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.
I had dinner with an old friend of mine last night--and, yes, this little anecdote will have a point. She's a single mom and has a daughter of junior high school age who began acting oddly a little over a year ago--wouldn't go to school, wouldn't do her homework, sleeping in class, putting on the emo makeup and so on--and several officials in Seattle public schools pressed her to get her kid on anti-depressants. We're talking teachers and school counselors here, not MDs. The mom knew something was up with her kid and so did I, since the girl had become combative and all the other things that generally lead to some kind of psych dx. The problems were undeniable. And acutely annoying.
Back then, I told her mom to keep her daughter away from any and all meds, especially the anti-depressants. The mother took her daughter to a naturopath and she didn't diagnose the girl with anything (probably because this was a naturopath and not an MD), but she didn't exactly have any words of wisdom either.
I won't bore you with the whole story, but a year later the girl is fine, going to school, doing fairly well and so on (although with teens it's always provisional) and tonight my friend thanked me for telling her that anti-depressants were dicier drugs than she'd thought. Which was nice to hear.
Now to my point. When I began this site many moons ago, I had no idea that I'd be writing about anti-depressants as much as I have been. In 2005, I figured that the public knew about the problems with these drugs--and knew of their benefits as well--and that there was a treasure trove of information available to them on the Internet and that doctors had backed off of prescribing these drugs as aggressively as they were in the 1990s and that everyone was well aware that the pharma companies had played dirty tricks with the evidence for these drugs. I was wrong, at least based upon what I've been picking up from recent research, readers of this site and various media accounts.
Not only are doctors prescribing anti-depressants at near-record levels, but the public is just not getting the picture that the risks with these drugs are very, very real. What I thought was common knowledge is in fact still known to a relative few. I think a lot of doctors don't know enough either about anti-depressants, especially their use in youths. I think everyone is still making the sweeping cultural assumption that these drugs are as wonderful as they were supposed to be circa-1990. Unfortunately, they are not.
There are, of course, a decent percentage of people who do benefit from anti-depressants, who are literally biochemically snapped out of whatever depression or funk they were in before taking them. That maybe makes up 20 percent of the people who take the drugs, but for some reason they become the proxy for everyone else and their experiences have been carved into our cultural and medical mythology as being what everyone should expect.
I don't know what to do to combat that false picture, but I know that there is a lot of legitimate information about these meds on the Net and that on sites like Paxil Progress people can sort through a very extensive database of experiences good and bad with these drugs. I hope regular people start asking some skeptical questions when faced with the choice of anti-depressant use and find a way to access the information that's online.
That said, I think the media needs to do a better job as well, although they are light years ahead of where they were a decade ago. I say this because various reports of the Northern Illinois University shooter's background indicate that he was on anti-depressants until recently and it's clear that the media has been interviewing sources with direct knowledge of what he was taking. The trouble is no one has yet reported what specific anti-depressant he was taking and after watching CNN's interview with the shooter's ex-girlfriend, I am convinced it's because the reporters aren't asking the right question.
They need to ask what specific drug or drugs he was taking, and what specific diagnosis he had. Not all anti-depressants are created equally and if the shooter did have a diagnosis of bipolar disorder or schizophrenia, as some of my sources suspect, then someone with either of those diagnoses who was simply taking an anti-depressant was playing with fire, regardless of how well he was using the drug or how badly he was misusing it.
I hope we can get further answers.
I suspect, too, that one of these days my friend's daughter will thank me when she gets older because, as it turned out, I happened to be dead right about something. Her problem was her environment. Her environment got straightened out and so, too, did the kid. Abnormal behavior and abnormal feeling of any stripe do happen in a social context--there is no ignoring that.
Which is a long of saying that I want to remind readers in the Seattle area that Charles Barber, a lecturer in psychiatry at Yale and author of Comfortably Numb, will be doing a reading at Elliott Bay Books at 7.30 p.m. this evening. Barber is a firm believer than social context needs to play a much larger role in how we approach, recognize and address mental illness in America. I know he's right and that's why I'll be at the reading.
Besides, Barber has recently been savaged by Peter Kramer and the New York Times' Judith Warner. He must be doing something right.
CNN has an exclusive interview with the ex-girlfriend/roommate of the NIU shoot
Here's her view of the shooter:
"'He wasn't erratic. He wasn't delusional. He was Steve; he was normal,' Jessica Baty tearfully said in an exclusive interview Sunday."Baty, 28, dated Steven Kazmierczak off and on for two years and had most recently been living with him.
"'He was a worrier,' she said. He once told her he had 'obsessive-compulsive tendencies' and that his parents committed him as a teen to a group home because he was 'unruly' and used to cut himself.
"He had been seeing a psychiatrist, Baty said, and was taking an anti-depressant to treat depression. But Kazmierczak had stopped taking the medication three weeks ago, 'because it made him feel like a zombie,' she said.
"'He wasn't acting erratic,' she said. 'He was just a little quicker to get annoyed....'"
"'The person I knew was not the one who went into Cole Hall and did that,' said Baty. 'He was anything but a monster. He was probably the ... nicest, [most]caring person ever.'"
For the uninitiated, the quicker to get annoyed thing is common to some people coming off an anti-depressant, especially the tougher ones to withdraw from such as Paxil.
It's still not clear to me what this guy's diagnosis was--and maybe it doesn't matter--but so far I've heard anxiety and OCD. More informally, I've heard that he may have been diagnosed as bipolar or schizophrenic because the residential facility he was in as as teen typically works with that audience. That said, if the guy were a bipolar or schizophrenic, I am pretty sure Baty would have said so or the press would've turned it up by now.
I've certainly seen people with anxiety and OCD diagnoses who could be very weird and explosive, but that's hardly the norm. Maybe the answer for whatever was up with this guy is well outside of his official Dx.
"Either the day of the shooting or the day after, Baty received a package in the mail from Kazmierczak. It was a two textbooks with what she described as a 'goodbye' note, and a new cell phone."She has no idea why he sent her a new phone, but read the contents of the note to CNN.
"'You've done so much for me,' the note said. 'You will make an excellent psychologist and social worker someday.'
"He sent her another package with a gun holster and ammunition in it, Baty said. She said she has no clue why he would have done that.
"Baty is haunted by a phonecall Kazmierczak made to her around midnight, the night before the slayings. 'He called me at midnight and told me not to forget about him,' she said.
"Then, Baty said Kazmierczak told her, 'Goodbye, Jessica.'
"Shaking and crying, her family at her side during the interview, Baty said she still loves the man she met in a hallway at NIU when they were both undergraduate students.
"Like comments from teachers which have been widely reported, she said Kazmierczak was an achiever who always tried to get ahead in class and seemed committed to criminal justice issues. He planned to go to law school and she hoped to get her Phd."
Someone doing as well as he did in life with whatever mental illness he had certainly doesn't foretell what happened at NIU on Thursday. I know of few cases where someone in his situation who'd become so well adjusted suddenly snapped and did all the things he did. He was simply too intelligent for me to believe that. There was either something very, very weird going on with this guy that had been going on for years under the surface or there was something strange that happened to him as a result of going off anti-depressants. Or something else that may come out yet.
I hope we get to an answer of sorts some day.
What with all the gloomy news on this site the last few days (and my doing posts on the weekend), I want to try something a bit different and pass along a YouTube of Uncle Tupelo performing the classic song "No Depression." About a year after this 1992 performance was recorded, the band split up and became Son Volt and Wilco. I was one of the lucky few who got to see Uncle Tupelo back when.
I may run more music videos on here in the near future.
Also, since I am going to be heavily involved with some outside writing on Monday and Tuesday, if anyone has anything they'd like to write and submit as something I'll post on here, send it my way. I don't care if it's in line with my views or not, I'm always happy to publish something provocative. You know where my email is.
David Tarloff was today charged with second-degree murder in the death of Kathryn Faughey, a psychologist who Tarloff allegedly killed in her office last Tuesday night. He was also charged with attempted murder and assault in an attack on Kent Shinbach, a psychiatrist who shared offices with Faughey. Some press accounts indicate that Tarloff was at the office to rob Shinbach with whom he was furious because the doctor had been involved in his involuntary commitment many years ago. BTW, I've read nothing so far indicating what Tarloff's diagnosis is, although some kind of psychotic disorder is an obvious guess.
Why someone as ill as Tarloff was not in a hospital or a very controlled environment is beyond me. A few weeks ago, Tarloff beat the hell out of a security guard at a hospital where his mother was being treated. Tarloff was arrested, but as I understand it a judge basically let him go later. It's not clear whether Tarloff was on medication of any kind or whether he was receiving any kind of follow-up care.
The psychologist's funeral was yesterday. Here's an account of that.
Why someone who was clearly delusional and had recently committed a serious assault was not pushed into outpatient commitment of some kind or held in a psych unit escapes me. I'm no fan of outpatient commitment or forced medication, but when someone crosses the line into violence they've lost my sympathy and my concern for their rights. As with the idiot who allegedly murdered Shannon Harps in my neighborhood on New Year's Eve, recent episodes of violence were pretty good predictors of where this guy was headed. In Seattle, several people and agencies tried to get the alleged murderer committed, but were unable to. In New York, it's less clear what happened in the weeks after the assault on the security guard.
Tarloff's brother had this to say to the press:
"'What I want the city to know is that my father and I and our mother all tried our best to keep him in the facility that he was hospitalized in over the many, many years of his illness,' he said. 'But they kept releasing him, even after we told them what had been going on with his situation.'"'We did the best that we could, asking them to keep him in there. They didn’t.'
"Robert Tarloff did not elaborate on the nature of his brother’s illness or where he had been hospitalized.
"'I really don’t want to get into our past,' he said. 'But I hope the family has peace that somebody has been caught and that my brother is, you know, will get the peace that he needs as well.'"
I'm sure we'll be learning more about this past in the coming days.
BTW, what the hell is it with these delusional guys stabbing female victims to death? And why is it men doing this? Or are there stories of women with psychotic disorders stabbing people to death that I am not aware of?
As it did soon after the Virginia Tech massacre last April, CNN has been airing a repeat of a program entitled "Criminally Insane." It's done by the networks SIU, or special investigations unit. As someone with a fair amount of experience with investigative reporting and the criminally insane, the program strikes me as remarkably thin and is just a typical cheap attempt to get viewers to tune in on a slow news weekend.
Not once in all my years of watching CNN--and that would be like 25 years--have I ever seen the network put on a program about why we keep having anti-depressants seemingly connected to some of these rampage shootings. I'm not blaming the anti-depressants, I'm simply saying there's something there that demands an examination. Given how shopworn this weekend's program has become, maybe it's time the network did an update. Or are they going to let Fox News have all the fun?
News is breaking just now that NYPD has arrested David Tarloff, a 39-year-old man from Queens, in connection with murder earlier this week of Kathryn Faughey. He was reportedly linked to evidence at the crime scene and by witnesses in a lineup.
Earlier today, the NY Daily News reported:
"Cops believe the suspect was furious with psychologist Kathryn Faughey over a decision that sent him to a mental institution, the sources told the Daily News."David Tarloff, a 39-year-old Queens telemarketer, was picked up by cops shortly after midnight, according to sources. Investigators and neighbors said he fits the description of the balding, fat-faced killer.
"Tarloff, who was being questioned at Manhattan's 19th Precinct stationhouse, has a long history of mental problems and previous hospitalizations, the sources said. He has not been charged with a crime.
"His neighbors said he had been institutionalized by the state. He shared his Corona apartment with his elderly mom until she was put in a nursing home, they said."
More as it develops.
There's been a trickle of new information about Steven Kazmierczak, the shooter at Northern Illinois University who murdered five people before killing himself. Several people remain hospitalized, some of them could die, one may be blinded for life. I would encourage one and all to please go visit this page which has links to pictures of his victims. I'd post them myself, but I am technically inept when it comes to resizing pictures. I want you to keep the faces of those young women and one young man in mind for the rest of your lives whenever you or anyone you know talks about coming off an anti-depressant or is actively messing around with their meds. People died because Kazmierczak, in my opinion, violated some key precepts of being a responsible psych patient. I'll get to those in a bit. It's literally the only wisdom I can offer as people try to make sense of this terrible tragedy.
Also, I know a lot of people from Illinois are reading this site today and are likely very shaken by what happened in DeKalb. I can assure you that I understand the swirl of emotions and anger--we had a mass murder in my neighborhood in Seattle two years ago and, in one of life's weird twists, I had to go cover it for days as a reporter (there was no anti-depressant or psych diagnosis tied up in that murder BTW--just a bad, evil man did that rotten deed). I'm trying to be as respectful of your feelings as I can be in what I write, but there are some major issues around medications and mental health care in this country that keep coming to the surface and they simply must be articulated.
I want to caution that the news accounts I am linking to continue to be updated--that's the nature of the web--and information may have changed when you click on the links.
First, the Chicago Tribune is reporting that the shooter had been diagnosed with an anxiety disorder (I can't find that link again due to all the updating on their site, but in a sub head of what I have linked currently, his meds are described as anti-anxiety medications). It's also reporting that he had clearly premeditated this rampage and had lots of ammunition. It's not clear how long he'd been buying ammo and guns for and it's not clear how long he'd been planning (it's one thing to guy buy a handgun and a couple of clips; it's another thing entirely to buy six guns and stock up on enough ammo to touch off a massacre), but I am not as warm to the going off-meds made him snap theory of this incident as I was yesterday. Unless he'd been playing the on-meds this week, off-meds next week game for a while. If the latter is true, then I can only conclude that this young man screwed up very badly and isn't the victim of meds that some would like to believe he is.
That said, it's entirely possible that going off-meds recently was connected to his behavior, that his rampage was somehow induced by having been on anti-depressants and then having gone off them suddenly. I know there are many readers of this site who passionately believe anti-depressants, often used to treat anxiety, are connected to every incident of violence where someone had been on an anti-depressant within the last few years. I know that some of you want to see these medications banned. I think you are kidding yourselves if you think this case is going to achieve that goal. I disagree with banning these meds--they are beneficial for enough people to merit their use--but I do agree that for a minority of people who take them that there can be very ugly outcomes and that, as a culture of the pill, it is essential that the public know of these problems. Americans need to be a hell of a lot more careful about how they use and misuse anti-depressants.
Back to the Trib:
"Kazmierczak spent more than a year at a Chicago psychiatric treatment center called Thresholds-Mary Hill House in the late 1990s, former house manager Louise Gbadamashi told the Associated Press. She said his parents placed him after high school because he had become "unruly" at home. She also said he used to cut himself for attention."She said he often resisted taking his medications, though he eventually became "compliant." Gbadamashi said she couldn't remember any instances of Kazmierczak being violent."
In earlier press accounts, Gbadamashi had indicated that the future shooter could sure be spooky though. It's clear that since he was in a group home setting and not being held at any point on an involuntary commitment that he would not have gotten into the DOJ database of people who cannot buy guns (and that would depend on Illinois state law anyway, and I don't know Illinois' gun laws).
Here's what WLS-TV has:
"Kazmierczak, 27, was treated for mental illness nine years ago. He was considered volatile, according to a staff member who worked at the facility at the time, and violent if he stopped taking the antidepressant and anti-anxiety pills prescribed for him. Including Paxil, it was medication he was supposed to still be taking and apparently stopped a couple of weeks ago."Shortly after Kazmierczak graduated from Elk Grove Village High School in 1998, his parents became unable to handle him, according to a woman who worked as a residential manager at a psychiatric treatment center for mentally and behaviorally troubled teenagers. Kazmierczak lived at the Mary Hill Home, 7356 N. Winchester, on Chicago's Northwest Side and received psychiatric treatment for more than a year after he was diagnosed as mentally ill in the late 1990s. His parents sent him for treatment...."
"But a former patient who lived at the group home with Kazmierczak spoke to the I-Team.
"You either take the meds and you're fine, or you don't and you snap, kind of like that. And that's all it was with him. When he didn't take his meds, he'd snap," said Jennifer, the former patient.
"Hardeep Rooprai was one of his classmates and a friend. She says he told her that he'd been in a psychiatric group treatment home.
"He said he was in a group home, and he said that he was a bad kid," she said.
"At their last briefing, Northern Illinois University officials said they had no evidence Kazmierczak had received psychiatric treatment. After he finished treatment and left the group home, he enlisted in the Army but never made it out of basic training. He was "separated" from the Army. There's a report he told his girlfriend he was discharged for psychological reasons."
Yes, WLS-TV used the term Paxil, but from how they framed its use, it sounds to me as if he was known to be on Paxil at some point in the past, likely when he was in the group home, given that the station's sources seem to have known him at that time. It is not clear at all what medication he was on more recently. Please, readers, hold your fire on Paxil until we know more.
Yesterday, Fox News' Douglas Kennedy did a piece on anti-depressants and school shootings. Although I don't think he's got enough information to make the assertion that he does about Cho and Virginia Tech, I agree with him that we need to take a much harder look at possible connections between these idiotic rampages and the use and misuse of anti-depressants. I congratulate Fox News for being the only major network that is willing to ask some uncomfortable questions. Why the hell are CNN, NBC, MSNBC, ABC and CBS so quiet on this point? And why has the New York Times been so shy about even broaching the issue in the NIU case? I'm glad that the Trib and Chicago area TV stations have been willing to at least broach the issue by implication.
Here's the Fox piece:
Now let's come to the bit about being a responsible psych patient. I know some readers have already chided me for saying that responsibility ultimately rests with someone under psych care for knowing what's going on with the meds they take and what effects they could have on them and others when it comes to issues of suicidality and violence, that I am creating too high of a hurdle for patients and that, since their doctors don't warn them, they shouldn't be held accountable for knowing about possible issues. Sorry, but we are in the age of the Internet, there is decent information available online about these issues and for someone like the NIU shooter, who was smart enough to have co-authored an academic paper as an undergrad, to not have accessed this information is hard to believe. The guy was a total stats jock nerd and ordered gun supplies on the Internet. He knew how to use the Internet. If he didn't have any questions or concerns about whatever weird thoughts were getting into his head and didn't check into it on his own, then he was being irresponsible. Intelligent psych patients who want to make it in life should always know everything they can about whatever meds they are taking. There are no excuses.
I don't care whether doctors are telling patients about possible problems with anti-depressants or not. In this day and age, you simply cannot rely upon your doctor for complete information about any drug, be it an anti-depressant or a cholesterol lowering drug. Many of the problems that arise with the use of these drugs affect a statistically small percentage of people and your average doc will likely discount these problems in their patient population. The trouble is that if a drug has problems for 1 percent of the people who take it and 1 million people take that drug, then you'd expect to see those problems in about 10,000 people. Docs often assume that their patients won't be among those 10,000 and so don't tell what they know. Trust me, this happened to my father with Lipitor (he had a bad reaction to the drug, lost feeling in his left hand and had massive leg cramps and his doctor openly told him he was making it up) and it's only been recently that he's been able to use his left hand fully again.
That's still no excuse for patients not being fully informed about these issues. I don't care if their docs are withholding information or if the pharma companies and the FDA aren't telling the public about a certain problem, these issues are still being actively discussed by real world people on the Net. In my 10 years of so of using the Net to access information about psych meds, I have found the information presented to often be light years ahead of what the media is willing to report upon and what docs and various authorities are willing to discuss. That doesn't mean the information is always correct (even though I've rarely found flaws), but it sure does give individuals better resources.
Speaking of resources, here's a David Healy paper that discuss risks of violence attached to Paxil and Zoloft. It describes the risk as rare.
My other point is that I am sick and tired of seeing psych patients play the game of off-meds, on-meds, off-meds, oh I'm so confused about who I am and what to do and my doctor isn't helping. It's time to knock it off with that whiny BS. You are either on-meds or you are off-meds. Make a choice and stick with it. Stop treating yourself like a victim and treat yourself like an intelligent human being with a social conscience. The consequences of playing games with meds--and I suspect the shooter likely was, probably for a long time--are far too high for anyone with two brain cells to rub together to pretend like they are exempt from the consequences.
Lastly, if someone is to come off-meds as a result of a personal choice, then they have got to come off-meds very carefully. You must taper down slowly over time. You cannot just say "Oh, I'm so confused and tired of this damn med, so I am just going to stop taking it cold turkey." That leads to disasters, personal and public, almost every time. We've known in the American patient community for at least a decade now that meds must be tapered. There is no excuse for anyone not knowing this except sheer stupidity. And stupid isn't a defense.
If you think stupid is a defense, then go back to the top and go look at the pictures of the victims of the NIU shooting and, then, tell me what you think.
This news comes from the ABC affiliate in Chicago:
Steven Kazmierczak, the shooter who killed five people plus himself at Northern Illinois University yesterday, had a mental health treatment history that went back to his teens.
"Kazmierczak, 27, was treated for mental illness nine years ago. He was considered volatile, according to a staff member who worked at the facility at the time, and violent if he stopped taking the antidepressant and anti-anxiety pills prescribed for him. It was medication he was supposed to still be taking and apparently stopped a couple of weeks ago."Shortly after Kazmierczak graduated from Elk Grove Village High School in 1998, his parents became unable to handle him, according to a woman who worked as a residential manager at a psychiatric treatment center for mentally and behaviorally troubled teenagers. Kazmierczak lived at the Mary Hill Home on Chicago's Northwest Side and received psychiatric treatment for more than a year after he was diagnosed as mentally ill in the late 1990s. His parents sent him for treatment."
Obviously, that news flash ignores the possibility that it may have been withdrawal from medications that could have caused some of his troubles. Then again, maybe not. And, let's be clear: We have no idea what meds he was on until recently. He could've been taking anything.
"He was already on medication, but he was not taking it at home and would not follow instructions," said Louise Gbadamashi, former manager of Thresholds, the company that ran the home. She said the first thing she thought when she learned the shooter was Kazmierczak was, "he didn't take his meds. He was kind of quiet, kept to himself. He picked his friends, he was kind of passive aggressive."He was a cutter," said Gbadamashi. "He would cut himself. Then he would let you discover it. He wouldn't tell you, he would roll up his sleeve and ask you a question, and you'd turn around and see it."
She said Kazmierczak's expression rarely changed, so it was hard to tell if he was depressed.
"He strikes out, and you have to really know him," said Gbadamashi. "In his eye, you can see it. You can't look at him like, 'I'm angry, you're going to know it.' It's just stoic, just stoic."
In the shooter's defense:
"Alexandra Chapman was a friend of Kazmierczak."He was one of the most genuine people I have ever met. I want people to know that he was a really great person, that he was just a really great guy, he was so kind and would always do anything for you. So it doesn't make sense. I just don't want people to think of him as a monster," said Chapman."
So what would turn a "really great guy" who had an undetermined mental health diagnosis into a "stoic" killer?
Let me know what you think.
Here's what beats the hell out of me: About 30 million people took an anti-depressant in the US in 2006. Let's assume the number is about the same now and let's assume the shooter was one of them. So how is it that if anti-depressants cause some problems and so many people take them that we only wind up with people committing violence towards others where anti-depressant use may be connected perhaps three to six times a year? Or does it happen more? And why does it always seem to be the men who do this? Or are there stories of women doing this kind of thing that I am unaware of?
I'm not enough of an expert to say.
UPDATE: (7:25 p.m. PST) Looks like the shooter had been taking classes on mental health issues at the University of Illinois last fall. So why would someone who was smart and likely very aware of problems with coming off or going on psych meds not be hugely aware of his own situation and take appropriate steps to ensure that he and others were safe?
There's something in all of this that doesn't quite add up for me yet.
Some of you have likely already seen Warner's post on the New York Times website where she throws all sorts of cold water on Charles Barber's new book, Comfortably Numb, as well as on Christopher Lane, David Healy and Joseph Glenmullen. BTW, for those of you in the Seattle area, Barber will be doing a reading at Elliott Bay Books on Monday evening at 7.30 p.m. I will be attending for sure.
I haven't received a review copy of the book yet because unlike Warner I am a nobody. From what I understand of the book and from reading Barber's excellent essay in the Washington Post, I think Warner may have ignored the book's larger message that recovery from mental illness happens in a social context and that we are doing a rotten job in our culture of addressing the social realities of mental illnesses. That's kind of an important point, given how many people we are diagnosing with mental illnesses in our country. I'd encourage one and all to read Barber's essay.
But Warner ignores that point (you can do this when you are a columnist at a major paper) and instead goes after the idea that Barber expresses in his book--and that Lane and Healy and many others have written about as well--that we have become a culture of the pill and that we are medicating ourselves into oblivion, and that that will have dire consequences for us as a culture. Warner is far more interested in a review of Barber's book written by Peter Kramer (Listening to Prozac) on Slate the other day, probably because Kramer savages Barber on the overmedication issue (he too ignores the rest of the book's points) and because Warner has sure made it her stock in trade in recent months to argue that medicating children is a good thing.
While I appreciate hers and Kramer's skepticism on this issue (both of them claim that there is no hard evidence that we are using meds in America more than any other culture), I think she's off the rails right here:
"Just because it feels like, just because it sounds like, just because soaring drug company profits and obnoxious direct to consumer advertising seem to indicate that everyone around us is popping pills like mad doesn’t mean that they are doing so. Nor does it mean that we’re in the grip of some new, previously unheard-of, and uniquely epoch-defining social phenomenon."
And here:
"Most of the critics decrying the over-medicalization of the American mind rest their arguments upon the bedrock assumption that people who have nothing wrong with them – happy-go-lucky types who essentially make a wrong turn on their way to Starbucks or soccer and end up in the consulting room – are being medicated for largely fictitious concerns."
Hers and Kramer's basic argument is that Barber is out of touch with history. You can read Kramer's review here for a much lengthier examination of the issue. While I get that point with adults (God knows Americans have been medicating themselves against whatever with all manner of booze, snake oil and pills since before we were a nation), I don't think it has nearly as much bearing on current times as she thinks. What's more, I think she's missing a very key point when it comes to kids and teens. And so I left her a comment on the paper's website:
"No disrespect Judith, but did you forget about the 4,000 percent increase in the diagnosis of bipolar disorder in kids that was revealed last year? Considering the split amongst mental health professionals on whether that dx is even real and the rise in the use of that dx in our country, I’d say you missed something that should’ve found its way into your writing. Or does it not matter because it mostly involves little boys? "
How she could've ignored the bipolar child controversy in what she wrote strikes me as sloppy work. How Warner could not have even referenced the recent studies showing that many ADHD kids turn out just fine with or without medication, that ADHD meds seem to retard brain development and so on strikes me, again, as sloppy work. How Warner could not have even flown the flag of concern around the use of anti-psychotics in children strikes me as a flagrant foul (she should be referencing it in adults too). I have no idea why Warner doesn't get that we are now diagnosing mental illnesses in kids where less than a generation ago we would've let the kids alone, and that all this dx'ing and treating with very serious medications has serious cultural implications--and last time I checked we had never done this with kids before in our entire history.
I don't think we gave little kids Valium in the 1970s. I don't think we gave them shots of whisky in the 1920s. So her argument--and Kramer's--that Barber and others, by implication, are losing sight of history utterly falls apart when it comes to kids and teens. I think it's weak when it comes to adults, as well.
Like I said, I do appreciate her skepticism. I simply wish she'd done more thinking and less reacting here.
This brings to mind two events from this week in my personal sphere. On Monday, I was interviewed by an NPR station in Massachusetts regarding the mandatory mental health screenings that the state is forcing upon children and teens. I have no idea if what I said will make it to air, but I pointedly objected to this diagnosing everything as a disorder culture we've created around childhood because there is much disagreement among doctors about whether some of these diagnoses are even valid, that we are using meds to treat them that are grossly underresearched in children (and adults in some cases) and that we've never done anything like this in our history. The reporter seemed a bit frustrated by my objections (apparently, she's got pediatricians telling her they are all in favor of this) and the fact that I couldn't point her to evidence that these screening programs are problematic in any way. So what I told her was that I couldn't point her to any evidence of problems because no state and no nation to my knowledge has ever done anything like this in such a sweeping fashion as is Massachusetts. We are in uncharted waters, I told her, and it'll be interesting to see how this plays out over the next year or so.
I'll let you know when I can when the piece airs.
Second, when I told students at UW the other day about just how much medicating of kids is going on in America these days, their mouths literally fell open. I really don't care if one is in favor of or against what's going on with kids these days, but to argue, as Warner is by implication, that there's nothing unusual in over 2 million children (and maybe more) getting anti-psychotics for things like child bipolar disorder and ADHD is to be wildly ahistorical. Perhaps even more than she and Kramer accuse Barber and others of being.
But then, like I said, Warner is a big shot, she's at the Times and she can say whatever the hell she wants and get paid well for it. I hate to sound too harsh here, but perhaps this is because most of the kids who are getting anti-psychotics are boys, Warner is a woman and I have noticed a trend amongst some women writers (certainly not all) that what's going on is OK because it settles rambunctious children (meaning boys) and makes them focus. To me, this is one of the ugliest strains of feminism, right up there with the "all men are rapists" school of thought. The discouraging thing is I support many of the precepts of feminism, but in the hands of some alleged intellectuals, it's gotten way out of hand.
During my talk the other day, I decided to finally say publicly what I've not had the nerve to write before: We have zero idea how these medications will affect the physical development of these children and I am especially concerned because of the propensity of some of these drugs to cause impotence. Do we really want to create a generation of little boys who can't get it up once they are men?
I assume most women would be against that. But maybe not.
Speaking of ahistorical times, during my talk I referenced Freud and Jung a few times and expected to see glimmers of recognition on the faces of students. I was trying to give students a sense that we used to use terms like neurosis to describe these issues--and that many of what are now considered valid dx's weren't even considered mental illnesses. I saw no glimmers and asked point blank if any of them had ever read Freud. These are honors students, as I was once, and I would've expected them to bump into Freud during some Western Civ class. No one had read him.
Regardless of what you think of Freud (I think he's lame most of the time), it's wildly out of touch with our cultural history that smart college students wouldn't have been exposed to his work.
There are now two press reports that the shooter at Northern Illinois University, who killed five people plus himself and injured many others, had recently stopped taking medication of some kind and had become erratic. Authorities have not identified the medication or the type of medication it was. That's all I know at this point, and I'm concluding anything. Just passing it along. More when I know more.
UPDATE: (3:38 p.m. PST) I am just pushing this out there and hope that people will not make too much of this, but it's highly likely that the shooter was taking meds for some unidentified mental health diagnosis. From the Chicago Tribune:
"Authorities in DeKalb confirmed Friday that Kazmierczak had recently stopped taking medication. Thomas said Kazmierczak had confided in him that he had served in the military and received a discharge for psychological reasons."'He only discussed that with me in passing,' Thomas said. 'He seemed as normal as you or I.'"
That said, there is no confirmation of what meds the shooter stopped taking recently. Almost every account I've read of this guy stresses that he was a very good student, who stood out in class lectures because he was interested in the material and that people who knew him cannot make sense of this act on his part. So clearly something unusual happened here.
I want to use this opportunity to stress, as I have before, that anyone who takes meds has to be very careful about going off of them. You owe that to your fellow human beings and to yourself. What's more, you need to be just as careful going on meds or during dosage changes. I don't care if you are for or against meds--meds are not be messed with. There are too, too many reports of tragedies involving people coming off meds or going onto meds or who are playing games with their meds. Please, please, please make sure that you involve family and friends in monitoring your psychological condition when you are coming off or going on meds. This is essential.
No matter where you stand on meds issues, I hope we can all agree that these situations need to be managed much better, particularly in younger people who do seem to react very strongly to these medications, both good and bad.
Yesterday, I wrote about the murder of a psychologist in New York City and wondered aloud and somewhat innocently at why this nonsense happens and continues to happen in our culture. I don't hear too many stories of Brits hacking their psychiatrists or psychologists to death--OK, I know of zero cases like that in the UK. The post received several comments that I find disturbing and unacceptable, forcing me to ponder why I am even bothering to do this blog if the best I can get out of readers is a bunch of inhumane BS and tired anti-psychiatry polemics.
I am just as frustrated as others are about the mess that is mental health care in America (the recent news about Paxil has increased my frustration), but that doesn't excuse me from following basic laws of human behavior nor does it justify the untoward acts of others (it might help explain them, but it will never justify them). If you cannot understand that, then I'd respectfully suggest that you stop reading this site.
I won't bother to quote from the comments (you can read them in the thread on the initial post), but can summarize a couple of the key sentiments: the murderer was likely on a whole bunch of meds that were making him crazy; and, mental health workers hurt patients all the time, so they get what they deserve.
At the risk of pissing off readers, let me point out that I have no tolerance for murder and violence--no matter who commits it and no matter what treatment they may or may not have been getting. Murder is wrong, always and forever. So is violence against innocent people.
The meds-made-him-do-it argument is meaningless--especially since we are talking about a psychologist and last time I checked psychologists don't prescribe anything--and justifies nothing. Individuals are still responsible for their own behaviors and this knee-jerk attitude that every violent act committed by someone with a DSM diagnosis is intimately connected with their meds is dumb. Yes, we all know of cases here and there where there's a fairly strong indication that meds played a role in someone's misbehavior. But there's no information along those lines available in this case--and I wish people would learn to push their personal experiences aside when such tragedies occur and wait until more complete information is available.
The argument that mental health workers get what they deserve is offensive to me. Anyone who subscribes to it needs to get their butt out to Seattle and give me what I deserve because I have done mental health work. In fact, during my recent stint working at a homeless shelter, I was actively involved in convincing several people diagnosed with schizophrenia to actually take their meds. As tasteless as I found that, these were openly psychotic and delusional people. They were violating even the simplest rules of human conduct in a shelter (running around naked, hitting others). In the system as it currently exists, there was nothing else I could do to help them lest they wind up on the streets where I am reasonably sure they would die rather quickly. The sad fact is that with some of these folks their best option for a decent life is to take their meds, get stable and see what they can do to improve their care and quality of life later on. Running around all delusional is a death sentence much of the time. So if you genuinely believe that mental health workers always harm their clients, please come to Seattle and tell me all about it.
There are a lot of things to dislike about mental health care in America, but turning one's frustrations with the system into attacks on caregivers who are genuinely doing the best they can is disrespectful and is likely disrespectful to yourself if you think about it. Or would you advocate hitting your local parish priest because the Catholic Church turned a blind eye to sexual abuse of children? Please. I think you know the answer.
But maybe some of you will be even more frustrated by the following: I am currently working on an article concerning anti-depressants. My personal views on these drugs are well-known. I don't think they work very well for many people, but they do work extremely well for others. But since I am doing professional work on the issue, I have to put aside my personal feelings and reach out to some of the key thought leaders in psychiatry and have them explain to me where we are in our culture with depression treatment. I simply have to be fair to both critics and proponents of anti-depressants. Readers of newspapers have a right to expect that and I am going to give it to them.
Why can't some of you be as fair when a psychologist gets stabbed to death?
You know about how key opinion leaders, as they are called, are used by pharma companies in pharma marketing, right? These are the researchers and leading authorities in whatever medical field who are often paid handsome sums by companies to issue statements praising company X's anti-depressant or its cholesterol-lowering drug. The statements show up in press releases, in company marketing materials, or the KOLs make public statements at conferences and such. It's all about giving a sheen of credibility to whatever the drug of the moment is so that doctors will prescribe the drug without a second thought, regardless of whatever doubts may exist about the drug. Why wouldn't they? Some big shot has just said the drug works and the big shot is always right. That's why they get the big money from Big Pharma.
I'm sure this system works out just fine somewhere in pharma marketing and that all parties involved are, in general, decent human beings. That said, CL Psych has parsed some of the recently released Paxil documents and it's clear that some KOLs were hip deep in the muck helping Glaxo obfuscate data that showed suicidality problems with Paxil.
Among these folks is David Dunner, now an emeritus professor of psychiatry at the University of Washington. Yesterday, I told students who attended my talk on mental health that the UW Medical School's hands were fairly clean when it came to controversies around mental health issues. I decided not to mention a thing about Dunner, who's been busted in the conflict of interest sweepstakes before, since I didn't know about this Paxil business.
Here's what Dunner did and said after apparently not reviewing underlying data from Glaxo concerning Paxil:
"Suicides and suicide attempts occurred less frequently with Paxil than with either placebo or active controls."
Thanks to recently released court documents we know that that isn't the case. In fact, Glaxo had been hiding the fact that it had known of increased suicidality attached to Paxil use since 1989. In 1995 Dunner co-authored a paper stating that Paxil reduced suicidality.
"Consistent reduction in suicides, attempted suicides, and suicidal thoughts, and protection against emergent suicidal thoughts suggest that Paxil has advantages in treating the potentially suicidal client."
Asked by a lawyer if he'd reviewed the underlying raw data as opposed to summary tables provided by Glaxo:
"Dunner: I didn't see the raw data in the case report forms. I did see the tables. I work with the tables. The tables came before any draft, as I recall. We -- we created the paper from the tables."Attorney: And -- and you never questioned, did you, or did you not question the validity of the data in Table 8?
"Dunner: No"
So why don't some researchers look at underlying data when they are authoring a paper? Does money from Glaxo buy that much laziness or academic disinterest? I would have no idea, but what burns me up about this kind of behavior--and Dunner is far from the only researcher to engage in it--is that researchers with MDs actually owe something to the patients who are the actual end users of their opinions. I'd wager that their Hippocratic oath requires it.
So much for clean hands over at UW.
Meanwhile, Bob Fiddaman at Seroxat Sufferers has posted pictures of some researchers who helped Glaxo hide the nad news about Paxil from their colleagues and patients. Yep, Dunner's picture is there.
It's been almost 14 years since I ran into problems on Paxil--I was an early victim--and this still kind of pisses me off. Thanks for helping to protect my interests, Dr. Dunner.
Yet another case of a mental health worker murdered on the job. A suspect is still on the loose, and police are operating on the assumption that a patient may have stabbed the psychologist to death and, then, stabbed a psychiatrist who came to her aid.
Psych Central has details of the recent murder of a psychologist in Massachusetts.
I'm simply lost as to why some patients turn on their caregivers, especially in such an inhumane fashion.
I am mostly going to be unplugged from my site today because late this afternoon I am presenting a "talk" (aka, informal guest lecture) to students at the University of Washington honors program. The title is "Mental Illness in America: Consensus, Controversy and Chaos" and I am spending time preparing for that as well as doing some reporting on an article that will run soon. Unlike the lecture I gave in Florida in November, I'll only be driving a few miles to get to UW. No jet lag. I'll let you know how it goes tomorrow.
In the meantime, feast your eyes on these.
I cross-posted yesterday's post on language I use to describe mental illness over on Daily Kos. One commenter ("oke" in the comment thread), a 40-something, late-diagnosis bipolar, called me a murderer for questioning mental illness' status as a disease (there's something about the D-word that I just cannot get out of my mouth). In recent years, there's been an upswing in late dxs of bipolar disorder and while I am pleased this person believes they have found some answers to their existence on Earth, I've certainly never been slandered in such a fashion before (other commenters were more agreeable). But, then, I have found that some of these late dxers can be very annoying to deal with. They are quite religious about their diagnosis and strident about how they think it ought to be treated. They often talk as if everyone should be medicated into the ground, children included. It's how they've overcome whatever ails them, so it must be the answer for everyone else. Their transference is very high, as a psychologist friend of mine put it to me yesterday. At times, I almost want to force them to read Foucault just to open them to other perspectives. I hope they get over themselves soon.
Diagnosed long ago, Liz Spikol, who does The Trouble With Spikol blog and column, has been having a tough go with depression lately as well as with Effexor, her longtime albatross of an anti-depressant. Add to that some personal turmoil and that she's edgy about the arrival her 40th birthday and it's no wonder she's been quiet of late. The weird thing, Liz, is what they say about life beginning at 40 is largely true--except I think it may have been at 41 for me.
CL Psych reveals a pissing match in the world of education over kids at school with bottled water. I once worked in the public schools and am not surprised that teachers are wringing their hands over this issue because, if it weren't for that, I can assure you it'd be something else. But they'd still be all wet.
Bonnie Fuller, the former Us editor, writes a truly air-headed piece at the Huffington Post about how Britney Spears should've spent 30 days in the hospital. How about everyone drinking a nice big cup of shut the hell up on the affair de Spears and let her figure out what's up with herself? It simply astonishes me how capricious some commentators in this country are when discussing the health and physical liberty of their fellow Americans. Have they read the Bill of Rights? Are they at all familiar with the Federalist Papers?
Aubrey Blumsohn, a British doctor, goes after delusional claims by Glaxo's outgoing CEO, who blames the company's problems on the media. No, Mr. CEO, you've got it all wrong. We're the ones who have been properly alerting the public to concerns around Paxil and Avandia amongst other of your company's star-crossed products. You are the idiots who've been covering up evidence of your drugs' problems for years. Blumsohn is assisted by our friend Matthew Holford.
Psych Central's John Grohol reports on a very creepy weblog and the trouble it could foster. I've reviewed the site and, hoax or not, find it to be equally troubling. Or maybe it's like Radar speculates--a viral marketing scheme along the lines of lonelygirl15.
Gianna Kali continues her journey getting off-meds.
Writhe Safely rightly takes on liberals who don't understand the liberal position on mental health issues. The author and I are both deeply frustrated with some readers over at Daily Kos and elsewhere in the liberal activist blogosphere. Have these folks never read John Stuart Mill? Did they think John Milton was just a poet?
Stephany at Soulful Sepulcher righteously rails against the mental health system that won't work for her daughter. Or her.
Going Through Hell has a very intense post that I won't even attempt to summarize.
You all have a fine day, wherever you are. I will be approving comments throughout the day.
Oh, this is just breathtaking: Blue Cross of California, the state's largest for-profit insurer which is operated by WellPoint, is asking doctors at large medical groups to tattle on patients of theirs for hiding pre-existing conditions from the insurance company. Seriously, the company is asking docs to breach doctor-patient confidentiality, which is supposed to be one of the toughest firewalls in all of human life. Various doctors' groups in California and patient groups are protesting the move and for good reason.
Not only would patients begin withholding information from doctors, which kind of works against what medicine is supposed to be about, but it just shows how all encompassing health care companies have become in our lives. Or are trying to become.
You can read about it in this Los Angeles Times piece. The implications for mental health care in this scenario are obviously immense.
So what's next? Insurance companies ask psychologists and therapists to phone in their clients' innermost thoughts to the company each week?
I hope whomever our next President is goes absolutely ripshit on the insurance and pharma companies who are acting much as the big oil trusts did before Teddy Roosevelt brought them back to Earth.
Many of you know that last week news came out that documents in a California-based lawsuit established that GlaxoSmithKline had been hiding suicidality data connected with the use of Paxil (Seroxat elsewhere) for some 15 years and that a US Senator was demanding answers. Bob Fiddman at Seroxat Sufferers has been demanding answers for even longer and here he puts some of the evidence Glaxo was hiding onto YouTube. With music.
A couple of weeks ago, I noted that Britney Spears was reportedly being treated for bipolar disorder, although to date there is has been no confirmation from Spears herself (People has her on the cover this week and declares in a subhead that she is "bipolar"). I wrote at the time that I was troubled that one entertainment web site had described Spears as having a "disease."
"But talking about this as a disease....Oh, well, looks like the fine entertainment media in this country may need a wee bit of education about the chemical imbalance theory and what it isn't."
Yesterday, a reader left the following comment:
"Why do you not want it called a disease? Is illness that different a term? Bipolar in indeed a mental illness."
Every so often, I feel the need to explain the terms I use when writing and talking about mental illness. Hopefully, I can explain myself once again in a respectful way.
When writing about schizophrenia, bipolar disorder, depression and all the other DSM maladies, I use the terms mental illness and disorder to describe them. I almost never use the term "disease" and I certainly never use the term "brain disease." My reasons are a mix of the personal, the scientific and the political.
Once upon a time, back in the early-1990s, I believed in bipolar disorder as a brain disease and that it had a specific, identifiable pathology, as many researchers theorized then. I turned myself over to the medical model of disease management, convinced that I had a disease caused by deficiencies of chemicals in my brain and that I was a victim of bad genes (even though no one in the entire known history of my family had ever been diagnosed with so much as depression), and that none of my behavior was my fault. I had a disease and couldn't help myself. All I needed to do was find the right combination of meds and I'd be back to my old self. Important researchers said so. Who was I to argue with them? In the meantime, couldn't people just stop the stigma and understand that I was helpless and offer me love and acceptance?
This mindset of mine damn near killed me, as I was undone by meds several times. I've written about this elsewhere and don't feel like repeating myself. I'm fine with describing bipolar disorder, depression and schizophrenia as mental illnesses some of the time, although I believe that in its subsyndromal forms bipolar disorder, for example, more closely resembles a personality disorder, at least for metaphorical purposes, than it does a true illness that renders the sufferer a helpless victim. I'm often use the term "disorder" as well to describe mental illnesses such as depression and schizophrenia. That's my deal these days on a personal level with the nomenclature of mental illness.
On a scientific level, my deal is that when someone can prove the biological mechanism of a mental illness to me and prove to me that said mechanism is the cause of the disorder (and this research is then appropriately replicated), then I'll consistently call use the term disease. I'm well aware that the brain and brain chemistry is connected to and associated with mental disorders, but I've never seen convincing evidence that they are the principle drivers. If they were, I think it would be safe to assume that 100 percent of patients (or, hell, 80 percent) would respond positively to anti-depressants, to use one example. This is not the case on any planet I am aware of. The short story is that psych researchers have never established the central lesion of mental diseases, and I don't believe that I am dipping into anti-psychiatry by saying so.
On a political level, I think insisting on the term disease as a proxy for mental illnesses and mental disorders sets patients up to be one-trick ponies in the medical model and on their knees for the rest of their lives awaiting the magic pill and the magic genetic fix that I believe will likely never arrive, not in my lifetime at any rate. I'm not interested in living my life on my knees and not too long after I stopped using disease as a metaphor for what I was going through, I felt better.
So if you want to use the term disease, go ahead. Whatever gets you through the night. Just don't expect me to use that terminology very often.
Another reader replied to the above commenter, arguing:
"Bipolar Disorder is a label used to take civil rights away from people, not a medical disease. Mental illness is a sane reaction to insane situations, not a medical disease. This does not mean human suffering is not real, it doesn't even mean it's wrong for people in extreme emotional pain to take drugs, but there is no evidence that there's a disease called bipolar disorder."
I am sympathetic to this argument, but I don't fully buy it either. After all, I've never had my civil rights taken away via forced hospitalization (or voluntary hospitalization for that matter) or forced treatment and I've never been arrested for anything connected with the disorder. In fact, the only time I've ever been arrested was after I beat the hell out of a guy at a party who picked a fight with me in 1985. It was self-defense as I argued to the police outside on the sidewalk, so they couldn't arrest me--except that I was drunk on a public sidewalk so they arrested me for that, took me to the Salt Lake City jail and beat the shit out of me in the jail's parking garage while I was still cuffed (I still have chips in my teeth). I was never charged with any offense. Gee, I wonder why.
Anyway, I agree with the commenter that in some cases mental illness sure seems to be kicked off by someone having an off-the-wall response to life's insanity (aka stress), but I'm not sure that explains all cases of mental illness. As for the evidence of a disease called bipolar disorder, I'd say there's abundant evidence of a disorder and maybe an illness, but much less evidence of a dominant disease state regardless of what all those PET scans, fMRIs and so on show.
Some would argue, "But the meds treat the disorder, so it must be a brain disease." That may be true for the minority of patients who are well-treated by meds, although I am dubious of that over time. But then how would you explain people who are well-treated and achieve subsyndromal states for long periods of time without meds at all or who achieve the same state via psychotherapy or psychotherapy with meds or by vitamins alone (yes, there are a few of those apparently). In these cases, where the meds are a supporting actor at most if at all, it sure doesn't sound to me as if the use of meds establishes a disease state.
If you think I am off-base, consider: I have some authoritative child psychiatrists telling me that what's called childhood bipolar disorder is in fact a blend of oppositional defiant disorder or conduct disorder, and, in their experiences, is the result of truly awful environments. So would that be a disease? Sure doesn't sound like it to me.
For me, the whole matter of diseaseing a disorder just boils down to the fact that disease is any excessive term. That said, I have certainly seen cases of schizophrenia, depression, OCD, anxiety and bipolar disorder that appear so profound and so awful that the term disease is almost warranted.
But almost only counts in horseshoes not in life.
At times, some readers have accused me of being in bed with the Church of Scientology for my skepticism about the dominant paradigm of mental health treatment. I think that amounts to hate speech on their parts, especially when they are effectively comparing me with the CoS's leader who gave this bizarre speech attacking psychiatry last year. Watch it. It's worth your time.
I'd trust Scientology's way to happiness about as much as I'd trust Code Pink to run a war, which is to say not at all. While it's not clear to me that the church's leader is advocating violence against psychiatrists, as the video's poster claims, it sure is creepy stuff.
And just for fun, here's a video from Sunday's protest at a CoS center in Seattle. Sunday was the day the "anonymous" campaign was allegedly going to shut down the church.
Last time I checked, the church was moving right along. And so was psychiatry for that matter.
I forgot to note the other day that Feb. 7 marked the one-year anniversary of this site's hosting of the leaked Zyprexa documents. They are still online for the public to peruse. Happy reading.
Yesterday, the New York Times' op-ed page had an opinion piece by a 25-year-old former drug addict and author arguing that Britney Spears is an example of how commitment laws in California--and one assumes elsewhere--are messed up. Why? Because Spears was able to sign herself out of a 14-day hold, which, as I understand it, was a voluntary hold at that point (she started her second psych unit trip on a 3-day involuntary hold). Nevermind that in the week or so since, all is quiet on the Spears news front and one assumes she's more or less OK.
Before I disembowel this piece, I have to really question why the Times chose to run it. I hate to be a nitpicker, but Spear's clinical diagnosis is not known and neither is her situation with drugs. She has issued no statement and I have read no interview with her where she 'fesses up to anything. Everything we "know" at this point is mere third-hand speculation, so I think it's a an ethical breach on the paper's part to let someone write an op-ed, which is essentially an advertisement for the author's book, and stand there and point fingers at Spears, especially absent a compelling news hook. This makes me think the paper's editorial board has an agenda when it comes to commitment issues and it's not one that I like.
It's also not one that is well thought out in the author's hands. She, Mia Fontaine, recounts her own history as a teen heroin junkie hanging out with dealers--one assumes she was doing more than hanging out in order to get her fix, but she skips that part--before she wound up in forced treatment after getting busted in Utah. She cleaned up and moved on with her life and has written a mother-daughter account of her experiences. That's very touching and it's nice to hear she got her act together, but to turn her experience into an argument that commitment laws are too weak and that parents ought to be able to commit their kids when they think it's necessary and that all these court hearings required by law to impose 14-day involuntary holds is somehow detrimental to people is a pile of BS. A steaming pile in fact.
Those court hearings are there to protect the Liberty of all citizens, so that the state or a cop angry at a girlfriend (yes, it's happened) cannot commit someone to a psych unit against their will without a legitimate underlying threat to the person or to society at large. It's not a perfect system, but unless you want to live in a dictatorship then it's roughly about as good as we are going to get. I know the weakness of this system very well, and will get into them another day.
Of course, various commentators with an agenda to push have been writing similar op-eds for the last decade or so. Fontaine does little to advance their cause, except for the luck of being published in the most important newspaper in the world. But as it is, she commits a whole series of journalistic sins, ones that an intelligent editor should have caught.
I've already mentioned that using Spears as the example for the article is incredibly weak and unethical in my mind. Spears has no way of clearing the record. Unless she wants to pen her own op-ed. I've also mentioned that Fontaine seems to have no idea that we've reached the point in time where there are appropriate tradeoffs between individual liberties and social safety carved into most commitment laws already.
Anyway, throughout the piece, Fontaine conflates mental health treatment with chemical dependency treatment. That's just stupid. You can't stop being depressed just by doing it, but you can certainly halt a CD issue by stopping use of the drug in question. While I know there's a fair amount of dual diagnoses afoot in the mental health world, the two things are still different beasts. In fact, most psych docs I know won't even diagnose someone who has an underlying drug addiction or alcohol problem until they are clear of said problem. There is plenty of alcohol-induced psychosis out there and I've seen cases where once the booze is gone the person ends up with a realistic diagnosis instead of schizophrenia, say.
Also, Fontaine makes the implicit argument that junkies should be forced into treatment. That's also dumb. If someone falls into the clutches of the law and works out a treatment plan with a judge in exchange for less jail time, fine. If a parent wants to force their kid into chem dep treatment, fine. But the sad fact is that the only junkies who ever get clean are the ones who want to get clean. I know this to be true of heroin and I know from personal experience that it is true of cocaine. If someone fundamentally doesn't want to be clean, then they will relapse again and again. Forcing them into treatment absent a criminal case or their being a non-emancipated minor is a waste of resources in a system that is so overburdened that it hardly has room for people who do want to get clean. What's more, the success rates of chem dep programs are hardly anything to cheer--they hover at around 20 percent, depending on the program, the person and the drug.
My larger point here, just to be clear, is that getting clean of drugs requires will power and desire. Just tossing someone into treatment doesn't provide that. How that point got left out of this op-ed is beyond me. Again, that makes me wonder what the agenda is over at the paper's editorial offices.
Here are some of Fontaine's thoughts:
"Hamstrung by the new laws, parents of mentally ill and drug-addicted young adults can now do little but stand by helplessly."Ms. Spears’s situation outlines the dangers of blurring the line between socially celebrated behavior and behavior with profound psychological causes. And while her friends and relatives (and a world of transfixed fans) seem to be able to differentiate the two, and recognize that Ms. Spears needs help, now our legal system can’t or doesn’t care to treat someone until he or she has endangered others or themselves, often irreversibly.
"Granted, the laws that once allowed us to force adults into treatment could be abused: extreme electroshock therapy, lobotomies, philandering husbands committing their wives, embarrassingly promiscuous daughters being locked up. But in trying to eliminate the possibility that someone could be wrongly committed, we have cast out Britney Spears, and others much less famous, from the havens where they might have been helped.
"They need to be brought back."
I'm sorry, but what's the argument that the parents of young adults--I presume we're talking 18 and 19-year-olds here--have anything to say about what their former minor-aged kids should or shouldn't do? Second, Fontaine sure seems to have a lot of faith in psych units--but calling them havens is a bit of a stretch and a political statement. When you can show me a class of psych meds that works 80 percent of the time and without injuring the patient, then maybe I'd buy that thinking.
I'm not sure if Spears and others need to be "brought back," but I'm pretty certain Fontaine's piece needs to be brought back for editing by an intelligent adult.
Nick Clegg, leader of Britain's Liberal Democrats, recently made some bold pronouncements about mental health treatment in the UK, basically that the NHS relies too much upon anti-depressants and makes it too difficult for patients to access psychological services.
"Clegg, who is putting mental health at the top of his party's public services agenda, said it was time that the issue was put at the centre of the political debate. He said: 'It is time to break the silence - we must take the issues around mental health out of the shadows.'"He accused the Labour government of under investment in mental health services and failing to provide alternatives to drug therapies, branding Britain as the 'Prozac nation' after revealing that 31 million prescriptions were issued for anti-depressants in 2006, including 631,000 for children.
"He said: 'What does that say about us as a society - that we [accept] the explosion of anti-depressant use as if it was of no consequence?'"
While I generally think it's time to head for the hills when political leaders talk about how they will fix mental health services, I admire Clegg's forthrightness. It's interesting that it comes right on the heels of the MHRA slapping suicidality warnings on anti-depressants sold in the UK.
And the Washington Post has a decent account of the situation, including a cameo by Alison Hymes, author the Charlottesville Prejudice Watch site and an ally in trying to get the big mess around mental health issues in this country resolved.
Researchers yesterday halted a portion of a long term study of diabetes treatment which, as it turns out, disemboweled a key bit of dogma in treating type 2 diabetes. One of the central conceits of diabetes care is that patients should lower their blood sugar level as low as possible, even to normal levels, in order to protect their hearts. That sure sounds like it should make sense. But patients who followed that strategy died of heart problems at a greater rate than patients who didn't.
The finding certainly upsets one of the central tenets of health care, and there's been a lot of that going on the last few years. The theory that hormone replacement therapy was good for post-menopausal women went down in flames; so did the belief that being skinny assured us of long lives; and that low-fat diets were a form cancer prevention; and that low cholesterol always protected against heart disease; and that anti-depressants were anti-suicide technology in a pill; and that second generation anti-psychotics had no side-effects in long term use. All of that has either been called into doubt or struck down.
Next thing, we'll learn that smoking cigarettes is actually good for you.
Strangely, I'm sure that there are thousands of doctors going into their offices today certain that all of the above theories are true and advising their patients to abide by their precepts, probably because they believe it works for their particular set of patients or because they are out of touch with the evidence base.
For the last 30 years in our culture, we've been doing medical research on a scale never seen in human history and doctors have been making sweeping pronouncements about how individuals should live and how society should order human behavior. We've got food bans, smoking bans and depression screenings in schools, and yet none of that seems to be having the effect on human health that the proponents of various theories claimed they had evidence of. That's just weird.
So what happened? How did medicine become so muddled? I don't even have a theory. Do you?
Note: As with other of today's posts, after 8.30 a.m. PST I won't be able to approve comments again until late this evening as I am on the road today. But comment anyway and thanks for your patience.
Sen. Chuck Grassley (R-Iowa) yesterday sent a letter to GSK asking for copies of documents recently unsealed in a court in California that point to the company knowing of elevated suicide risks around its anti-depressant Paxil as far back as 1989. In particular, the senator wants nine pages of documents that were left out of the public release.
Grassley, the ranking Republican on the Senate's Finance Commitee, has been banging on a slew of pharma companies and the FDA for some time now, including Lilly and AstraZeneca.
Note: As with other of today's posts, after 8.30 a.m. PST I won't be able to approve comments again until late this evening as I am on the road today. But comment anyway and thanks for your patience.
Thanks to Rosie at ssristories.com for pointing me to this account of actress Delta Burke ending up in a psych unit and for pointing out that Burke, the former star of Designing Women was once a spokeswoman for Wyeth's Effexor, an anti-depressant, and made public appearances on behalf of the company.
That makes reports that she was on as many as five different medications, including anti-depressants, sadly ironic. Even more ironic is that she says the meds weren't working. Burke is reportedly being treated for depression, OCD and hoarding behavior. I wish her well.
Of course, the whole celeb spokesmodel thing for anti-depressants has always been a bit weird. Four years ago, former Steelers QB Terry Bradshaw was on the road making appearances on behalf of GSK's Paxil. Said Bradshaw at the time:
"'I was diagnosed with clinical depression about five years ago," says Bradshaw, who won four Super Bowls. 'When you're clinically depressed the serotonin in your brain is out of balance and probably always will be out of balance. So I take medication to get that proper balance back. I'll probably have to be on it the rest of my life.'"
When I see Bradshaw yukking it up during NFL games I often wonder if he's still suffering from depression and how the Paxil worked out. Or didn't. Anyone know?
Note: As with other of today's posts, after 8.30 a.m. PST I won't be able to approve comments again until late this evening as I am on the road today. But comment anyway and thanks for your patience.
That's the angle the New Scientist takes on recently released court documents from a lawsuit against Paxil's maker, GSK.
"An analysis of internal GSK memos and reports, which were released to US lawyers seeking damages, suggests that the company had trial data demonstrating an eightfold increase in suicide risk as early as 1989. Harvard University psychiatrist Joseph Glenmullen, who studied the papers for the lawyers, says it's 'virtually impossible' that GSK simply misunderstood the data - a claim the company describes as 'absolutely false.'"Glenmullen's report rests on documents obtained by lawyers in Los Angeles, who are bringing around 30 cases against GSK linking suicides and suicide attempts to the use of Paxil. The report was under seal at a district court in Sacramento, California, until 18 January, when the judge agreed to make parts of it public."
GSK did not alert the public about increased suicidality around the drug's use until 2006. You can read the rest of the article to see what trickery GSK was allegedly up to. You can also click on a link there and view the court documents.
It'll be interesting to see how this trial plays out. I congratulate the judge for making the documents public. More judges need to follow his or her example.
Most readers know that I had some nasty experiences on Paxil in 1994, ones that were so unacceptable to me that I told my doctor that I was coming off the drug with or without his approval. It was the first time I'd stood up for myself that way with a doc. One of those things in life that you have to do.
I am so weary of pharma companies hiding data from anti-depressant studies that there's very little I can say that would not come off as deeply bitter and angry concering this news. I don't feel like going there today. But I welcome your thoughts.
Much credit to Pharmalot for having this up first.
The FDA psychopharmacological committee yesterday voted to recommend that the full FDA approve Lilly's new Zyprexa Adhera, a two to four-week long-acting injectable formulation of the company's Zyprexa. The drug now awaits approval by the agency for treating schizophrenia, likely sometime later this year. Committee members noted that the drug should carry special labeling around its tendency to cause extreme sedation, and the FDA will likely slap a black box label on the drug around risks of diabetes and hyperglycemia, among other things. A few committee members recommended that the drug not be approved as a first-line treatment, but only be given when other injectables such as Haldol and Consta have failed.
I know a lot of readers will be disappointed by the recommendation, given all of the many well-known problems with the drug. But I'm not surprised by the move. If there's any decent news here, it's that the injectable market isn't a large one and this drug will not be used on many people. People who get this drug will have to have long-term, chronic psychosis and will have had to blow off their daily oral meds repeatedly before, I assume, any legitimate doctor would use an injectable on them.
That said, I hope that the FDA very closely monitors the safety of this drug once it's approved. I hope as well that doctors, patients and their families will be aggressive about filing adverse events reports if there are any untoward experiences using the drug. Also, I think given the dicey reputation of Adhera's pill form sister that doctors will be extremely vigilant in monitoring patients on this drug. Even Lilly stresses that patients should be closely monitored for signs of extreme sedation for at least an hour after receiving the injection.
I hope the company understands that there are many patient advocates out there who will closely monitor how the company markets and promotes this new product. In addition, if I hear of any off-label use of this drug in bipolar disorder or dementia, I'll make an issue of it.
So far, none of the advocacy groups such as TAC have cheered the drug's impending approval. I hope they keep their mouths shut. But if they want to stir the PR pot for Lilly, let them do so after they've had a nice fat injection of Adhera.
I've recently had to rethink my stance on the use of injectables because of a murder that was committed five blocks from my apartment, allegedly by an ex-convict with a long track record of extreme violence who was blowing off his meds and whom, for some reason, did not get admitted to a psych unit. The short story is that there is a very small portion of people diagnosed with schizophrenia who should be forcibly medicated with injectables. It's just about the only available option. I say that with much regret. I'll get into my thoughts on this another day.
The pop star apparently walked out of the psych unit at the UCLA Medical Center yesterday, where she'd been for much of the last week. Her parents told the AP that they were concerned for her life. Spears, for her part, got into a dark Mercedes and was driven around Los Angeles, hounded by idiotic photographers every step of the way.
I wish these fools would leave her alone before they cause an accident of some kind. Or drive Spears into an even worse psychological state. But then humaneness has never been an overriding concern of the entertainment press.
As for Spears, I wish her luck.
Australian actor Heath Ledger, who was found dead in New York City on Jan. 22, died from a cocktail of prescription medications, according to the medical examiner. The ME listed the following prescriptions as being in the actor's body: OxyContin and Vicodin, both painkillers; Valium, Xanax and Restoril, all three being anti-anixety drugs or benzodiazepines; and, doxylamine, an over-the-coutner sleep aid. No mention of the Zoloft that was reportedly by his bedside.
Reportedly, Ledger was taking these drugs at legitimate doses and simply ran into a fatal reaction to the combination. One has to wonder, however, who the hell this guy's doctor or pharmacist was, because using three benzos in combination with two painkillers strikes me as a prima facie recipe for disaster. One wonders why Ledger's own common sense didn't kick in at some point, too. A completely avoidable disaster.
Sad.
It's hard to believe that Lilly could look worse after settling about $1.3 billion in civil claims and being on the verge of working out a $1 billion deal with the feds in an attempt to escape federal prosecution and a raft of states lawsuits, but things just keep getting weirder and weirder around the Zyprexa story. Yesterday, news came out that last week's scoop by New York Times investigative reporter Alex Berenson on the developing federal settlement may have occurred not because the reporter has great sources but because he has the right last name.
As it turns out, according to portfolio.com, a lawyer at Lilly's main outside law firm, Pepper Hamilton, tried to email Bradford Berenson, a lawyer at another of Lilly's outside law firms. Instead, the first lawyer somehow pulled up the reporter's email in their address book--the two have similar emails addresses--and unwittingly tipped Alex B. to the pending deal with the feds. Then, Berenson, the reporter, starts making all kinds of phone calls to all kinds of sources and he appears to have inside information which Lilly thought had been leaked to him by the feds.
As a fellow reporter, all I can say is I am jealous.
Others have different thoughts. The WSJ Law Blog notes that lawyers have got to be damn careful with their emails (yeah, no kidding) and Sparkman & Associates, a corporate communications firm, notes that Lilly's handling of the PR around the Zyprexa scandal has been a "debacle."
I think one of the key mistakes Lilly made was in assuming that the story would die down and go away and that the media and the public would accept its spin. Just like with Prozac in the 1990s. Well, here we are over a year after news around leaked Zyprexa court documents broke and the story just won't go away. Lilly is of course still spinning the PR and, while I get that that's part of what corporate spokespeople are supposed to do, isn't there a time when honesty might better serve their cause?
You almost get the sense that somewhere in communications academia a PR professor is assembling a doozy of a case study. I cannot wait to see it.
Meanwhile, Ed Silverman at Pharmalot looks forward to pharma companies hiring lawyers named Silverman while I look forward to them hiring ones named Dawdy.
Four years after the US made a similar move, the MHRA has announced it will order companies making anti-depressants for the UK market to put warnings on their drugs advising patients and doctors of risks of suicide and suicidality associated with the use of anti-depressants in some people. Much like the American warning, the UK warning will only cover people under the age of 25-years-old. Apparently, these risks magically disappear as soon as one can rent a car. No idea if there is a connection or not!
Much of the credit for this long-needed move by the MHRA must go to the various Seroxat (Paxil) user groups and blogs in the UK who have all really kept up the pressure on the MHRA and Glaxo itself. Good work guys.
The swirl of news around Britney Spears has gone from weird to weirder still, according to news accounts of a move by the singer's father to get a restraining order against her new manager. Spears, who allegedly has bipolar disorder, has had her stay in the psych unit at the UCLA Medical Center extended beyond 72 hours and it seems like this may be more about getting her away from madness at home than in an attempt to treat Spears.
According to the press accounts, Spears was being drugged with Seroquel and Risperdal and was appearing groggy and sleepy. Apparently, her manager was grinding up the pills and sticking them in her food. Whatever one thinks of anti-psychotics, that's simply bizarre. Allegedly, her manager was trying to get her into a coma so that "her doctor could give her drugs to heal her brain." Whatever the hell that means.
The singer was reportedly also being given Adderall, an ADHD drug that's not exactly the healthiest thing to give someone diagnosed with bipolar disorder.
Anyway, stay tuned for more...because there is bound to be more to this story.
Apologies for not having too much up today, but I am tied up with some outside work. In the meantime, feast your eyes on the following:
The Washington Post discovers online support groups a decade or more after they first gained popularity. John Grohol at Psych Central does an excellent take down on the article. As a reporter, I find it kind of weird that the reporter in question didn't interview Grohol, who has been running online groups and forums since the early-1990s. Were I writing the article, he would've been my first call.
Grohol also wrote yesterday about his post-Super Bowl despair, being a longtime New England fan. Being a longtime Giants fan, I smiled at every word of it. Better luck next year!
The Trouble With Spikol has this on the alarming increase in suicides and suicide attempts by military personnel. Yet another argument for getting out of Iraq.
The Last Psychiatrist, always interesting and contrarian, has an interesting take on the recent FDA warning on suicidality and anti-convulsants. He says he doesn't even buy the data on anti-depressants and suicidality. Whatever, dude.
Dr. X has a fascinating reminder that the whole press hullaballoo around Britney Spears being dragged off to a psych unit has weird overtones of what went down with Frances Farmer in the 1940s. Presumably, Spears will be spared the frontal lobotomy at Western State Hospital.
Meanwhile, the news from New Jersey is that several workers at a psych hospital are to be disciplined over the suicide of a patient at the hospital. Looks like some folks screwed up big time. Looks like the state is taking it seriously. Good.
Soulful Sepulcher has an item on battles with depression. BTW, I know several of you have been pressing me to write about depression and such lately. I've taken a couple of stabs at penning something, but it just hasn't come out of the typewriter quite the way I want yet. But it will soon enough.
John Grohol at Psych Central had an important post yesterday concerning an insurance company in New Jersey that's refusing to cover some of its members for treatment of an eating disorder because of some things said members--children, as it turns out--have written about themselves online. The whole thing smacks of a case that's begging for a Supreme Court ruling once the matter has crawled through lower courts. Grohol, who's pretty much the godfather of mental health BBSs and websites on the 'Net, says it should give people who write blogs and post on websites and forums much cause for concern. I agree. I just don't know what to do with that concern.
Someday soon it might be central to my own life. I have not had health insurance in almost one year (I simply cannot afford it) and when I go back into the insurance market it will likely be as an individual and not as a group member, so I will potentially be much more exposed to something along the lines of what's up in New Jersey. I'm not going to live my life in fear of the bastards, but it does make you think.
Here's the gist of the Jersey story from the New Jersey Law Journal:
"Litigation over an insurer’s refusal to pay health benefits for anorexia or bulimia may turn on what is revealed from the alleged sufferers’ e-mails and postings on the social networking sites."The plaintiffs are suing in federal court in Newark, N.J., on behalf of their minor children, who have been denied benefits by Horizon Blue Cross Blue Shield of New Jersey.
"Horizon claims that the children’s online writings, as well as journal and diary entries, could shed light on the causes of the disorders, which determines the insurer’s responsibility for payment. New Jersey law requires coverage of mental illness only if it is biologically based.
"Horizon claims the eating problems are not biologically based and that the writings could point to emotional causes. It contends that access to the writings is especially important because the court has barred taking the minors’ depositions."
If a court won't allow a defendant to take a minor's deposition in real life, why would it allow evidence snatched from the child's cyber life to be introduced as evidence? How that question will be answered ultimately is beyond me, but beyond finding the insurance company's behavior to be sleazy and contemptuous (um, in the America I signed up for, major corporations and governments should stay the hell out of the private lives of citizens, especially those of children--except I know there are legitimate exceptions), I found myself chilled at the thought of writing today. Grohol, whose judgement I trust, says that blogs and social network posts and threads in forums are now fair game for lawyers and insurance companies.
Given the number of insurance companies and law firms who read this site and the degree to which everything I have written about mental health issues--be they personal or not--is indexed in search engines over the last four years, I would say I might be in a dicey position over all of this someday. Or maybe not.
Of course, things people write or post about themselves and their lives and the secrets of their souls have become weird fodder in America in recent years. You've all heard of variations on the following: the college student denied a teaching degree (and thus her state certificate) by a college because she had posted some pictures of herself drinking at a party. The basis for the denial was some jumped-up moral turpitude claim (I tend to think it's immoral not to drink at a party, but that's just me). And, you've surely heard of people who lost jobs or lost job offers because of things they'd posted about themselves.
I'm torn as to what to make of the dynamic and the tension between free expression on what is still a somewhat nascent medium and behavior by private businesses and public agencies. Yes, I think it's beyond lame when someone loses a sales job because they posted pictures of that special tattoo (Who the hell cares? Does anyone think customers are going to go snooping for that stuff?), but I think a legitimate interest is served when a police agency, say, pokes about the MySpace profile of an applicant, discovers that said applicant dropped acid at a rave one year before because dude is bragging about it on his profile, and denies said applicant a police job (yes, this really happened at a local police agency I am not at liberty to identify).
But we're getting into some really weird territory when insurance companies are using such postings to play games with patients' coverage. I guess I'm not surprised that they would give that tactic a go, but I am confused that state insurance commissioners have not carved into states law how citizens' online gibber-gabber can be used against them by health and auto insurers. And, more pointedly, what online communications should be protected.
Do we really want something someone posted on a MySpace group three years ago when they were depressed off their butts, for example, to be used against them when it comes time to get health coverage or new health coverage? I think not.
Grohol points out that people can take the tactic of limiting their online profiles, take their blogs private and make sure they only post to private online forums, especially where they involve discussing personal health issues. The tradeoff is that such moves will dramatically limit online discussions over time.
I've long been concerned about what I say about myself in print and online. A little over four years ago as I was writing a long essay about suicide and depression, I got into an extended conversation with a friend of mine who is a reporter at another paper (yes, reporters at competing papers do sometimes discuss what we are working on with trusted--OK, very trusted, blood oath--friends) about writing about the subject in the first person.
"You'll ruin your career," she advised. "I doubt it," I replied. "Besides, none of the experts I've interviewed on the subject seem to really know what they are talking about, and I cannot stand aside and print a bunch of BS when I know the truth to be different."
"Cover your ass," my friend told me. I didn't. If you are amused by such things, the resulting story is here. The online version has been read by well over 100,000 people and the print version was likely read by as many people when it came out in 2004.
I paid almost no professional price for what I wrote (OK, it helped), but I have paid a personal price. In the opinion of several of my friends, that article and the things I have written since here and elsewhere have hurt my dating life. I don't know if I agree with them completely, but from time to time over the last few years I have run into situations where I saw evidence for their point.
I'd tell you all about it. But someone might use it against me. I just hope it's not an insurance company or a bank or the government. Potential small-minded dates I can deal with (buh bye), but Blue Cross, Wells Fargo or the feds I'd have a tougher time addressing.
Thanks to those who've alerted me on news of the FDA's concern that the up-for-approval injectable version of Zyprexa called Adhera has triggered concerns by the FDA that the drug causes profound sedation in about 1 percent of patients who went through clinical trials for Eli Lilly, the drug's maker. Adhera is set for a hearing on Feb. 6 before the FDA's Psychopharmalogic Drugs Advisory Committee.
One of the studies Lilly submitted for approval of the drug was eight weeks, the other was a 24-week maintenance study. I am a bit confused that sedation may have been the only notable side effect to show up in these studies. Approximately 35 percent of patients getting this new drug gained over 7 percent of their body weight in a short period of time, according to the FDA's packet for the hearing. That percentage is triple the number of patients receiving placebo who gained that much weight and is right in line with the percentage of patients taking Zyprexa in pill form who packed on the pounds.
The fact that the FDA has not flagged this for the committee as a safety concern is simply bizarre. You can read the FDA's full background packet on the drug here (1.6 MB .pdf).
Via Pharmalot and the Wall Street Journal.
The conclusion of a recent study in the Cochrane Review, as noted today by the New York Times's Well blog, is that anti-depressants aren't particularly useful for treating back pain.
"Most of the studies found that patients receiving antidepressants didn’t experience any more pain relief than those taking a placebo, although some of the research suggested a benefit. Overall, the analysis concluded that there’s no evidence that prescribing antidepressants to treat back pain relieves pain or improves function. The researchers also found that in patients with low back pain, antidepressant treatment didn’t curb depression, either."
This ties in nicely with a recent paper pooh-poohing Eli Lilly's claims that Cymbalta works to ease chronic pain, as I noted in December.
It's not clear to me how much of the approximately $20 billion a year in anti-depressant sales is driven by prescriptions for treating pain, but I know it's a hefty amount. A friend of mine in antoehr state who suffers from degenerative disk disease was forced off his opiate prescriptions by his pain management clinic a ways back due to an agreement his doc had with the DEA. He was forced onto Cymbalta and Lyrica, which did nothign to alleviate his pain and screwed up his liver. He's off those drugs now and back on the opiates, but they don't seem to be working as well this time out, possibly due to effects Cymbalta had on his liver.
In the sickest irony of all, he recently went to a counselor on his pain management team and spoke to her about medical marijuana. He lives in a state without a medical marijuana law. His counselor told him that if he ever broached the subject with her or the doctor again that they would force him to undergo random, mandatory urinalysis or he'd lose his prescription for opiates. Nice bit of coercion there--and I thought it was unethical for medical professionals to coerce patients.
BTW, his doctor's pain management clinic has approximately 600 patients and he tells me that about 75 percent of the patients have been put on Cymbalta or similar anti-depressants in the last year or so. Nice little target market for Big Pharma.
I think this shift to using anti-depressants has been driven by the DEA's push to limit the use of opiates in treating chronic pain, principally because the feds hate any drug that gets people high (unless it's an anti-depressant) and because some opiates have been getting diverted into the black market. I understand the feds' concerns, but I think the DEA's policies--as well as those of some states such as Washington--have been a true disaster for people with chronic pain.
I genuinely believe that what we are seeing here is yet another argument for the use of medical marijuana in treating chronic pain. Why? Because it works for a number of patients and because it doesn't turn people into pill junkies or kill them with overdoses of opiates, not does it carry all the problems that anti-depressants do. I simply think it's time for the feds to take a chill pill--may I suggest Paxil?--and support adequate research of medical marijuana for treating chronic pain, and perhaps reschedule marijuana. After all, citizens and legislatures in 13 states have decided that pot is medicine. Surely, they cannot all be wrong.
But I'm sure the feds will continue to persecute medical marijuana patients in California and elsewhere (it's hard for the DEA to justify its existence otherwise), and that this situation will not change under the next President. I've heard that Obama has made noises about decriminalizing pot. That's nice, but I'll believe it when I see it.
To those of you who will object and say that pot causes psychosis and other untoward reactions in a small percentage of people who smoke pot, I'd simply point out to you that anti-depressants are well known to cause the same exact problems in some people.
I am still overwhelmed by a couple of things from last evening, so I'll be late with posts today. A big bunch of my life was spent in New Jersey, I am a longtime New York Giants fan, and yesterday's Super Bowl was the greatest Super Bowl of all time, and arguably one of the greatest football games of all time. The Giants won and in some ways I am still on Cloud Nine. It would be difficult not to be.
However, soon after I got home last evening I got a call from my best friend in New Jersey. He told me that his father, who is an outstanding man whom I've stayed in touch with since my teens years (and that should tell you something), is going to die very soon due to a heart ailment. I am beyond crushed, for him and my friend.
Later on this evening, I went out for a drink and learned that a dear friend of mine is moving from Seattle. I'll soon be losing the fourth significant Seattle friend of mine to another town in the last 18 months. I'm getting tired of that drift.
Kind of a weird evening in the face of which I can hardly think of anything to say.
I'll get back to the usual crap later this morning.
Not only was January a very busy month for this site news-wise, but it was a busy month reader-wise. Last month, this site got over 20,000 hits for the first time (almost hit 21,000), a 13 percent increase over my previous high in November 2007. That's something of a milestone.
Thanks for reading. Have a nice weekend.
The FDA yesterday issued a major warning on suicide and suicidality connected with the use of mood stabilizers such as Depakote, Lamictal and Topamax. The warning only affects mood stabilizers in the anti-convulsant class of drugs, which is to say drugs that are used both for bipolar disorder and epilepsy and other seizure disorders. Lithium, generally regarded as the best suicide-prevention drug there is, is not affected by the order.
This class of drugs is used by many millions of people diagnosed with bipolar disorder around the world, and are generally used after a patient fails a trial of Lithium. In recent years, however, some psych docs have gone to them as first-line agents in treating bipolar disorder.
"In the FDA’s analysis, patients receiving antiepileptic drugs had approximately twice the risk of suicidal behavior or ideation (0.43%) compared to patients receiving placebo (0.22%). The increased risk of suicidal behavior and suicidal ideation was observed as early as one week after starting the antiepileptic drug and continued through 24 weeks. The results were generally consistent among the eleven drugs. Patients who were treated for epilepsy, psychiatric disorders, and other conditions were all at increased risk for suicidality when compared to placebo, and there did not appear to be a specific demographic subgroup of patients to which the increased risk could be attributed. The relative risk for suicidality was higher in the patients with epilepsy compared to patients who were given one of the drugs in the class for psychiatric or other conditions."
The FDA's analysis was based upon more than 43,000 patients who took the drugs in placebo-controlled trials. The risk was greatest among patients taking the drugs for epilepsy who had a relative risk of 3.6 while patients taking the drugs for psychiatric diagnoses had a relative risk of 1.6, according to the FDA.
I am not familiar with claims of suicidality in this class of drugs, but you can bet I'll be asking questions of the FDA. Now, I have some serious questions about my own experience on the drugs which runs from 1993 to 1995 with Tegretol and from 1997 to 2007 with Deapkote and Lamictal. The market for these drugs affects some so-called blockbusters. In 2006, Depakote has over $1 billion in sales for Abbott Labs, while Lamictal sales were about $2 billion and Topamax sales were $1.5 billion. Throw in the other anti-convulsants in branded and generic form, and I bet that market runs to about $6 billion a year in sales.
In its alert, the FDA said it would work with the drugs' makers to hammer out changes in labels to incorporate the warning. The warning also covers the drug Lyrica which is often used for pain management in cases of chronic pain.
It's not clear to me what the implications are for treatment with these drugs in bipolar disorder, but they cannot be very good. In coverage by the New York Times, doctors stressed that the benefits of these drugs outweighed the risks both in treating bipolar disorder and epilepsy. But the more important question is what patients think--doctors sometimes forget that it's patients' butts that are on the line--and how they respond to the warning. Obviously, people diagnosed with epilepsy don't have a lot of options for controlling seizures. Aside from Lithium, patients with bipolar disorder don't have many options either.
The paper said that the suicidality risks in found in anti-depressant use in children and teens was 10 times higher than among anti-convulsants. But the FDA's warning doesn't break out risk among various age groups, so I am not comfortable making that comparison.
I'll have more on this after I've had a chance to do some reporting later today.
You've got to wonder how long it'll be before a sales rep for Lilly or AstraZeneca walks into a doctor's office and asks a doctor, "Did you know that the FDA issued a warning on suicidality in mood stabilizers? Why don't you start a patient on Zyprexa today?"
My hunch is by the time you read this, it will have already happened.
A new shareholder lawsuit has been filed against Eli Lilly over allegations involving the drug Zyprexa. Some shareholders are angry with the company because they contend that the lost money on their Lilly stock due to news reports of coverups of illegal marketing and injuries caused by the atypical anti-psychotic.
What Lilly's spokesman Phil Belt told the AP is remarkable even by Lilly's standards of spin:
"Beginning in late 2006, a series of articles in the Times, based on confidential documents, said Lilly downplayed the drug's risks and did off-label marketing."'Those stories were full of inaccurate, incomplete and what we would say was misleading information,' Belt said.
"Nevertheless, he said the company's board has appointed a committee to complete a 'thorough and importantly independent assessment' of the lawsuit's allegations."
So if the information put out there by the paper and others was misleading, then why would the company's board pull together a committee to examine these claims?
Yesterday, I ran across several interesting accounts of the atypical anti-psychotic Invega, J&J/Janssen's Son of Risperdal. One was a patient account left on this site:
"I was on Invega for 4 months for bi polar. I was taken off it due to a rise in my glucose level and weight gain. My glucose level rose ten points per month I was on Invega. I experienced dizziness and tiredness."
Another was here:
"On Invega, I was doing really well for quite a while, not hearing things, and not hallucinating at all, and not having delusions. I had them ocassionally, but it was mild in comparison to the way things used to be before I was on medication. I did well before Invega, on Risperdal, so I've been getting better for quite a while now."
And, it sounds like some J&J/Janssen sales reps are running into problems selling the one-year-old drug, according to the anonymous gossip on CafePharma:
"Now that Invega is officially not on national VA formulary and many of us can't discuss it or promote it....why isn't Janssen removing it from our territory? How come upper management doesn't have a plan to get it reviewed again? The pull through demand by the local reps didn't work but they keep it in our comped on universe. I think it is ridiculous we are penalized by keeping these large dollar volume accounts when we can't move any sales. Do we even have a government accounts team that focuses on the VA anymore?"
What's bad for sales reps sure sounds even worse for patients.