from these nasty meds and I've never felt better. In fact, with a complete lack of what you might call clinical depression since tossing aside the atypicals almost three years ago, you might even say I'm better than well, to use Peter Kramer's very shopworn phrase.
But that's a story for another day. Until then, abre los ojos, people.
Well, I sure didn't see this coming, but it's just moving on the news wires that the FDA has decided not to approve the long-acting Zyprexa injectable called Adhera for use in schizophrenia.
"In its "not approvable" letter to Lilly, the U.S. Food and Drug Administration said it needed more information to better understand the risk and underlying cause of excessive sedation seen in about 1 percent of patients in clinical trials, the company said."
Interestingly, earlier this month the FDA's psychopharmacology advisory panel recommended that the FDA approve the drug but with extensive warnings included about sedation. Clearly, the full FDA wants to know more.
And you'll know more when I know more.
Yesterday another $10 came in via PayPal which I appreciate. That brings the total for the first three days of the fundraiser to $200. Some other contributions are headed my way via snail mail, but I won't know what they are until they get here.
Don't take the following as me bitching, but please understand it as my being totally honest with readers. Here's the short version: If this fundraiser doesn't bring in at least $2,000 by the end of next week, then I will significantly scale back my work here. I'll have little choice. I have put my professional life on hold for over a year now in order to make sure that readers who are interested in mental health issues had a place to go every day instead of relying on the when-they-get-around-to-it coverage of the mainstream media and the delusional opinions of the likes of Judith Warner, Fuller Torrey and NAMI National.
If you aren't down with Warner's nonsense, then please consider contributing $10, $15 or $25 to my work here. I know intimately that the economy is very weird out there right now and that times are tight, but small contributions from the many thousands of readers this site has (February became a record hits month for this site late yesterday) can add up very quickly. I need you all to pull together and give what you can to make this happen.
Unless you think Judith Warner's vision of an America where every child is medicated simply for being a child and every adult is pressed to take medications that we know don't work well and have untoward side effects is what you want. I don't want to live in Warner's world. I bet you don't either.
So please give what you can. Large, small and in-between. The PayPal button is on the right. Or you can email me for a snail mail address.
Thanks for your support.
So someone left a comment on one of my Lamictal withdrawal posts yesterday. The basic story is that a young medical student goes to a psychiatrist complaining of anxiety, doc decides he's slightly bipolar-ish, doesn't make a diagnosis of bipolar disorder, but gives the guy Lamictal anyway. For anxiety. That's so far off-label and experimental, it's like me suggesting you go try a snort of cocaine as a sleep aid. Anyway, young medical student has a bad reaction to the drug and here's what he wrote:
"This Lamictal is the worst cancer in the world. I started taking 100 mg for anxiety only to notice that my memory was shot. Perfect for a medical student. So I have begun to taper off, only to have the worst headaches imaginable. So now I might not be able to finish medical school because of a retarded, greedy psychiatrist just looking to experiment on another individual. They tell you, "No withdrawal." FUCK THAT. And no one else understands or gives a fuck. That makes you more depressed and then they want to give you more drugs. Fuck'em all. They are too trigger happy with their drugs. Half of the people taking this shit would be fine if certain circumstances in life changed and they could make that happen on their own."My doc tells me to mix in Cymbalta, Zyprexa and all that shit. Of course I don't do it. Then, the next week he forgets to even ask how they are going. This whole business about mixing all this shit is garbage. It's gotta stop. The brain just can't handle.
"Look, it's one thing if you got real psychosis; schizophrenia, borderline, delusional disorder etc. Do whatever you have to to keep this people in society. But I was just an anxious medical student having a little trouble stopping thinking about a girl in Med School. OCD I definetly do have. That I can consider an asset. Truth of the matter is, my natural defense mechanisms--like knowing to get to the library 3 weeks before finals or else I'll fail--would have been enough to take my mind off the girl. But by that point it was too late.
"The doc saw an opportunity to drug me up and he did. Instead of doing the right thing and saying, "Sac up. Stop being a pussy. And go study." And now I'm the paying the price. At 200 mgs. a day I couldn't remember shit. 100, not so bad. But it might cost me a little."
I hope it costs him less and less each day and that he's able to get through med school, although he's having all sorts of withdrawal issues now. You have to sense that he'll turn into an excellent clinician because he will know some of the nonsense many of us have been through with mental health care.
Just as a thought, would anyone care to join me in calling on GlaxoSmithKline to include warnings in its packaging and such about withdrawal problems with this drug?
Yesterday, MSNBC.com had a piece up about a new study which claims that biomarkers in human blood can be used to test whether someone has bipolar disorder, how severe the disorder is and what treatment they should receive. I hope readers recognize that such a claim is an immense one and that such a claim will need to be replicated many, many times before it can be accepted as scientific fact. And, once that happens it would be several years before any sort of test would be marketed. My point is that this work is very much in the initial stages and wouldn't likely affect the real world until, say, 2015 or so.
And that's assuming that researchers can actually prove that it's genetics driving bipolar disorder instead of the wild collision of environment, personality, stress, psychology, brain chemistry and genetics that, in my opinion, is what's at work. I'd say the bar for proof should be very, very high, especially since the researchers at Indiana University feel they can expand the concept to schizophrenia and, one assumes, every other DSM malady between heaven and earth. Yes, I am very skeptical on these issues for two key reasons.
One, I have been a psych patient for almost 20 years and a reporter on science and health issues for a decade. In that time, I have heard dozens of researchers make claims about genetic this, genome that, gene tests this, gene therapy that. Very little has come to fruition so far in any realm of medicine especially when it comes to treatments, so I am not holding my breath over this alleged bipolar blood test.
Two, one of the claims the researchers make is this:
"Niculescu, who is also working on identifying biomarkers for diagnosing anxiety and stress as well as hallucinations in schizophrenia, said the bipolar findings could be the dawning of a new age in psychiatry. 'It would put psychiatry on par with other medical specialties,' he said."
You mean the chemical imbalance in the brain business that was supposed to make psychiatry like every other medical speciality 20 years ago didn't pan out? Hmm. Here's why I simply distrust such talk from researchers. The last time they trotted out the claim that psychiatry was just like any other old medical specialty, we ended up with talk that psychiatry was scientific truth and that anyone who resisted diagnosis or aggressive treatment was somehow denying this new science its rights. And, what did listening to that talk get us in the real world, as opposed to the summer camp where Judith Warner lives? It got us a new generation of antipsychotics that have turned out to be a disaster, it got us far too many Americans on anti-depressants, it got us way too many kiddos on ADHD meds and it's wound up with little boys being diagnosed with the alleged child bipolar disorder and being tagged with that diagnosis for life. The latter for a disorder that doesn't even exist in the DSM.
If that's science, then I am the Pope. Psychiatry has never been the same as other medical specialties and it's time for psychiatrists to wake up to the fact that it never will be. Human behavior and human feeling are not cardiac surgery. The sooner psychiatrists stop handing out pills at first sessions and start getting back to the mix of therapy and meds they all used to do a generation or so ago, the better their patients will be.
Here's an abstract of the work which appears in the current issue of Molecular Psychiatry. If anyone has access to the full study, send it over please. I won't bore readers with a discussion of how the test would work since it's pretty speculative at this point.
But let's skip the science class for now and assume for a minute that the test becomes reality. Let's say it's all real. Let's say it's available tomorrow. I am going nowhere near that test because its results--unless you do the test privately--will follow me the rest of my life and be used to discriminate against me and people like me in insurance (health and life), employment, schools, housing and God knows what all.
As Art Caplan puts it:
"Genetic testing for disease has long been controversial, but Art Caplan, director of the Center for Bioethics at the University of Pennsylvania and an msnbc.com columnist, said a genetic test for mental state could intensify that debate."'We're likely to see much more controversy with genetic testing when it's about behavior, mental states and personality characteristics than when you're testing for cancer risk or prostate problems,' Caplan said.
"The tests are particularly concerning if they could be used to screen for mental illness in the workplace or for college admittance, Caplan said. Other controversial areas include requiring people pass a blood test for mental competency to purchase a gun or for high sensitivity jobs, such as police officer or to enroll in the military."
Keep in mind that current genetic testing for cancer and the like is already controversial. Genetic testing for a mental disorder will be far more intense. All the talk of parents aborting fetuses based on genetic tests has pretty much been theorizing up until now, but toss mental disorders in the mix and look out.
So, I am basically a bit more concerned about this potential test and what it means than I am charmed by the possibility that it might become reality.
One thing that I did find charming about all of this, however, was that I got to thinking. "Hm, let's see--bipolar disorder, Indiana University in Indianapolis, can the mailed fist of Eli Lilly be far removed?"
This from an Indiana University press release:
"The researchers isolated the blood biomarkers in 96 patients involved in the initial research, which was supported by National Institutes of Health grant funding, NAESAD and funds from Eli Lilly and Company. Next the Indiana University researchers are planning a larger study looking at these mood markers in response to treatments, and they will use their unique methodology to seek biomarkers for other psychiatric diseases." (Emphasis def. mine.)
Yep, if Lilly's behind it then the whole thing is likely to be on the up and up.
Yesterday I asked readers here and, separately, at Daily Kos if knowing what we now know about anti-depressant efficacy what your thoughts were on taking an anti-depressant. Here are the results:
"Yes!" 22.7% (FS) 43% (Kos)
"No way" 34.1% (FS) 30% (Kos)
"Um, maybe" 14.8% (FS) 15% (Kos)
"Only with a gun pointed at my head" 28.4% (FS) 10% (Kos)
There were 88 votes on Furious Seasons and 205 votes on Daily Kos.
I find it interesting that "Yes!" couldn't muster a plurality on either site--and each site definitely has different dynamics when it comes to mental health issues.
Thanks for voting! More polls coming.
As I'm sure most of you could guess, there's been some very heated reaction around the world to Monday's PLoS paper which asserted that Prozac, Paxil, Effexor and Serzone performed only as well as placebo in trials submitted to the FDA for approval of the drugs. What's been discouraging is to see the lack of response by the mainstream media in this country, especially by those major news outlets which have dedicated reporters writing about mental health issues. This is a major study and a major bit of news that confirms both the landmark paper in the New England Journal of Medicine in January as well as several previous small studies that asserted much the same thing.
Elsewhere in the world, reactions are split, as you might imagine, between shock that such drugs could be marketed for so long that were apparently of little effect in many cases and warnings to not dump the pills and make sure you talk with your doctor. While I understand the "see your doctor" line most of the time, I'm not sure it makes much sense in this case. Most doctors barely read academic journals to begin with--this is sadly true--so what would they have to add to a patient's decision-making process.
Here's a round-up:
First, GlaxoSmithKline, makers of Paxil fire back at the study: "GSK hits back over 'alarmist' antidepressant analysis"
From the UK:
"The creation of the Prozac myth"
The Telegraph offers two personal accounts and a doc saying he's seen anti-depressants save lives
And that's just a sample of the Brit press today. I'll come back to the Brit blogs soon.
From Canada:
"Study finds antidepressants no better than sugar pills"
From Australia:
"Experts support anti-depressants"
From New Zealand:
"Greens call for review after drug study shock"
From the US:
On a personal level, I am stunned that in Seattle--the most depressed city in America--that neither of the daily newspapers ran so much as an AP wire account of the study--at least as far as I know. That's weird. But then the New York Times has been mum to date as well. That's even weirder. I am so looking forward to Judith Warner's column this Friday. How much you want to bet that she says that the study is fake but proves that anti-depressants are good for growing boys?
Not so the Washington Post, which has a decent article.
There was this odd piece on the Huffington Post.
Soulful Sepulcher goes after the study here. CL Psych points out that we've seen news like this before. Psych Central offers its take. Mind Hacks has its go.
Speaking of go, I posted my thoughts on the study yesterday over at Daily Kos where some readers were wildly defensive of anti-depressants.
Another $90 came in yesterday, which brings the two day total of this current fundraiser to $190. I know some other contributions are headed my way via snail mail, so the total is likely a bit higher, but I won't know that for a day or two. Thanks for your contributions.
A reader pointed me to a recent article on the blogger Josh Marshall who runs the very successful Talking Points Memo site. What's instructive about the article isn't that Josh is a big shot now or that he just won a fancy journalism award, it's that he was on a mission to pay attention to important political and governmental issues that he thought were being overlooked or downplayed by the mainstream media. I'd say that this site's mission is quite similar except it's applied to the realm of mental health, a realm that is largely overlooked by the mainstream media and where many of the crucial issues are downplayed.
If you think I am kidding, check out the near silence in this country in the wake of the British study showing that anti-depressants were essentially no more efficacious than placebo in clinical trials submitted to the FDA. That's kind of big news, but to date the major media in the US is being very quiet--although I am sure Judith Warner will find a way to spin the study's results as being bogus in a forthcoming column in the New York Times. Now compare it to the tripe I wrote yesterday concerning the same study.
Anyhow, TPM, as it's called, was largely supported in its early days by reader contributions because readers were very frustrated with how the media in America handled some of the pressing questions before it. If you are reading this site, then chances are you are frustrated with how the media has been handling mental health issues in America and the UK for the last 20 years. You can do something about that--and that pesky Judith Warner--by hitting the PayPal button on the right (or contacting me for a snail mail address) and contributing what you can.
Thanks for your support.
BTW, I'll be back with more later today, but am currently burning the midnight oil to finish some outside work so I can pay my rent.
What with all the news around anti-depressant efficacy in recent weeks plus a complete lack of wise commentary on the same, I thought it would be interesting to run a poll to see where our heads are at on this issue. BTW, I will be back later today with what I hope are some intelligent thoughts on anti-depressants. But for now, I am curious what you all think. So ignoring safety questions....
As I mentioned yesterday, I am asking readers to make contributions to support my work on this site. Reader contributions are an important part of how I support myself while the crazy media business in this country figures itself out during its worst restructuring since TV news hit the world in the early 1960s. I said yesterday that I am not setting a dollar goal for this fundraiser, but am trusting you all to contribute what you can and let's see where we get over the next week or so.
The first day brought in $100, which I truly appreciate. So do my cats. Reader contributions are also helpful when it comes to feeding my furry office assistants.
As usual, there's a PayPal button on the right. If you prefer snail mail, send me an email and I'll send you a mailing address.
Thanks again for your support.
I'm not sure how many of you saw the item on my site late yesterday, but there is a very important study out in PLoS Medicine (meaning it's online and free), asserting that several anti-depressants aren't up to clinical measures of efficacy when it comes to treating depression. The study was lead-authored by Irving Kirsch, a psychologist at the University of Hull in the UK.
It is a very complicated study when it comes to the statistical analysis, but these were the very studies that the makers of Prozac, Paxil, Effexor and Serzone submitted to the FDA to gain approval for these drugs in treating depression. The researchers used as their clinical measure an index created by the National Institute for Clinical Excellence (NICE), which is a British agency. The NICE standard is that for an anti-depressant to be considered efficacious it has to beat a placebo by at least three points on the Hamilton Depression rating scale. Anything less, and it's all placebo effect that's being measured in essence, or it's very expensive pharmaceutical equivalent.
This study comes five weeks after a separate study in the New England Journal of Medicine examined clinical trials data submitted to the FDA for all 12 of the new generation anti-depressants and found that, owing to numerous unpublished studies, pharma companies had been overstating anti-depressant efficacy by about 30 percent.
I won't bore you with all the numbers from the British study but it basically concludes what the NEJM study did. Here's the conclusion from the PLoS paper:
"Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decreased responsiveness to placebo among very severely depressed patients, rather than to increased responsiveness to medication."
In other words, if the drugs work at all, then it's for severely depressed patients, but they don't outperform placebo that much there either. That is simply a staggering conclusion--and validates much of what I've been writing for the last few years--but I need to be fair and point out that the study only examined four drugs and that these were only the FDA approval studies, not the post-marketing studies of these drugs which are much more extensive. Then again, given how badly post-marketing studies tend to be twisted and contorted to produce positive results, I have no problem with relying on these FDA studies.
The drugs in the study beat placebo by 1.8 points on the Hamilton scale.
Also, a couple of pharma companies had some thoughts for the British press (I've not seen any US press accounts of this study yet beyond this slim Reuters piece):
Lilly, maker of Prozac, was apparently steamed and issued a statement, which isn't on the company's website as yet, so here's the Guardian's account:
"'Extensive scientific and medical experience has demonstrated that fluoxetine is an effective antidepressant,' it said in a statement. 'Since its discovery in 1972, fluoxetine has become one of the world's most-studied medicines. Lilly is proud of the difference fluoxetine has made to millions of people living with depression.'"
GlaxoSmithKline, maker of Paxil/ Seroxat, was similarly upset:
"A spokesman for GlaxoSmithKline, which makes Seroxat, said the authors had failed to acknowledge the 'very positive' benefits of the treatment and their conclusions were 'at odds with what has been seen in actual clinical practice.'"
If there were very positive benefits in the data they'd analyzed, I expect the researchers would've reported it.
"He added: 'This analysis has only examined a small subset of the total data available while regulatory bodies around the world have conducted extensive reviews and evaluations of all the data available, and this one study should not be used to cause unnecessary alarm and concern for patients.'"
The Brit press has been having some fun with this story already today. So check these out. BBC Radio also had a small item, which was likely heard by many millions around the world.
For the last few years, the news on the anti-depressant front hasn't been good. There were the black box warnings in 2004 and 2007. Then, there were very disappointing results from the STAR*D and STEP-BD studies. Then, there was the NEJM study. And, now this one.
So at this point I think it's fair to ask: Why are anti-depressants the go-to choice for addressing depression when the evidence for their use is very shaky and the side effects of these drugs are well known? Why were they approved by regulators? And, have all of us who've taken anti-depressants in the last 20 years just been taking a big old placebo the whole time?
Any ideas?
Several very interesting pieces have drifted through my pea brain in the last few days--some of them worthy of analysis on their own were there the time--and I wanted to pass them along. I'm busy finishing a freelance piece and just cannot give these the attention they deserve otherwise.
First, the Los Angeles Times' Melissa Healy pokes into issues around anti-depressants, withdrawal and violence in the wake of the NIU shooting. Her handling of the issue is one of the better efforts I've seen in major media in recent years.
The New York Times' Alex Berenson profiles the former Eli Lilly scientist who helped the company develop its forthcoming glutamate receptor drug for treating schizophrenia. As I've noted before, the drug doesn't seem to be super-promising in terms of efficacy (less efficacious than Zyprexa) and while few side effects have shown up in trials to date, the trials are also only 28 days long. That's not exactly much of a window to measure problems. Anyway, it's a good article, and I just hope that as the switch from dopamine drugs to glutamate drugs takes place over the next five to 10 years--assuming this new class of drugs proves out on some level--that advocates and researchers temper their enthusiasm with memories of just how badly the atypical anti-psychotic paradigm shift has played out and how unethically the makers of these drugs have behaved in promoting them.
The Wall Street Journal's health blog talks about both of the above articles.
The Newark Star-Ledger has a long piece on the problems that have cropped up around Chantix/Champix, the stop-smoking drug.
An interesting story on a homeless man coaxed off the streets of Columbia, SC and into a new life, courtesy of Risperdal Consta.
A big fight is shaping up between Congress and the FDA Commissioner over some documents.
Scientific Misconduct asks what outgoing Lilly CEO Sidney Taurel is smoking.
A wonderful post at Beyond Blue on faking your way through life while massively depressed.
Bipolar Blast asks if her suffering while going off meds whill be transformative. I hope so.
LSD is providing insight into psychotic delusions and could help with research. That ought to be a trip.
Fred Baugham, a neurologist who is deeply critical of ADHD meds, takes on the NIU shooting.
That's about enough. I'll be back with more later today. And, please don't forget my ongoing fundraiser.
I'm not joking. A study by researchers at the University of Hull in the UK, reported on by the Financial Times, came to the following conclusion:
"Prescribing anti-depressants to the vast majority of patients is futile, as the drugs have little or no impact at all, according to researchers."Almost 50 clinical trials were reviewed by psychologists from the University of Hull who found that new-generation anti-depressants worked no better than a placebo – a dummy pill – for mildly depressed patients.
"Even the trials that suggested some clinical benefit for the most severely depressed patients did not produce convincing evidence. Professor Irving Kirsch from the university’s pyschology department said: 'The difference in improvement between patients taking placebos and patients taking anti-depressants is not very great.'
"'This means that depressed people can improve without chemical treatments. Given these results, there seems little reason to prescribe anti-depressant medication to any but the most severely depressed patients.'
"The researchers focused on four widely prescribed anti-depressants and the clinical trials that were submitted to win licensing approval from the US Food and Drug Administration.
"The drugs included fluoxetine (Prozac), venlafaxine (Efexor), and Paroxetine (Seroxat)."
These are likely some of the same studies as were reviewed in a New England Journal of Medicine paper last month, which came to the conclusion that anti-depressant efficacy was overstated by 30 percent and that for decades pharma companies had not published negative findings of the efficacy of their anti-depressants. That study was very big news in the States and I wrote about it previously here.
The British study was published today in PLoS Medicine. Here's the study. I'll likely have more on this tomorrow once I have been able to review the paper.
Glad to see the female cast members of SNL, plus guest Tina Fey, having some fun with the DTC ads for those period-reducing drugs now on the market. I've always watched those ads and thought, "Ewwww." The pink axe in the skit is classic.
As I did last October, I am asking you all to make a financial contribution to support my work here. Last October readers contributed about $2,400 to this site and several of you helped cover my butt in December when Google basically stole about $600 the company owed me for text ads on this site (if you're fairly new to this site, the Google back story is here--it's a doozy). I was humbled by the support in both instances.
This time out, I don't have a specific dollar goal. I'll just trust those of you who are so moved to contribute what you can and we'll go from there. The more money that comes in, of course, the less outside work I need to do and the more time I can devote to mental health issues. I can assure you there's so much news on that front that it even surprises me. Ever since the CATIE study of 2005 and the Zyprexa scandal of 2006, it's been a flood of news around mental health care--and not just in the US either. What's going on in the States is largely echoed in the UK, Australia, Canada and New Zealand. And it sure needs to be documented, and that's what I am trying to do.
There's a PayPal button on the right. Or if you prefer snail mail, shoot me an email and I'll give you a mailing address.
That is the conclusion of this paper in the BMJ, which has surprisingly received little press notice. It's accompanied by a paper on suicide among youths in the UK and an editorial by Greg Simon, a psychiatrist with Group Health Cooperative, a large HMO in Seattle.
The main paper essentially shoots down the assertions of last fall's infamous Gibbons paper, which tried to link a slight uptick in suicides in 2004 to warnings issued that year concerning suicidality and anti-depressant use. While there are a lot of apples and oranges between the British study and the Gibbons paper (which looked at the US and the Netherlands) because of cultural factors and differing time lines, the lack of a relationship between anti-depressant use and suicide rates is still an important fact and one that should be both interpreted carefully and also give anyone who cares about these issues, regardless of where they sit on anti-depressant issues, much to think about.
For my part, I've been wondering aloud here over the last year or so about the fact that anti-depressants just don't seem to be the anti-suicide technology that some make them out to be. I say this independently of what we know about these drugs' role as proximate causes of suicide and suicidality, where I think the evidence is mixed depending on whether you look at clinical trials, population-based studies or anecdotal accounts.
I think the more important issue is how suicide rates have changed versus how anti-depressant use has changed over time. The rhetoric of the last two decades has been that a rise in anti-depressant use would lead to a decrease in the rate of suicide. In the UK, it seems pretty clear at this point that suicide rates and rates of anti-depressant use are essentially independent events. One is not driving the other, at least among youths. Anti-depressant use goes down and so do suicides, at least in the study above.
As the authors put it:
"We found no evidence of a temporal association between trends in antidepressant prescribing and deaths from suicide or hospital admission for self-harm in young people despite a halving in levels of prescribing after the Medicines and Healthcare products Regulatory Agency's regulatory interventions in 2003."
Those interventions included banning the use of Paxil (Seroxat) in anyone under 18 and, later, of advising doctors that the risk/benefit ratio of SSRI anti-dpressants wasn't good for youths. The lone exception was made for the drug Prozac.
What this study tells me is that asking how anti-depressant use influences suicide isn't asking the right question. We should be asking if we are treating depression at all and how we are treating it. I point this out because just after the time period in the above British paper, the NHS began leaning much harder on things like exercise, diet and psychology than on anti-depressants. I know that that paradigm shift is still essentially just under way in the UK and that loads of patients are not being given proper psychological services, but Britain is light years ahead of the US in this respect. What's more, the paper doesn't attempt to account for psychological treatment or other methods of treating depression that may well have been employed with British youths in the period under examination.
But it's clear that some other dynamic may have been at work. The drop is suicides among the 12 to 17 age group was dramatic--a reduction of suicides in that age group from 80 in 1993 to 48 in 2005. I'd kind of like to know what was going on with British youth over this time period and how their depression was being treated, especially in 2004 and 2005, when the shift away from anti-depressants seems to have begun. I don't think the cultural differences between the US and the UK are so great that there isn't something to be gleaned here.
In this country, we are seeing evidence that during a time period in which the overall suicide rate--and here I am talking adults, teens and kids--has stayed relatively stable, allowing for small year to year variation, anti-depressant use has increased. I know there was a drop off in 2005, but I also have seen figures showing about a 10 percent increase in anti-depressant scrips from 2000 to 2006, when 227 million scrips were written. We don't have 2005 or 2006 suicide data, but it won't be wildly different from the previous few years, I suspect.
What we know already is that preliminary 2005 suicide data shows a slight drop in the suicide rate in the US that year, the same year that anti-depressant Rxs dipped in this country. How that fits in with the 2000 to 2006 prescribing trend remains to be seen and you can bet some researchers are looking into this.
For those of you who suspect anti-depressants of inducing suicides, I'm not sure this study speaks to that issue--this is population-based data, not more narrowly focused clinical trials data.
All in all, an interesting study that surely points to something odd being at work here. What do you all think?
A mother in New York apparently snapped and murdered three of her own children on Sunday. Reportedly, mental illness of some kind was percolating in the background and so was a broken social services system and, inevitably, there are treatment issues buried in this as well. I'll update those when I know more, but for now I am going to hold judgment until more is known about this tragedy. Other than that, there's not a lot to say. There have been a few of these sorts of murders in the US in recent years and I just shake my head.
The New York Times offered this bit of context:
"While the debate over degrees of mental illness and the legal definition of insanity continues, mental health experts and defense lawyers in recent years have been encouraged by the outcome of several high-profile cases in which mothers who killed their children have been found not guilty by reason of insanity and committed to mental institutions instead of prisons."
I'm not sure that encouraged is the right word, but I have a lot of doubt about a mother being able to kill her own children without being insane. I imagine that's controversial to say, but I just don't get there with the idea that a sane woman could murder her own children, be found guilty of the act and go to prison for life or be executed. I'm sure there are instances of that happening, but I imagine they are damn few.
I'm sure many of you saw the Oscars last night and I wonder if you were as struck as I was by an ad for Eli Lilly's Cymbalta during the last hour of the program. There amidst expensive ads for perfume and cosmetics and so on was an ad for the anti-depressant that has really arrived now, I guess you could say. Having an ad on during the Oscars is about as big of a deal as having on during the Super Bowl. I couldn't really hear the ad over the party I was at, but it talked about pain and depression and so on, and had happy, contented looking people going about not-so-filmic lives. We live in interesting times.
That wasn't the best part of the Oscars--that would be when the producers of "No Country For Old Men" finally thanked Cormac McCarthy, who wrote the novel the movie was adapted from. The movie had just won its third major award and I was sitting there gloating over the fact that I first read McCarthy's work and pushed it on others 20 years ago before anyone knew about him and his weird Faulknerian-Hemingway-gothic unvierse. He didn't win an Oscar, but he obviously kind of did. For someone who toughed it out in obscurity for many decades, it must've been cool.
And, it didn't look as if he needed any Cymbalta.
Montana AG Mike McGrath on Wednesday filed suit against Janssen/J&J and AstraZeneca over allegation relating to Risperdal and Seroquel. I haven't had time to review the suit yet, but here's one press account:
"He charged that the two companies 'have engaged in false and misleading marketing, advertising and sales campaigns to promote these drugs for non-medically indicated uses.' McGrath said the companies “successfully deceived physicians, citizen-users and others in the medical community” about the safety of these drugs compared to other antipsychotic drugs in order to carve out a greater market share."
More on this later. For those of you who wish to read it, the suit is right here.
Yesterday, the New York Times embarrassed itself by running an article on John McCain in which he was accused of having an affair with and doling out favors for a female lobbyist. I happened to read the piece when it went live evening before last and found it very thin--so thin that, as someone who's done a fair amount of investigative reporting, I know that article would've never had my byline on it. If you are going to wipe out a politician, then you'd better make sure your Glock is loaded with live rounds instead of blanks.
Another piece that wouldn't have my byline on it since its argument is mildly intriguing but runs counter to the facts as I know them was penned today by my new best friend Judith Warner in her blog on the Times' website. Last week, I hammered Warner for making the argument that as a culture we were too warm to the notion that we are overmedicating ourselves and that things are just fine.
This week, she's back with a piece entitled "The Med Scare." And I am back to give her the ass-kicking she deserves. She's playing the old game of everything-is-social-conditioning like a dumb Lit grad student trying to play New Historicist. Let's just dive right in:
"I asked Mintz [Steven, a Columbia University historian] this week what he believes are the underlying anxieties — conscious or not — that animate the stories of peril we tell about children in our time."'Tremendous fears about downward mobility,' he quickly answered. 'We believe we’re living in a new world where the avenues of success are harder to get into and there’s no guarantee that things will work out. There’s tremendous worry that our kids won’t be able to recreate our class status. This creates an adversarial relationship between our kids and other kids.' And, he added, 'displaced guilt.'
"I couldn’t agree more. And I believe it’s these fears, this worry, this adversarial attitude and this bad conscience that keep the narrative of the overdiagnosed and overmedicated child alive.
"Let me make clear again why I keep referring to the overdiagnosis and overmedication of children today as a 'narrative' – the sort of phenomenon that deserves to find its place among what Mintz calls 'public panics' – and not as an established fact. It’s because I believe that, over the past decade or so, scattered reports of increased diagnoses of mental health ills and of increasing use of psychotropic medications by the young have been woven into a scary storyline that distorts the reality of what’s happening to kids in our country.
OK, so how does an increase of 4,000 percent in the diagnosis of alleged child bipolar disorder over the past decade or so and concerns about the same get written off as mere narrative, when in fact the diagnosis does not exist in the DSM and is hotly debated by child psychiatrists? How would the fact that these children are mostly boys and are being slammed with anti-psychotics--a narrative shift without historical precedent--go down with any intelligent adult as not being a big deal?
More Warner:
"Only half of the 3 to 5 percent of children believed to have ADHD receive any kind of treatment (generally medication)."
I am beginning to wonder if Warner reads journal articles very often or just cites the ones her sources hand her, because how else could she be unaware of recent studies which establish that ADHD treatments don't make much difference in at least 50 percent of cases of ADHD, that most ADHD kids turn out just fine by the time they are 18 (medicated or not, and I refer to the previous link) or hit the fifth grade? And, BTW, ADHD meds seem to slow brain development too (referring to the link immediately prior). None of that strikes me as panicky narrative. Kind of beats the they-aren't-getting-treatment argument to death. Or renders it a moot point.
But, then, let's be clear: most of the ADHD kids are boys and Warner must find it really easy to stop digging around for information the minute a historian--who last time I checked has no credentials in the medical world--tells her something that suits her own preloaded panicky narrative of we aren't treating the kids enough. I just don't think Warner gives a crap about little boys unless they are well-behaved and docile.
"Why, then, the exaggerated belief that we’re raising a nation of pacified, high-performance zombies? I think it’s because we have real worries about the state of children – and childhood itself – in our time. We know that our current lifestyle of 24/7 work, constant competition, chronic stress and compensatory consumerism is toxic. But we also know – or feel – that there’s not much we can do about it. We feel guilty about the world we’ve created for our kids, one of lots of work and not much free play. But we’re also wedded to that world, invested in it, utterly complicit with its values and demands."And so we shift the focus of our fears away from big forces we feel we can’t do anything about (globalization, an increasingly merciless marketplace, a growing gap between the wealthiest Americans and everyone else, the general indignities of life in the beleaguered middle class). Instead, we focus on decisions we can control (whether or not we will “drug” our kids). Our minds shift away from the myriad ways we collude in making life toxic for our children, and we obsess instead on condemning other people for allegedly poisoning their children’s bodies."
Her assertion that this is all somehow misplaced guilt over toxic lives led by adults is an interesting one, but she sure takes it places I wouldn't. She apparently forgets about the Rebecca Riley case, the boy on Risperdal wildly jerking his head about on Frontline recently, the fact that in Washington State there is an 8-month-old child on Zyprexa. The fact that in Florida half of the anti-psychtoic use in the state's Medicaid program is for ADHD diagnoses--last time I checked ADHD was not a psychotic disorder. The fact that in upstate New York, one county is doping the hell out of its foster kids. The fact that some child psychiatrists argue that the alleged bipolar child diagnosis is in fact a personality disorder. The fact that Massachusetts is engaging in a brave, new social experiment. And so on. These are hardly isolated narratives.
Oh, but there's more:
"We jump at every story that shows other people’s kids (and it’s always other people’s kids whose maladies are “fashionable;” one’s own children’s problems are always “real” and unique) succumbing to any one of the “epidemic” mental ills said to be sweeping the nation’s youth. And we snap up the idea that other parents are drugging their kids to perform like racehorses; how could they not be, when our own kids are struggling so much to get by? In this age of personal trainers for tots and pre-K tutors, isn’t everyone always fighting to do whatever they can do to give their kids an advantage? Take away test jitters with Zoloft, super-prime their minds for cram sessions with Adderall, chemically lobotomize them into the kind of docile behavior that wins a spot in the very, very best private preschools?"The belief that overmedicated children are the canaries in the coal mine for our sick society ought to place the onus of blame upon society. Instead, I fear, to borrow a phrase from family therapists, it’s the kids who have emerged as the “designated patients” in our self-serving displacement systems.
"It’s easy to panic about the state of The Child. It’s a whole lot harder to take action on behalf of real children."
I don't know about that Judy. I have. And what is this special universe Warner lives in where rich parents dope their kids so they get into the best private preschool? Maybe, Warner should take a look at what's up in public schools where most of America's school children exist.
I suppose Warner is entitled to a narrative of childhood behavior and its cures all her own but her blog posts are sure beginning to read like a weird form of self-therapy and self-justification. What really bugs me is that if you just rest upon the testimony of academics without testing the evidence yourself, then you will never stand on your own two feet. That's often the outcome when a writer is sent to do a reporter's job.
I know for fact that some prominent psychiatrists are beginning to say that anti-depressants sure ain't all they are cracked up to be in adults and the evidence base for their use in children is very thin. You would've never heard such talk in news articles until very recently. And I'll tell you more about what I know when I can.
I think it's high time that the Times started introducing some counter voice and opinions on the pages of its paper and on its website. They do it for politics. Why not here where medicine has clear socio-political overtones? Or is Judith The Medicator solely in possession of the truth?
What do you all think? BTW, if any of you are so inclined, go leave comments on Warner's blog. Be polite, please.
Information continues to come out around the Northern Illinois University massacre. Funerals have been held for the five victims, others continue to recover--and hopefully recover speedily. Meanwhile, we continue to get tidbits of information about what meds the shooter, Steven Kazmierczak had been taking in the recent yet indeterminate past. In addition to the Prozac he reportedly stopped taking about three weeks before going on a rampage last week, we know learn that he'd taken Ambien and Xanax in the past.
The only problem is that that tenor of these reports make it sound as if these were drugs he only took intermittently or which he had stopped taking some time ago. So, it's unclear what role these drugs may have played. Yes, I am well aware of problems associated with benzos and benzo withdrawal and that Ambien usage has led to some weird behavior in high places (Congressman Patrick Kennedy anyone?), but I'm just not sure they were involved here and will remain dubious until I know more about how frequently he took these drugs and how recently he stopped their use.
As for Prozac, it's entirely possible that it played a part in his behavior due to withdrawal crazies, but it remains only a possibility until I see or hear more compelling evidence of his behavior and that would have to come from his ex girlfriend Jessica Baty, who appears to only be talking to CNN and whom CNN isn't exactly probing for information about his medication routine. They are getting the basics, but more detail is needed.
On another front, a Chicago radio station got a look at comments on a memorial Facebook page for the shooter before the owner of the page took it private.
"The name of the site is: Steve Kazmierczak was our friend, co-worker, and classmate. And then in capital letters: WHY?"Sharaelle Arizmendi writes on the Facebook page that Kazmierczak was the 'sweetest…most caring guy in the entire world'…..that he would sometimes give her rides back to her apartment from the Sociology lab because he was concerned for her safety.
"She writes she’s 'tired of people judging him for his last action.'
"Another wrote…'thank you for everything….your wisdom…guidance…and especially your friendship. I will remember nothing but the best things about you.'"
It's because of comments like these from his friends that I am not ready to dismiss the possibility of a bad reaction to medication withdrawal. They certainly knock down the sociopath, psycho-gamer speculation that's been bandied about.
But it's also because of comments like these from his friends that I have to wonder if medication withdrawal could ever account for this entirely. He just seemed to be too solid of a student and too committed to marching forward with his life to where something very, very weird couldn't have been gone on in his own personal psychology. The meds could certainly be a proximate cause, as Sara Bostock pointed out the other day.
All in all, however, I continue to think that the relationship between his behavior and meds isn't very strong. That's more of a gut hunch than anything, and I know others have different views on this. So let's hear them, please.
Like I said yesterday, I do think that there needs to be an exhaustive academic study of these types of shooting because there's often an anti-depressant sitting in the background and I think after 20 years of America's embrace of these drugs and sporadic tragedies such as this one, it would behoove us to get some solid, evidence based answers.
I noted last week that I hadn't heard of any cases of Brits assaulting their mental health care givers. Spoke too soon. This week a retiree from County Derry (and, yes, I am highly aware that Ireland is independent, but close enough for rock n' roll today) is on trial for punching his doc. The man had gone to see his GP, who'd prescribed him Seroxat (as Paxil is known across the pond), the day after a BBC "Panorama" special on suicides connected to the use of Seroxat/Paxil.
"Dr. Palin said the defendant had been on Seroxat for two years because of his history of depression. He described the defendant as anxious, nervy and constantly repeating things."He became agitated and began to swear and was verbally abusive to me.
He continued with his complaints and I realised he wasn't listening to me. I began to rise to indicate that the consultation was over and I moved towards the door so that I could open it to let him out", he said."After I told him I felt the consultation could not continue, I began to
rise. Mr. Bradley leapt to his feet. He said 'you bastard' and he came at me kicking and punching me a number of times. One punch connected with the left side of my head. Most of them were glancing blows and I was able to fend them off and I tried to hold his arms to stop him punching me and I fended him off", he added.Dr. Palin said the defendant then lay down on the floor in the foetal
position before he eventually left the surgery."
So what does that sound like to you all? Paxil induced-aggression or an unbalanced Irishman?
Meanwhile, another patient writes a love letter to Seroquel entitled "Seroquel Can Kiss My Bum."
And just to show you that I am equal opportunity around here, here's a link to the 567 places on the Net where someone has written the phrase "Paxil saved my life."
Most of you probably know that I worked all through the weekend on this site and have been doubling up during the week between the site and some outside work. I am tired and burned out, and will be back later today with some more posts and some more reader written posts. For now, I need to take things slowly.
I should make you all aware that at least one reader departed this site forever yesterday, frustrated over being criticized for sharing her own experiences on Prozac. That concerns me, because I would like this to be a site where all views are welcome and respected regardless of whether they agree with yours or mine. In addition, I had to ban someone who cruised through the site and tried to leave one of the uglier comments about schizophrenics I have seen in a long time. I do not enjoy banning people, but I certainly will do it if I have to. I think, however, that I have only banned four readers in the two-and-one-half years this site has been around. That's not bad, I guess.
Anyway, there's been no new news on the Northern Illinois University massacre and the shooter in the last day. What's startling to me is the number of news articles and web pieces that have hit the universe in the last two days. All of them basically ask "Why did this happen?" and offer a pet theory or two and then say "We'll never know." That may be true.
One of the best things I've seen is by John Grohol at Psych Central who carefully walks through the evidence for a possible Prozac withdrawal reaction, concludes that it's within the realm of possibility based upon the research he's reviewed (I agree with this research), but concludes that we may never know. I agree with that as well.
Meanwhile, CL Psych was able to get his head above the academic murk long enough to tear apart a negative study for Abilify in which the authors tried to turn those negatives into positives.
I also wanted to thank all of those who passed along Tuesday's New York Times piece on the CDC finally saying what I have been saying for four years--namely, that middle aged men commit suicide far out of proportion to the rest of the public. Nice to see the government and the Times play catch up. When I get some time in the next day or so, I will have more to say about this sad dynamic.
Until then, have a nice day.
It's ironic that today marks my seven month anniversary of going off-meds because the phenomenon of going off-meds--well, anti-depressants at any rate--is very much in the media these days due to the NIU shooting. More on that in a second.
I am doing fine, for those of you who are interested. And given the rigorous life stresses I've been under, I am pleased to be able to say that. For those of you who are new to this site, I'd stress that this was not my own idea, but was the idea of a very experienced psychiatrist whom I've seen for four years. It's a well planned experiment. And I say that in as non-delusional and subclinical a manner as possible. Even though I bet there are people who suspect I am full of BS.
Anyway, in recent days, there's been a rush to judgment on both sides of the meds issue--on or off-meds--in the wake of the Northern Illinois University massacre. I think that it's just not clear yet if going off Prozac made him do it, as some critics of SSRIs claim, but what's intriguing to me in a forensic sense is that he was going off Prozac for roughly three weeks leading up to the shooting and during that period began doing all manner of things that were sort of out of character for him: buying guns, ammo and clips; reaching out to his long lost godfather (why not earlier when he was on Prozac? and why didn't he call his father?); writing what was in essence a suicide note to his ex-girlfriend; covering his tracks from investigators by removing his computer hard drive and the SIM card from his cellphone. All of that would be out of the ordinary for someone who's described as not being a monster, according to those who knew him. And all of those behaviors would be well within the window of withdrawal from Prozac, or the after-effects of withdrawal which are a poorly understood phenomenon.
In other words, there are things that point to an off-meds reaction driving this and there are things that point away from it. For example, numerous medical authorities are quoted as saying Prozac doesn't have the "withdrawal crazies," for lack of a better term, attached to it, that do other anti-depressants, especially Paxil and Zoloft. I doubt that they are lying but are speaking from their own experiences as clinicians. That said, one doctor is quoted as saying something a bit different: "his history of psychological problems leads her to believe that a lack of Prozac could cause such violent actions." That statement was made by Sherry Falsetti, Director of Behavioral Science for the U of I College of Medicine at Rockford.
For its part, the AP weighs in with its official salute to meds article.
What confuses me is that journalists are supposed to be skeptical and look at all sides of an issues. In this case, they are only talking to people--fed to them by advocacy groups apparently--who went off meds and had problems. They are having problems finding someone who went off-meds properly and has done well? What's more, the AP article talks about a woman who went off an anti-depressant but had what sounds like possible rebound symptoms to me and went right back on the drug, when in actuality the symptoms she was experiencing were likely part of the withdrawal process. In Prozac Backlash, Joseph Glenmullen describes this problem at length.
Seriously, though, if as many people go off anti-depressants as some press accounts claim--anywhere from one-third to one-half--then they shouldn't have problems understanding that it must've worked out well for some of the people, or there would be human wreckage all over the place. No mention of that anywhere in the media or coming from the mouths of doctors whom I'm sure know of numerous patients who've gone off anti-depressants and done alright.
The fact is that the research base on these questions is appalling limited. You'd think after 20 years of new generation anti-depressants and 20 years of people going off the meds that someone would've done a big long-term study of how people fare who go off-meds. Then again, who would fund it? Then again, why wouldn't they fund it? Whether anyone is for or against people being on meds forever is beside the point. There is a very real phenomenon going on in America around meds and it's time for someone to take a hard, scientific look at the issue and do the kind of study that will actually tell us something useful.
I'd say the media has some more work to here as well. This is a very serious issue that deserves a serious gander.
Let me make sure that readers understand my views here before I get slammed too much. I'm not an advocate for anyone being on or off-meds. I am an advocate for people being responsible adults and doing things properly, no matter what choice they make. And nothing I've said in this post relates to schizophrenia or other psychotic disorders. They are their own special universe when it comes to these questions. There is something very powerful about anti-depressants and coming off of them that other classes of psych meds can't come close to claiming. I'm unaware of withdrawal crazies being attached to people who go off a mood stabilizer or ADHD meds, for example. I know there are individual cases that speak to problems there, but I've never seen it to be on the scale of anti-depressant withdrawal. And I don't know of too many people who are taking an anti-psychotic for a non-psychotic disorder who go off the handle as they come off the drug. In fact, I don't know of any cases of anyone losing it as a result of going on either of those meds classes, whereas with anti-depressants there are well known problems attached to a minority of patients who start an anti-depressant or undergo a dosage increase.
So what's so special about these serotonin enhancing drugs? Remember it's not just their interaction with people with depression that's at work. These same kinds of issues have been seen in people with anxiety, back pain, OCD and so on. What should the special case of anti-depressants be telling us? I ask this in as philosophical a manner as possible.
And just so I am clear on another point: I don't think the NIU case will ever be Exhibit A for the reported dangers of SSRI withdrawal. There are too many unknowns and imponderables in the shooter's life story and behavior. I think there are other, better examples of the phenomenon than the tragedy in DeKalb. This one sure makes you ask questions, however--and I think the families of the victims deserve answers, as do all of us.
I know this is emotional stuff, regardless of what side of the issue you are on and since this is the Net I expect a fair amount of flaming and Lord of the Rings style clashes. I just ask that people continue to keep things respectful.
As I noted the other day, I knew I'd be tied up today with outside work and so I asked readers to submit contributions of pretty much anything they wanted to get off their chests. This one is from Sara Bostock, one of the forces behind ssristories.com. I have a couple of other items that I will post over the next day or so. And if anyone wants to write a "this med saved my life" post, feel free to pass it along. I'll be glad to run it. Bostock's post came in response to someone who'd left a comment about Prozac saving them. Bostock's views are her own and, for those of you unaware, one of her daughters committed suicide soon after beginning treatment with Paxil.
I wish people would stop saying that those of us who query the role of antidepressants in an incident of this sort are blaming it ENTIRELY on the drug. That is ridiculous. We are not doing that.
But yes, we certainly do want a lot more information about exactly how these drugs work and what they do to vulnerable individuals who may already be manic or even psychotic. Also can we please get it through our heads that a drug can be a "proximate" cause of an incident without being the SOLE cause of it?
As for prisoners, there are in fact hundreds of people who are in prison, even for life, for acts they committed while under the influence of antidepressants and I for one believe that many of them never would have committed the act if they hadn't been on the drug. Furthermore those prisoners that are now off the drugs are in many cases fine, upstanding individuals who have no understanding of how they committed such acts of atrocity. Should they be there? I'm not going to say I have the answer but I certainly think it is up for debate.
The whole issue of free will and psychotropic drugs is something I have wrestled with a lot. Did my daughter CHOOSE to die? I really do NOT think she did. Did Christopher Pittman CHOOSE to murder his grandparents? Did he have any control over it at all? I'm not really sure.
And if one more person who claims Prozac has "saved their life" and, therefore, thinks that someone else had control over what they did while they were on Prozac, I think I'm going to puke. This is not a simple black and white, the drug did it/the drug didn't do it scenario. Unless we understand more precisely exactly what these drugs are doing we are not going to be able to prevent more of these episodes that are escalating in numbers exponentially from recurring.
The New York Times has a good article--very fair, very balanced--on the weird connection between anti-depressant use and misuse and violent acts in today's paper. The article quotes Sara Bostock, one of the ssristories.com people and a frequent commenter on this site.
The article comes in the wake of the massacre at Northern Illinois University and the use and misuse--ie, poorly managed withdrawal--of Prozac by the shooter. As you might expect several psych docs are quoted in the article and they claim that since the guy stopped Prozac several weeks ago that they doubted that withdrawal problems could've played a part in his actions.
"Dr. Garland said some people could and did become agitated and unpredictable in response to the drugs, usually just after starting to take them or soon after stopping."'But it’s hard to make a case for a withdrawal reaction here, because Prozac comes out of the system gradually,' she said."
It's true that Prozac isn't as dicey to come off of as are Paxil, Effexor and Zoloft, but that certainly doesn't mean it's not within the realm of probability. In fact, I still want to know a lot more about the shooter's diagnosis and how he'd been using the drug over the years before I dismiss the withdrawal issue in this case. My semi-informed guess is that he'd been playing the on-meds, off-meds game for some time and that he did his withdrawals cold turkey. And that's a recipe for bad things.
That said, there may be other explanations and answers for what happened at Northern Illinois University last week.
Bostock says:
"Ms. Bostock wrote in an e-mail message, 'As an observer and suicide survivor, my main wish is that medical professionals, regulatory authorities and other scientists will examine closely the entire medical and treatment history of the perpetrators of these violent incidents in which innocent people are victims.'"She is a founder of ssristories.com, a Web site that has tallied 2,000 news reports of violent acts in which people were thought to be taking antidepressants or had recently stopped them.
"'If it weren’t for us, many of these stories would be lost to oblivion forever,' Ms. Bostock said."
I couldn't agree with Sara more--these incidents and the histories of the perps need to be closely examined. We've simply had too many of these shootings and random violent acts where anti-depressants are connected to not do a thorough look-see. I congratulate Bostock and the others at ssristories.com for keeping this issue alive. I think that this whole question really ought to be looked into by the Institute of Medicine.
Here's one doctor who could probably make use of a look at ssristories.com or a good IOM study of this issue:
"Dr. Michael Stone, a professor of clinical psychiatry at Columbia, maintains a database of 1,000 violent crimes, including mass murders, going back decades. In many cases the accused had stopped taking drugs for schizophrenia, Dr. Stone said."'I only have a handful of cases,” he added, “where the person was on an antidepressant.'"
One wonders what planet he's on. If he'd like to return to Earth, perhaps he could start by reading about an elderly man in Washington State who was driven to stab his own wife while on Wellbutrin--often presumed to be the softest of anti-depressants. A judge believed his story and the evidence.
Meanwhile, a columnist at the Dallas Morning News has gone to bed with Fuller Torrey and TAC:
"I'm not suggesting that someone could have followed around Steve Kazmierczak to make sure he took his pills, and I'm certainly not intimating that people with diagnosed mental illness don't deserve our compassion."We need to recognize, though, that many people with severe mental illness need these drugs to function in society. It's more than a minor issue of personal preference to unilaterally decide to stop taking them.
"Mr. Kazmierczak's case, perhaps understandably, set off a fresh round of gun-control debate.
"If he had stayed on his meds, he might not have gone looking for guns in the first place."
Life is always so simple in the hands of newspaper columnists and TV commentators. The columnist's email is on the article, so if anyone feels like dropping her a note, have at.
While I understand her broad point, it's a wildly simplistic one. She may wish to consider something new--and so may the judge she quotes in the article, who's hardly a medical authority--but it's something I've had rammed in my face big time the last few years as a reporter, observer and sometime mental health worker: there is a significant percentage of seriously ill schizophrenics for whom meds do nothing, no matter how compliant the patient may be. I estimate that at about 30 percent of people with severe schizophrenia. Charles Barber, whom I spoke with after his reading Seattle last night, puts it at 20 percent of people with severe schizophrenia. Regardless, that's a lot of people.
Do we as a society have the right or even the need to force folks like that to take medications that do nothing for them, that don't stop their hallucinations and such, that rip their bodies and minds apart, just because we think they ought to work? If someone has a track record of violence, maybe. But absent that, I'd say we have little interest in it as a society. We ought to have a lot of interest in trying other solutions with these folks. I stress the "trying" piece of that.
Perhaps, the Times captured it best when its reporter Ben Carey noted that the NIU shooting and its connection to Prozac is "likely to fuel the debate over the risks and benefits of drug treatment for emotional problems."
No kidding. Ever since I first wrote about the shooting and, separately, the stabbing death of the NYC psychologist last week, this site has been seeing a large uptick in hits and a flood of comments, which I appreciate and am flattered by. Detractors and proponents of anti-depressants have duked it out in comment threads. I hope at some point we are all able to walk away from the NIU shooting and other recent tragedies much wiser.
Speaking of being wiser, I'll largely be off the site today--absent any breaking news--in order that I can focus on a freelance piece I am finishing. I will approve comments as the day goes on however.
UPDATE: Not long after I posted the above, several articles relevant to this NIU case hit my radar and I wanted to pass them along. A columnist at the Chicago Tribune takes on the shooter's possible fascination with Nietzsche (I'm not buying a connection), the same paper has a decent article about anti-depressant withdrawal (downplaying Prozac's role in spurring irrationality in those coming off the drug, however), and gamers are concerned because apparently the shooter played some violent video games and now an anti-gaming lawyer is going after NIU to get records of what the shooter played. I think he's on a fishing expedition.
This is a work of fiction, a fictional mood piece, authored by Susan S. Repeat: this is fiction, so accept it as art not as "fact." PD
Samhain- definition. SAMHAIN (October 31st -Nov 1st)
The Last Harvest. The Earth nods a sad farewell to the God. We know that He will once again be reborn of the Goddess and the cycle will continue. This is the time of reflection, the time to honor the Ancients who have gone on before us and the time of "Seeing" (divination). As we contemplate the Wheel of the Year, we come to recognize our own part in the eternal cycle of Life.
I know why I am here. They think I am crazy, don’t they? They want me to be normal. Don’t people realize normalcy does not exist?
You want me to lie down on your couch. No. Why? I do not want you, Mr. Viennese Head Thumper to get in my head. You want me to lie down and spill my guts, to tell you a nice story like Holden Caulfield, or David Copperfield. You want me to say something wonderful, so you can write a paper, present it at your next Head thumpers convention and win some kind of Freud award. A silver cigar, or something.
Please.
I am here because people want to kill me. You know if I lived 400 years ago, I would have been burnt. For the very thing that I am about to tell you. I have died that way in the past. Can you not smell the smoke if you get too close? What they don’t tell you when you are burning, is that there are 2 ways to burn a witch. You didn’t know that? One is the humane way, not done so much for witches but for political heretics. You put a sack of gunpowder around their neck, so they die from that before the flames touch them. Or you burn. It’s painful. Do you know why witches were burnt? Because someone got the idea, it’s better to burn for the ten or 15 minutes it takes you to die on earth, than have your soul burn for all of eternity. Bloody Mary, Mary Tudor believed that. That is why she burnt so many Protestants at Smithfield. To save their souls.
Well now hers is burning. She knows how it feels.
So I am here because someone thinks I am crazy. I am not. If I was on the ”X files” I would have tons of fan mail. Do you think I want to see the things I see? Do you honestly believe that?
Oh my, then you need a shrink more than I do.
Is it a crime to see auras? No. To see past lives in people as you look at them? No. To see how they die, yes. That is a crime I am punished for continually. But am I breaking any laws? No.
Well, I can see how they will die in this lifetime. I can only see how they died in past lives. I can see they will be come back in the next life, unless they progress. So why am I here? Because of these visions?
Auras? What do you want to know about Auras? How long I have been seeing them? Since I was three or four. Good people had shiney ones. Bad people had dark ones. The dying have dark ones. I could not tell the difference until I was in my late twenties. I met someone, and he was a mess. I thought he was a God, he had a silvery aura, but it was black and silver. He followed Alistair Crowley. We walked down a street in New York and the dogs barked at him. I never saw anything like it. It scared me. One time a waiter didn’t wait on us correctly, he took out a match and said some horrid things on it. And lit it. I found out later the waiter died a few months later, his car flipped over , he couldn’t get out and he burnt to death.
I couldn’t save him. I wish I knew. But I did not know my powers then. I thought what was prophesized will take place. I did not know that some prophesies are warnings. I have since learned how to reverse magick, but it’s hard. Good fights evil, but … sometimes good does not win. Sometimes it’s a truce. Sometimes evil wins because good does not have the tools or knowledge to fight.
And sometimes evil recognizes good and wants to take it for itself. To claim it. Have you ever met a practioner of the black arts? I mean a real follower. It’s scary.
He tried to take my soul. I could have let him. I really could have. I was so tired then, and I wanted to die so badly. But my soul was not mine to give. It was promised to another. And you cannot give what you do not have. Can you?
Who has my soul? Oh that’s easy. My soul belongs to my twin soul, my best friend. . We swapped souls eons ago, and when I meet him again, we will reclaim them. The angels didn’t want us to swap like this, but we thought it would make our lives more difficult, therefore our karma would be better, and when we met again, it would be – my heaven.
They told us we might never meet each other again. One could evolve higher than another. Or go the other way. But I do not want anything to happen to his soul. I loved him so much. I miss him so much it tears me asunder.
I just am having problems with humans. This body does not work. I unzip myself out of it in the evenings, so I can fly to the moon and soar among the stars. Its so hard to come back. This reality this plane of existence is really limited. It’s so much better in higher dimensions.
And they send me to people like you because I see things.
What can I see in your aura? Well for one you smoke way too much. You stress. You drink too much coffee. It’s a muddy brown. You are not happy. You chose this field so you could try and make sense of your problems and your inadequacies. Your ticker is not working properly. You have a relatively new soul. You haven’t been around much, yet. So you listen to people’s problems and you are not in a position to make judgments. But you do. Someone who does your job should be around the reincarnation block more than twice you have. I don’t understand new souls. They judge too much. They expect things and do not understand the great universal laws. But you will. What goes around comes around, and every evil action you do will come back to haunt you 3 fold.
How many times have I been around this block? How many stars are there in the sky? I am sorry, for laughing. I lost count. I could have finished awhile ago, but for some reason, my soul is a bit sadistic. I have already achieved angel status, I want to keep learning more. So I keep coming back. Alternating lives. Male once, female the next. Sometimes I have been children, not progressing. Once I was an infant who died in labour. I wanted to know what that felt like. So I came back both as a mother who died in childbirth, and then immediately after, as an infant who died in childbirth.
But the last 500 years or so, I have to help other people. To save them from the darkness. It’s been easy, you radiate life, you give life. But now… I don’t know. I still do not know why I was burnt like that. I was a young witch, not a crone. I saw things. I don’t want to see things. Oh help me, I do not want to see things.
Do you know what it is like to be in the fifth grade and see in a math class your grandfather will die the next day? And the death before that will be a goldfish? And the next day you wake up and your goldfish, Lennon and McCartney are floating on top of the bowl. One of them anyway. Paul was ok, John was floating. And John got flushed down the toilet by my mother, with a rest in peace prayer.
So, since my fish died I knew my grandfather would also. I went to school knowing this. The sky was ominous that day, the air smelled of ozone like it does after a good rain. There was no rain. None.
I shivered. I can still remember how still the sky was , and no birds singing. The clouds looked like they had been torn apart by a jagged knife. It was macabre. And that was the first time I ever heard that word. Macabre.
I went to school that day, and saw the death as it was a movie happening to me. I went home that night, and my mother got the phone call, and it was like seeing the movie again.
The worst is seeing people’s aura change as you watch them. You can see them before they will die. You can see if they are cancerous or not. What I do not understand, is if you see that someone will die suddenly, do you tell them so they can try to cheat this? Say for example, Julius Caesar. He was warned to beware the Ides of March , by both the soothsayer, and his wife. He chose to ignore it. Free will. Can it then be considered free will to cheat death if the warning is heeded? Free will. It’s a marvelous thing.
But I digress. Back to auras? I have a friend who has the most marvelous one. Bluey green with silver sparkles. Gorgeous. Oh Gorgeous! He is my teacher, and a good friend. I thought he was my twin soul, but I think he is a soul mate. Maybe I am wrong. A psychic sees things for others, there whole life they look at like a horse in Central Park- with blinders. Do you know the difference? I cannot explain. Someone who is your best friend someone you are even closer to than your soul mate. I wish my aura was as brilliant as his. Mine is light pink. No sparkles.
No I will not lie down. How do you know I am wrong. Let me ask you something. Just because you cannot see something , that does not make it false. I hear my heart beating, but I do not see it. Does that mean it does not beat?
I see the beauty in the world. Does that mean that if I see it and others don’t, that the beauty is not there?
Why do you write everything I say in that book? You know you really shouldn’t smoke those cigars. Did you know Freud died from those? He had part of his tongue cut out.
Oh you knew that. You are really upsetting me. I see your aura withdrawing from me as you write, getting darker. What are you writing? Can I see it?
“According to the DSM IV, this patient displays several personality disorders. She experiences delusions that she believes to be visions of the future. Client also details further delusions of seeing auras around people based on her perception of these people’s attitudes and personality. These colors manifest in her mind to suppress childhood trauma. A pattern of schizophrenia or possibly bipolar disorder (to be determined by testing and by drug treatment) exists in that she attributes other personalities to be those from past lives. An obsession of good vs. evil exists as client attempts to gain control over or emancipate self from schizophrenia – especially during moments of transition to different personality. These transition states manifest as client perceives a “being” trying to “take her soul.” Client has chemical imbalance – possible lack of seratonin. May need to be placed on Prozac, Zoloft and Depakote. CONCERN EXISTS as “evil” personality may manifest and thus exhibit homicidal behavior.
"Recommendation: Drug therapy to inhibit bipolar disorder (or schizophrenia). Strict care and observation. Client should remain under chemical treatment until potentially dangerous, delusional behavior subsides. Immediate treatment necessary."
"One slight paranoia. She believes she hears things talking to her, and that people want to kill her. She believes in past lives. She sees auras that are not there. Obsessed with concepts that are alien to me, like good vs evil.
"Recommendation, severe hospitalization followed by ECT to calm down, and frontal lobotomy to bring her back to a level where she can be with her family and friends and once again be a vital member of society. Slipped through the cracks as a child, must be fixed now and retrained. Immediately”.
No. That is not right. You can’t do that to me. Oh you are. Please. You don’t understand my abilities. You don’t understand what you’re doing. Please!? Don’t. I don’t want to go there. I don’t want you to do that , I don’t want to be like everybody else. You will take away my soul, I will die. Please Please…Tell those men in the white coats to leave me alone…. Don’t come near me, Oh why can’t you help me? Please? Can anyone please help me? Does anyone hear me? This life was not supposed to happen this way. I’m not ready to die. Please. I am not ready.
I asked readers the other day to submit contributions of whatever kind so that I could post them today while I busied myself with some outside writing. This one is by Jane Alexander, who authors the fabulous Bipolar Recovery website and is becoming well-known for her YouTube videos, lashes out at group homes she was put in as a teenager. Group homes are a topic of interest because Steven Kazmierczak and Robert Hawkins, the Omaha mall shooter, both spent time in similar facilities. BTW, like me, Alexander is a longtime bipolar who's made the transition to life without meds.
About psychiatric juvenile group homes--these are not country clubs or summer camp. If you can imagine an orphanage combined with high school level dorm setting, combined with a flavor of psychiatric hospital and a dash of juvi detention you get a juvi psych group home.
I spent four years in them [here are links to the two homes she was in]. The State run jobs are the worst, barely a notch above juvi hall/psych prison. The private ones can actually afford to hire a few humans amidst the keepers. The food is better, the cook cares just a fraction more and you can taste the difference. Nevertheless group homes are a nightmare.
They exist in an artificial structure that kids are made to conform to or else. Threats and coercion are the norm. It was horrible living in them. You do not get ‘care’ you get ‘treatment’. Which nearly always means drugs, structured living programs and therapy. That’s it. Everything is in terms of compliance or noncompliance. Acting out always ends up in restraint. I went into those places with extreme PTSD at 14 and I stayed at red alert in these places until I was 18. You can not relax. You are not safe.
There is no trusting the staff and opening up to anyone. You have no privacy, few rights and no say over anything. When you confine a population like that of 40 girls and boys, every single day is insanity hour all day long. It turns out when you force teens with severe mental and emotional problems to cohabitate in a structure of unreality unlike anything they grew up, they get stressed!
In these places it is not unusual for kids to attack each other and the staff. The staff attack back. They call it restraint but it is assault and battery. If you grew up with child abuse only to have staff pin you down to the hard floor, all your triggers go off. They add injury to the injustice. Your roommates are cutters, ODD/ADD, teen addicts, criminals. Some would never hurt anyone but themselves. Others physically assault you because of a perceived bad "look" in the blink of an eye. There is no escape from the other kids or the staff.
When you get sick of it and run away, you get recaptured and punished for it. You are put in isolation for days. One kid brings a miniscule amount of contraband, like a single cigarette, and the entire facility is locked down while the staff ransack everyone’s stuff. Even in the middle of the night you are woken up because someone is getting restrained again or it’s time for another random room search.
You see kids twitching, going into seizures in their chairs or slurred speech in groups because of their psych meds. Sexual assault, especially male on male, is rampant. Then there is staff favoritism which can make or break your entire stay there. Or at least a particular shift. It is simply and truly awful.
You don’t get training on how to be an adult. You are not taught anything. The on-site schools are sub par and lean to those with learning problems and low IQ rather than those with higher IQ. It is like an abusive dysfunctional drama family times 100 and, worse, they are all strangers.
To this day, I can vividly remember the things I saw being done to people and the things done to me while I was there. It took me years to get over the nightmares playing in my head from 4 years of psych group homes. Not to mention the rage, the anxiety and triggers. I was a mess when I got out of them at age 18.
Robert Hawkins (Omaha mall shooter last fall) was in group homes too. They said "everything had been done to treat this kid while he was services." These group home admins are full of shit. You do not get help at these places. All you can do is survive them with your personality intact. Many do not.
As chance would have it. I met two former group home "alumni" years later. One girl, as soon as she turned 18, got pregnant and on welfare. She had many problems when she was a resident. One boy was a homeless bum. He was addicted to heroin and sold meth and pot to pay for his habit. He was wanted in half a dozen states and had abscesses from shooting up with low quality drugs all over his body.
I can assure you people, that both this Steven kid and Robert were not being "cared for" in these facilities. Such nonsense.
There is now confirmation that the anti-depressant NIU shooter Steven Kazmierczak went off of a few weeks ago was Prozac, but it's not clear if he was on the original patented version made by Lilly or if he was on a generic. His ex-girlfriend told CNN that the drug made him feel like a "zombie."
Prozac does have documented withdrawal problems and with the drug's long half-life these effects can play out for a few weeks. While Paxil is best known for making people really erratic when discontinuing the drug, Prozac has almost as bad of a reputation on this front.
I want to stress a few things here. One, no matter what anti-depressant someone is taking or coming off of, they must withdraw from the drug carefully and slowly--cold turkey leads to disasters. Two, I'm not against anti-depressant use, but I am against the misuse of anti-depressants and not withdrawing carefully certainly counts as misuse. Three, I continue to bang on the matter of what anti-depressant the shooter was on because I don't want to see any more of these ridiculous shootings--we've had too many in this country the last 15 years or so. Four, I remain open to the possibility that there may be other explanations for the shooter's behavior while acknowledging that SSRI withdrawal could've pushed him over the edge.
His reaction to withdrawing from Prozac may not turn out to be the final answer, but in the absence of other concrete explanations it certainly offers a significant clue.
I hope we get more answers.