I'd thought it wasn't possible for the infamous Paxil Study 329 to be even more infamous, but I was clearly wrong. A new paper, based upon court documents, is out and, while you need to understand stats more than usual to understand what's going on, it's clear that GlaxoSmithKline and the study's authors were up to some deceptive crap. Not that that wasn't clear before.
For newbies, Study 329 was published in the Journal of the American Academy of Child and Adolescent Psychiatry in 2001. It claimed that Paxil was good for treating depression in kids and that patients didn't suffer many adverse effects from taking the drug. The study, however, was one of the most corrupt I have ever seen in all of psychiatry--and that's saying something--and contained all sorts of jury-rigged data, hidden data and, yes, it was ghost written as well. That means many of the big name psych docs such as Martin Keller whose names were on the study didn't have much of an idea of the supporting data. The paper has been thoroughly discredited at this point, but has never been retracted by the journal.
Healthy Skepticism has been questioning this study for years and has a resource page here.
CL Psych gets all the credit for getting this new analysis of 329 online the other day and for explaining what's really going on here. (I also need to credit him for the fabulous headline I stole for this post!)
"Let's break this thing down for a minute. The authors planned to look eight different ways for Paxil to beat placebo. They went zero for eight. So, rather than declaring defeat, the authors then went digging to find some way in which Paxil was better than a placebo. Devising various cutoff scores on various measures on which victory could be declared, as well as examining individual items from various measures rather than entire rating scales, the authors were able to grasp and pull out a couple of small victories. In the published version of the paper, there is no hint that such data dredging occurred. Change the endpoints until you find one that works out, then declare victory."
Fiddy has his take on this new paper, as does John Grohol at Psych Central. Matthew Holford writes about the study as well and wonders aloud if there wasn't some actual fraud involved, as opposed to usual chicanery. I wonder the same thing.
The whole sordid saga of this study isn't really worth repeating, but for those of you who are new to these issues you need to understand that the reason this study has generated so much heat over the years was because it involved children. I think as a culture we expect the pharma companies to lie like crazy when it comes to studies of how "well" their drugs work in adults, but when one of them would clearly manipulate a study involving children so shamelessly...well, that just hits the outrage button so much harder.
Besides, this study and the initial paper in 2001 establish just how ugly the world of academic publishing has become and just how badly it needs to be reformed. Why this hasn't happened yet is far beyond me.
Things have been getting heated in the comment threads again of late, and especially in my inbox. Yep, the anti-psychiatry camp is onto me again, especially folks from Australia and the UK, saying some of the vilest, nastiest crap. The kind of crap that I'll repeat just to give you an idea of what's up.
Because I don't bow down to the intellectual power of Michel Foucault and Thomas Szasz (and for all I know, L. Ron himself), then I am a "motherfucker," a "cocksucker," a "fence sitter," a "fraud" and a "greed filled pig." Those are just some of the highlights of unapproved comments in recent days and of emails that have been sent my way. One longtime reader sent me an email yesterday noting that I must have very tough skin--I'd argue it's a thick head--to put up with that kind of abuse and still pump out the prose on this site. The reality is I have been harshed by the anti-psychiatry crowd before--just as I've been smacked up by the psychiatry worshipping crowd of fools who call me a "murderer" for pointing out that research shows anti-depressant are a weak technology, a "Scientologist" for pointing out that there are clearly softer forms of mental disorders being diagnosed and treated as the worst thing this side of John Hinkley, and an "anti-psychiatrist" for daring to question the wisdom of psychiatrists.
Anyway, one of the more polite missives from the anti-psychiatry camp was a comment I approved yesterday in response to my cheering the fact that the Chinese government had banned ablative surgery for schizophrenia. A pretty non-controversial statement if you ask me.
This fellow from the UK wrote:
"The post reminds me of the popular 'Russian psychiatry was political but American psychiatry is not' falsehood. By criticizing specific procedures you imply agreement that others are bona fide treatments for a medical illness, and I reject this implication as totally erroneous."For a few brief moments I had some faith in this blog, but sadly both the writer and majority of those leaving comments seem to strongly believe in mental illness and all of the dire consequences that ugly concept entails. It wouldn't surprise me if China frees Tibet long before American citizens are no longer subjected to coercive psychiatry.
Sincerely, Ted"
Hm, yet another member of the anti-psychiatry community who's upset with me? Yes, when I posted the Zyprexa documents for the world to see at much personal and financial risk to myself, I can see how you'd lose faith in me. Same as when I took on Fuller Torrey and the other conservatives in the mental health industry who use scare tactics and false data to force free people onto meds for life. Same as when I challenged the bipolar child paradigm when no one else was. Same as when I helped disentangle the political misuse of suicide stats. Same as when I stood up for the bipolar cop and took on our local sheriff for firing her. Same as when I have spoken out against forced medication and coercive psychiatry. Same as when I stuck out my neck and said mental illness is not forever. And so on. Yes, Ted, I'm so damn disappointing. And so are the readers and commenters here--they don't want the forces of Big Pharma and Big Psychiatry steamrolling human lives, but, yes, they are most disappointing.
OK, joke over.
Ted, and others of you in the anti-psychiatry world who've been coming after me in comments and very ugly emails lately: you need to truly get over yourselves and your identity politics and stop being as simple-minded and one dimensional in your social thinking as the very psychiatrists you despise. You are as dangerous as the hardcore Fuller Torrey wing, because if I understand the basics of anti-psychiatry, then mental illness is not real--it's a medical fiction designed to let the powerful consume the weak. If one form of treatment is barbarous, then all forms of psych treatment of barbarous. If antipsychotics were evil for you, then they are evil for everyone. It's the flip side of Torrey-land where if one schizophrenic (or bipolar) does something violent, then everyone diagnosed with schizophrenia is violent, forever and always. By your math, it's perfectly fine for a schizophrenic with a long history of assaulting innocent people to go around unmedicated, undiagnosed, free as a bird to stab up whomever he wants.
Well, kids, the world ain't like that and can't be like that. Mental illness actually exists. Depression, mania, schizophrenia, anxiety and so on have been delineated and described going back to the Ancients. No one has a particularly good answer as to where it comes from, but it's reality and as human actors we have got to deal with reality. I think that the docs have cast their nets far too wide to capture every human psychological flaw under the sun and softened just about every diagnosis in the DSM over the last 28 years into a syndrome that requires bad medications and plenty of them (and gone after children in the bargain), but that doesn't change the fact that there is something in this world called "crazy" and it truly exists and we've got to do something to address it in most circumstances. What you or I would do with that is probably far different than what most docs would do, of course.
We can all argue about whether something is a minor mental illness or a major mental illness or a personality disorder or just screwy. We can argue about how mental disorders--or illnesses--should be treated and we can mostly agree upon how lousy most medications work and how much certain researchers and pharma companies and government agencies have lied to make them look like gold.
But you know what? Just because I had rotten experiences on anti-depressants doesn't mean I'd deny them to anyone else who wants to take them. It's the most confounding thing: as poor as the results are for most people who take SSRIs, there are about 30 percent of people who take them who seem to get pretty good results, albeit with some side effects. I'd like to say it's not true, but then I'd be a liar. X percent of people actually do derive a benefit from the voodoo the rest of us hate. Same thing with antipsychotics--and here I am talking about drugs I personally hate and have every incentive in the world to think no one else should take. But if someone wants to take them of their own free will, then have at. If someone is too crazy to stop running in traffic or can't wipe their own butt, then maybe they need a little dose of coercion. It's the only way I know of given our current system to help these folks out while giving them a modicum of personal freedom. As much as I'd like to see the mental health system veer more towards the Soteria model for treating seriously sick people, I simply cannot make that happen. I don't have the time or money. Why don't you guys in the anti-psych world get off your duffs and do it yourselves?
But I know why the anti-psychiatry crowd is mad at me. They sense that I am one of them, that I've seen into the big ugly heart of the machine and somehow survived its grasp. Trust me, I've got as many reasons as you do to hate the psych world, aside form the fact that I never saw the inside of a psych unit (except as a reporter). I took meds for 18 years, ones that truly screwed me up at times and ones that I should've been wise enough to get myself off of far earlier. I know all about the subtle coercion of the system. I know how most of what it says about many people are pretty much lies.
The trouble is that they aren't always lies. Go ask Shannon Harps if you don't believe me. Oh wait, you can't. She's dead. Stabbed to death by one of those cats diagnosed with schizophrenia whom the anti-psychiatry crowd claims isn't sick at all, just totally misunderstood. He was really just a peaceful man who wanted to stand in front of a tree and recite poetry to it backwards and, wow, the world just doesn't get how peaceful and loving folks like that really can be. Well, some of them are. But guess what? Not all of them are.
And that's the problem with both psychiatry and anti-psychiatry. Both camps are far too extremist in their views and their evidence and in their notions of human possibility. One size fits all anti-psychiatry is just as dangerous as one size fits all psychiatry.
But I'm not the only one who's been getting chopped up by the anti-psych crew of late. I know there are a lot of people who have been carving up Charles Barber on list-servs and message boards. They are too chicken to go any more public than that. His book, Comfortably Numb just doesn't go far enough even though he's written the most humane book on depression in ages. Since he's willing to admit that there are cases of depression, schizophrenia, bipolar disorder and so on that require the big old sledgehammers of psychiatry, then he's clearly on the payroll of Eli Lilly & Co. Please. Such bullshit. It's not a prefect book, but compared to the excessive nonsense spewed by Peter Kramer, Charles Nemeroff and Fuller Torrey it's the Odyssey, Huckleberry Finn and Bhagavad Gita all in one. And people are mad at him about it? Maybe, they are simply full of themselves and their own history of suffering and, yes, victimization and incapable of seeing past their own nose. Because it's a big old diverse world of humans and experience out there. And the truth is your truth and my truth aren't everyone else's truth. I try to keep that in mind at all times. Try.
And to the Teds of the world: If you don't like what I am writing on this site, then grow a pair and start your own. Blogspot has got everything you need for free.
John Grohol at Psych Central had an interesting post yesterday about how patients who fall in love with their therapist should handle the situation. I'd frankly forgotten that this does happen from time to time, and I'm glad Grohol tackled the issue, since the outcome of a poorly handled situation can be bad for one and all. Here in Washington State, the government is just now requiring all therapists--or most as it'll turn out--to be properly certified and licensed because there had been some serious problems in recent years with unlicensed counselors and therapists who were unethical actors, abused their patients' trust, took over their lives and bodies and so on. There was one counselor who had had built a small cult around herself. The Seattle Times series on this in 2006 was a Pulitzer finalist last year.
It also gives me the perfect opening to tell one of the strangest stories I've ever heard of psychiatrist-patient interaction. Keep in mind that once upon a time psychiatrists were also therapists and didn't always load people up on meds. So this psychiatrist somewhere in Washington State basically starts manipulating several of his female patients for sex. They would come over to his office on Christmas, for example, and service him. Some doubled as unpaid housekeepers. Eventually, someone reported him to the state medical board, he lost his license, but in the weirdest twist of fate, he had a disability insurance policy. So he files for disability, claiming he cannot work any longer. His claim gets paid. Diagnosis: sex addiction.
This hasn't even hit the news yet in the US, but in Europe word is trickling out that Albert Hofmann, a Swiss scientist who was the first to synthesize LSD, has died. He was 102 years old.
Asked how he accounted for such a long life, Hofmann once said, "You have to take the time to stop and be the flowers once in a while." A classic line.
Hofmann called LSD "medicine for the soul," and despite the drug's bad rap, thanks to its overuse in the 1960s counter culture, Hofmann hated the prohibition on the drug in the US and other countries. The reality is that LSD was used by psychoanalysts for about a decade before the drug was banned. What's more, researchers at one point theorized that mental illness, particularly schizophrenia, must be caused by similar compounds and actions in the brain. Seeing that the source of schizophrenia is now firmly nailed down by science (I'm joking people), maybe we ought to go back to that theory and see where it gets us.
No pun intended, but I think it's high time researchers starting looking into positive qualities that might be contained in the LSD molecule once again, as a slightly different metabolite, for example, might yield beneficial results. I feel the same when it comes to Ketamine, MDMA and marijuana. No, I am not advocating for you or your kids to go off an use these drugs, I'm simply saying there are beneficial qualities to these molecules--especially on depression--and since anti-depressants such as Prozac have proven to be such duds, we ought to be looking into alternatives and leaving no stones unturned in our quest for workable treatments for depression and other mental illnesses.
There could be no more fitting tribute for Hofmann.
Hofmann himself had high hopes for LSD:
"He remained convinced that the drug had the potential to counter the psychological problems induced by 'materialism, alienation from nature through industrialisation and increasing urbanisation, lack of satisfaction in professional employment in a mechanised, lifeless working world, ennui and purposelessness in wealthy, saturated society, and lack of a religious, nurturing, and meaningful philosophical foundation of life.'"
Gee, no wonder the drug had to be banned.
The Chinese government has banned an inhumane form of psychiatric surgery--or neurosurgery if you prefer--that first gained international attention last fall when Nicholas Zamiska, a reporter in the Wall Street Journal's Hong Kong bureau, exposed the practice. It's somewhat analogous to a lobotomy--surgeons drill holes in the skull and then burn sections of a victim's brain. The surgery, which is only rarely used in the US and only then for very, very severe chronic depression (and even then I'm not sure I approve), was being used far more broadly in China to "cure" depression, schizophrenia, OCD and so on. Quite a few patients were left disabled by the procedure.
In a follow up piece, Zamiska reports that the government has now banned the practice in schizophrenia (link is subscription only, but the first link is a freebie).
"A page-one article in The Wall Street Journal in November exposed the relatively widespread use of the procedure in China. Government officials including members of the Ministry of Health and the People's Liberation of Army, which also oversees some hospitals that offered the surgery, met in January to evaluate the practice. Participants at the meeting concluded that the government needed to regulate the use of the procedure, called ablative surgery."Friday's announcement appears to be the culmination of the effort to draft regulations. Hospitals must now first seek approval to operate on patients with 'serious obsessive-compulsive symptoms, depression and anxiety disorders that cannot be cured' by other means and where the surgery's benefits are 'indisputable among the international medical community,' according to the Xinhua report.
"Xinhua also said 'neurosurgical operations should not be used to treat schizophrenia.' Military hospitals have performed the procedure on hundreds, possibly thousands, of patients with schizophrenia."
Keep in mind that Chinese health authorities have likely known about this barbarous procedure for years, but it took a reporter at an English language paper and victims' families he interviewed to do something about it. Yes, we sure don't need print reporters around anymore, now do we?
I don't want to sound like too much of a judgmental Westerner here, but China's track record on treating the mentally ill is rotten and makes much of what we complain about here in the US and Western Europe look like a tea party by comparison. It's nice to see China deciding to get its human rights act together for once. I hope that the paper's editors realize that there is much else on the mental health front to be written about in China and let Zamiska go for it.
I won't hold my breath for the Chinese to free Tibet, however.
Yesterday, in response to my post calling for research on psych med withdrawal, I got many wonderful reader comments. This one took the cake, however, as it came from a mother whose child had been variously diagnosed with ADHD, autism and mood disorder NOS (meaning child bipolar disorder):
"Philip, thanks as always."My son's experience in going off of Abilify was very difficult for him. The docs saw his 'withdrawal' behavior as proof that he was indeed bipolar and needed the aap's. I went against their advice, and almost five months since his last dose of Abilify (after tapering for about 7 mos), I really don't think he meets a single criterion for bipolar."
The mother is the author of the Soapy Water blog, and a year ago or so she was much more in agreement with the various psych paradigms around kids (but skeptical at the same time), having essentially had to throw up her hands due to her son's behavior and pressures on the school front. She first wrote about why she medicated her child last year and she and I emailed back and forth a few times. She and her kid have been through hell and doctors making med switches and med adjustments all over the place. Suffice to say that the kid has been on stimulants, antipsychotics (Risperdal and Abilify), anti-seizure drugs and so on and became wildly erratic during the process--so much so that mom had to have him put in a hospital so he could be stabilized.
She tells me now that her son has been rediagnosed with ADHD--which I think makes sense based upon what I've read of the kid--and she thinks he may be somewhat autistic as well (a very high functioning one, if I am using the correct terminology). But no more bipolar!
Since he's been off the Abilify, she reports that he does much better each and every day.
So I'm just sitting here wondering if any other parents have had similar experiences with their children. I am also wondering what's going to become of all those allegedly bipolar children created by the bipolar child army at Harvard. I wonder if any of their parents have called BS on the whole diagnosis and gone in a different direction with their kids and what the results have been.
Yes, that would be Dan Savage himself and he's dubbed Ambien "Scambien." By his own account on the Stranger's blog yesterday, he'd started taking the drug, albeit with much skepticism, after his mother died.
"I made an exception that night and took the pill. When I woke up and it was still dark I figured that, shit, Ambien isn’t that great. I was groggy, but I wasn’t asleep. So the drug didn’t work—not for me, anyhow. But when I looked at the clock in the kitchen it wasn’t 2 AM, my usual wake-up time, but 6:30 AM. I’d been asleep for nine hours. Nine hours in a row."I got a prescription. I took the drug every night for three weeks. I slept and slept and slept and slept. But one night I couldn’t take the pill—I was home alone with the kid and I needed to be capable of waking up in the middle of the night and snapping to attention if there was a late-night emergency, a nightmare, a zombie attack, etc. So I didn’t take the pill—and I didn’t sleep. Not at all, not a wink.
"The next day I got online and looked up Ambien’s less spectacular side effects—the side-effects that hadn’t made headlines—and guess what I found? One of the side effects was insomnia. Insomnia! But you’ll only get insomnia, I read, or get insomnia back, if you stop taking the drug. They call it 'rebound insomnia.'
"I stopped taking Ambien—and I didn’t sleep for three days.
"Nice drug they’ve got there. Glad I’m not addicted to it. Anymore."
Yes, the alleged neuroscience drugs--so that'd be the shooting gallery of psych meds, new sleeping pills, and anti-addiction drugs--are sure as hell nice drugs. OK, make that not-nice drugs. The range of problems with these drugs is just staggering--tolerance, addiction, agitation, depression, suicidality, diabetes, withdrawal problems, rebound symptoms and on and on it goes. It's nice to see someone of Savage's stature open his eyes to the problem.
There's an angry and poignant post over at Bipolar Blast containing Gianna Kali's thoughts on withdrawing from psych meds after being on them for two plus decades, a process that has literally ripped her apart physically and spiritually. She's had to essentially put her blog and her life on hold for the time being, as a result. Her post is worth reading, since it stabs at a core issue in mental health care: we simply don't know how to help people withdraw from medications safely and effectively. Although there are some decent guidelines for coming off anti-depressants--I'm thinking of Peter Breggin's 10 percent every two weeks rule--what Kali has run into is a complete dearth of knowledge of how to get people off of meds who've been chronic users of psych meds for many years and who've been on multiple meds.
This is an important issue not just for patients but for clinicians and mental health caregivers of every stripe because, sooner or later, they too will have a patient who needs to come off meds, for safety reasons or clinical reasons. It's important too because we are a medicated nation, damn near from cradle to grave these days.
So we're clear on where I'm coming from, I am not arguing that anyone should or shouldn't be off-meds. That choice belongs to patients almost exclusively, or it should. What I am saying is that in the real world patients do need to come off meds for a variety of reasons and it's time the mental health industry stopped avoiding the issue. The days when caregivers and patient advocates could blithely assume that once someone was on meds they'd take them for the rest of their lives are over. The meds simply don't work well enough long enough for enough people for the industry to operate on that assumption any more. And, I'm sick of watching friends and acquaintances get ripped apart coming off meds. I think, too, that it's time pharma companies were required to work out methods to get people off their meds and report them to the FDA and the public at large. If you are going to create a paradigm where Americans are turned into drug addicts (how else to describe someone who's been on Prozac 10 years of more?), then you've got to show us the way to kicking the habit. I think this for psych meds and for all meds--I've seen both of my parents suffer ill effects when they stopped taking statins due to some nasty side effects, for example, and I know they are far from the only victims there.
Put another way, we've got tens of millions of people taking tens of billions of dollars worth of meds each year who, at some point, will want to or need to come off those meds and we have very few ideas on how to manage the process so that people don't end up on the floor. Or dead.
Here's what Kali is saying:
"I am very very sick and I for the most part followed the rules of psychiatric withdrawal—-what few there are. What I didn’t always do was listen to my body—-that is a much more subtle thing than following printed out proclamations of good practice. My body told me I was getting sick and had I listened to one of my mentors who always insists that after each taper one wait until they feel as good or better than before the taper, I wouldn’t be in this predicament."I did not listen to that. What I did follow was the 10% or less rule. No more than every two weeks. One drug at a time. That can still be way too fast. Especially if one has a long and complicated history.
"I cringe at the thought of all the fly-by comments left by random readers, many of whom I never heard from again, blithely saying how they were coming off of multiple drugs in a matter of days, weeks or a couple of months.
"Why did we never hear from them again? I hate to say it but it’s likely they failed. Short of people who have been on drugs for a short time, coming off drugs is dangerous and should be done with great caution and conservatism.
"I have learned the hard way. I’m extremely ill. My endochronological system is shot and I have some awful sort of withdrawal syndrome. I am debilitated in a way I wish on no one ever."
I wouldn't wish it on anyone either. In fact, even though I've been off meds with mostly good success for over nine months now, I still think I am going through a withdrawal process, or a body recalibration process. My energy isn't what it was one year ago and, over the winter, I put on a bunch of weight (I haven't put on weight over the winter since I was a teen). And this is despite eating well, when I could, and taking lots of multi vitamins and a nice dose of Vitamin D each day. I happened to run into someone the other night who sells supplements and he told me that, in his opinion, I hadn't had enough "liver support" (whatever that is) while coming off-meds and that I needed to take higher doses of Vitamin D. He had no research to buffer his points, and that's precisely the problem with most alternative mental health therapies and withdrawal programs--there's plenty of individual experiences and testimonies, but very little thorough research. I know complementary and alternative medicine is still an emerging field in this country, at least in the mainstream of research, but it would be nice if it'd emerge a bit faster. I have a hunch there are many answers to be found both in treating mental health issues and in helping people get off of toxic substances such as psych meds.
It's time for researchers of all stripes to get off their duffs and start looking into these issues. They owe it to their profession and to their patients, at least as long as they plan on being ethical, Hippocratic actors in the medical game. We don't need any more studies of this or that anti-depressant or this or that antipsychotic used in conjunction with this or that anti-depressant--we already know the answers after 20 years of study upon study: the drugs have about a 30 percent effect size at best. Now can we please start getting some research funded and done that actually helps people who need to get off meds?
The need for such information is immense, and if the folks at NIMH aren't interested in funding the work maybe the people at NIH's National Center for Complementary and Alternative Medicine will be. There are roughly 40 million Americans, if not more, on a psych med of some kind. Many of those people have been on meds for longer than one year, perhaps as many as 50 percent. It's safe to say that a large percentage of them will choose to not be on meds at some point and that that decision will make medical sense. What's more, my casual guesstimate is that at least 10 million Americans are on more than one psych med at any one time. That's a whole lot of voodoo floating around the American brain and the fact that we don't know how to get people off multiple meds is stunning to me, especially given all the research and folk knowledge we have a as a culture about getting long-term street drug users and alcoholics off of their substances.
This is a human rights issue and a matter of fairness.
Look, I know I am going to get bombed with links to this and that person's book or guide, and I appreciate the input, but I don't think anyone has gotten us to a final answer yet. We are very much in uncharted waters, especially for people who've been on psych meds for more than one year. One of the better guides for thinking about all of this is the Icarus Project's "Harm Reduction Guide To Coming Off Psychiatric Drugs." You can find a free .pdf of it here and it has links to various other guides and resources. BTW, I don't think the guide's author believes that the guide is anything other than a work in process.
Let me stress again that what I've written is in no way an argument for anyone to be on or off-meds, nor is it an explication of the divide between "serious" mental illnesses and "mild" mental illnesses, nor is it an attack upon or defense of the DSM. I'm not looking for a fight on either front. I'm simply trying to acknowledge a real world dynamic and try to help prevent others from having to go through what Kali and I (and many others of course) have been through.
Because at the end of the day, consumers are the ones paying the freight in the mental health system and our needs should be tended to.
I've not written about ECT in ages, so it was nice to see a piece in Ireland's Independent yesterday wherein an Irish psychiatrist slammed the use of ECT:
"Dr Michael Corry, consultant psychiatrist at the Institute of Psychosocial Medicine, contends that the state of confusion, sometimes tinged with a mild euphoria, that is regularly encountered in the aftermath of some types of head injuries, temporarily obscures the patient's original symptoms, which is then erroneously classified by psychiatrists as an 'improvement.'"'The fact that these results wear off is underlined by the reality that some patients have literally had hundreds of shocks. Why is this terrible and devastating human rights abuse allowed to go on?' he asks.
"Dr Corry is leading the Irish campaign to abolish ECT. 'It's irrational, archaic and barbaric it has no place in the 21st century,' he says.
"'It is universally agreed that the occurrence of seizures in a patient is always harmful to their brain. Within neurology as a speciality, every effort is made to prevent seizures but, incredibly, psychiatry stands out as the only branch of medicine that specialises in deliberately causing seizures.'"
Separately, the paper reports on a former ECT patient who is campaigning to end the use of the procedure.
My own view is that I am against ECT, even though doctors I know and respect believe in the procedure. For whatever reason, I cannot wrap my mind around shocking someone's brain and I have seen too many patients experience bad outcomes from the procedure, chief among them Ernest Hemingway who claimed that the procedure "put me out of business."
I am also against the forced use of ECT on any human being. If someone wants to opt for the procedure, go right ahead. And, good luck to them.
I've been watching this campaign by Anonymous to out the Church of Scientology's secrets with much interest because all sorts of information that's been bottled up for years is suddenly becoming public. Now, a man who was formerly the head of video production for the CoS alleges that he was punched in the face by David Miscavige, the head of the Church.
"In late 2004 I was walking through the main factory facility with David Miscavige and I had made a smart-alec comment in response to one of his questions, apparently he’d not had a good day already and my comment was not well received and he proceeded to unload on me."He punched me in the face at least ten times and my glasses fell off, I was thrown up against a desk unit, a counter top, and that was the moment right then when I realized I could go no further down than this, to be beaten by the leader of my so-called church. What else could I do that could get me in a lower status than that? And I decided that I would strike back. As soon as he saw that in my eyes, I was grabbed and escorted out of the building and made to take a walk for about an hour or so. He sent several people off to console me, that he really shouldn’t have done that and he was really sorry. While I was being escorted out of the room I heard him say to his staffers, 'He was going to hit me back.'"
If true, that's really interesting behavior on the part of the head of a church which claims it has the answer to the world's emotional problems. Maybe Miscavige could use an audit. Or a benzo.
This letter, sent by a parent to a news service's advice doctor, speaks for itself:
"My daughter is a junior in high school who is preparing to take the ACT. She is an excellent student with a 3.75 grade-point average, and she wants to apply for early admission to college."Given this background, you can imagine my surprise when she asked that I take her to the doctor to get a prescription for ADHD medication. I was blown away. She says many “smart” parents have their children tested and diagnosed with attention deficit disorders so the students have the advantage of prescription medicine and un-timed standardized tests.
"Is this really a trend in education?"
The doc replies that this is a trend--one that's apparently going on in Major League baseball as well, as I noted earlier--and rips this apart as part of a broader social trend wherein keeping up with the Joneses now requires an Ivy League degree, then advises the parent:
"Talk to your daughter and explain to her that this scenario is no different from a student-athlete taking steroids to increase physical performance. Just like steroids, ADHD drugs will not magically provide the skills needed for success in school and life. Any perceived benefits from these drugs are fleeting, and long-term success is rooted in hard work and dedication."
Smartest talk I've heard from a doc in a while.
I've noted several times in the past that psych meds and DSM diagnoses have crept into corners in our culture where I don't think anyone would've augured when Prozac hit the streets in 1987. We're talking antipsychotics for sleeping, ADHD drugs for test taking help, and anti-depressants for people who want to take off their edge. This is a dangerous and stupid trend in our culture. One of these days, we are going to have to let people be what they are once again, or we are going to lose ourselves.
I cannot wait for the backlash.
As the bad news continues to build in the scientific literature about how weak anti-depressants are, some researchers continue to pound on the idea that if at first an anti-depressant doesn't work, then try, try again. Here's a newish paper from Biological Psychiatry (abstract is on this page) wherein researchers do a meta study of four previous studies and find that for people for whom a first line SSRI doesn't work, then switching to a non-SSRI anti-depressant is slightly more efficacious than trying a second SSRI--28 percent remission versus 24 percent.
Reuters thought this study was sexy enough to merit an article, but there's a point where I just begin to shake my head. The best study looking at the what to do after an anti-depressant fails is STAR-D--and in that study each try at another anti-depressant produced weaker and weaker results, all the way down to an 8 percent remission rate on the fourth try. That tells you a lot about the nature of depression and of anti-depressants.
Speaking of this current study:
"The results indicate that current treatments for depression are still less than ideal. 'There continues to be a pressing need to introduce new antidepressant medications,' comments Dr. John Krystal, the journal's editor."
I assume Krystal isn't thinking of Pristiq and I hope to God he isn't thinking of antipsychotics as the new anti-depressants (don't laugh: Seroquel's maker has submitted three separate applications to have the FDA approve its gnarly drug for treating depression), but I think docs ought to be looking to something other than new anti-depressants for their hope. Like maybe CBT. But maybe it's expecting too much to get that talk from the editor of Biological Psychiatry.
I'm not being dismissive of treating depression, but there are limits to where meds will get most people. I had to face up to that fact a few years ago and I think my life--physically and psychologically--is better as a result. But that's just me.
A few months ago, I wrote about something called persistent genital arousal disorder, and here it is once again in this foxnews.com piece. This time out it's called persistent sexual arousal syndrome, and, once again, Paxil makes an appearance as a treatment that has worked for some people who've developed PGAD or PSAS, or whatever the hell the lords of the DSM are going to wind up calling this business.
A researcher describes the syndrome thus: "intense feelings of genital congestion and sensations that are typically unaccompanied by any conscious awareness of sexual desire." This doesn't sound like much fun (genital congestion? yikes) and, indeed, the women interviewed in the article certainly seem to have had their entire lives overtaken by the need to get off. What's driving all of this--hormones, childbirth, etc.--isn't particularly clear, but it is evident that there are cases that won't respond to psychotherapy.
One woman notes the advantages of Paxil:
"'It had a good benefit,' she said. 'It put a damper on the sensations; they weren’t as strong. I could masturbate once and as time went on, it was every other day; then every few days. Now, I can go until the seventh or 10th day — and by then I can’t even concentrate.'"
As I mentioned a few months back, looks like someone has finally found a good use for the sexual side effects of SSRIs.
Just a quick note to let you all know that Comfortably Numb author Charles Barber will be on NPR's "Fresh Air" today. If you want to listen live, go here to check out air times in your area. If you want to listen later, the podcast will be posted here at some point this evening.
Most of you already know that I think Barber's book is one of the best things ever written about depression and I'm pretty much in line with his views on how America's anti-depressant addiction has caused us plenty of problems as a culture and how the whole thing was loosely engineered by a cabal of pharma companies and well-meaning, but sloppy research. The second half of the book delves into the world of cognitive behavioral therapy.
If you wish, you can find his book on Amazon here. I previously reviewed the book here.
A fascinating article by the AP today looking at the phenomenon of the stop smoking drug Chantix and other anti-addiction pills that seem to be causing depression in some users, as well as other odd reactions (eg, mania among some Chantix users). Pharma companies offer the usual counter arguments:
"The makers of the new drugs insist they are safe, although perhaps not for everyone, such as people with a history of depression. Having to restrict the drugs' use would be a big setback because it would deprive the very people who need help the most, since addictions and depression often go hand-in-hand, doctors say.A bigger fear is that the whole approach may be in trouble. Researchers say blocking pleasure, especially the way the obesity drugs do, might take the fun out of many things, not just the harmful substances and behaviors these drugs target."
The problems with Chantix are well known and I have written about them before, as have many readers who've chimed in--pro and con--about problems with the drug. Pfizer, the drug's maker, voluntarily issued warnings about problems with Chantix earlier this year.
A researcher at NIH's addiction institute offers this:
"'It certainly diminishes my enthusiasm' to see these side effects, said Mark Egli, co-leader of medicine development at the National Institute on Alcohol Abuse and Alcoholism."Looks like doctors may become more enthusiastic and old fashioned solutions to addictions--you know, like diet, exercise, self-discipline and other such allegedly outmoded concepts.
I am often confused by the inanity of some governmental bureaucrats and attempts by the head of the VA's mental health system to cover up the true number of suicides and suicide attempts among veterans leave me shaking my head. Ira Katz, the man in charge, knew full well that there are about 1,000 suicide attempts among vets each month, but told CBS News last fall--which has done a great job of covering this issue--that there were only 790 suicide attempts among vets for an entire year.
I don't even understand how lying about such an obvious problem would benefit the agency. Lying about it certainly misinforms the public and Congress about a serious problem in our culture that demands attention.
Like John Grohol at Psych Central, I think Katz needs to resign. He might want to do so soon, as Sen. Patty Murray (D-Wash.) is on his case also, and she's the ranking member on the Senate's Veteran Affairs Committee.
Sadly, I had to ban a commenter just now, an anti-psychiatry sort from Australia. I didn't ban him for his views--I'm sympathetic to some stances of the anti-psych camp even where I don't think they'd translate into sensible policy--but because of a string of personal attacks on me, both by email and in recent (unapproved) comments. This marks the fifth time I've banned someone from this site. I guess for a two-and-a-half year old site that's not too terrible, but it's not something I enjoy doing. I'm generally open to people saying whatever in comments, but the kind of attacks this fellow engaged in I refuse to endure.
I think three of the five people I've banned have been anti-psychs from Australia. Is there something going on in Oz that I don't know about, or is it just their way of saying hello?
From time to time I run across new accounts of children born with heart abnormalities and I pass them along because--regardless of what you think of anti-depressants in general--Paxil continues to be connected with these kinds of problems. This new case from PaxilProgress.org really steams me for reasons you'll see:
"I had a very hard first trimester carrying my son. I had to go to the doctor every other day to check to see if I had started miscarrying. Once things seemed to level off, my doctors wanted me to start Paxil. I wouldn’t do it at first. Then after several doctors wore me down that it 'would be better for the baby,' I thought they knew what they were talking about. I didn’t start until after my first trimester."In the seventh month, they found a hole in my son’s heart. Because of it, they induced me at 38 weeks. He seemed to be fine. A very quiet baby. Almost perfect. He didn’t want to breast feed, which was fine since I had severe post-partum. At three weeks old, he went into the hospital for stomach surgery for Pyloric Stenosis. At six months old, he had his first of two surgeries for a hernia and hydroseal (not sure about the spelling). He had fluid trapped in his legs all the way down to his knees. It looked like he had liposuction when they were finished."
It gets worse from there.
The doctors who pressed her to take this particular anti-depressant while pregnant ought to face some kind of action, before a court or a medical board. The problems with this drug in pregnant women are well known (a group of OB/GYNs issued a warning on this in 2006, see third item) and doctors who prescribe this SSRI to pregnant women are playing Russian Roulette with both of their patients. They should be held accountable. So should GaxoSmithKline, the drug's maker.
What do you think?
OK, I am being sarcastic with my headline, but there was a fascinating bit on WSJ's Health Blog yesterday wherein Wyeth talked about making Pristiq--the Daughter of Effexor; it's the well-known anti-depressant's metabolite--available to consumers for a 20 percent discount over Effexor. Effexor goes off-patent soon and the company wants to capture market share with its old-wine-in-a-new-bottle anti-depressant stat. The company is reportedly going to make Pristiq the focus of its primary care sales force (good luck Wyeth reps!). The pill will sell for $3.41 per dose. No word yet on whether it has the same ugly withdrawal profile as does its daddy (it's only been on the market about two months).
I have to think that not too many doctors will bite on this approach. A 20 percent discount means a month's supply will save someone about $25 a month, give or take, and that doesn't strike me as a particularly strong "benefit" of the drug. Besides, when's the last time you saw a doctor prescribe on the basis of saving someone 25 clams?
The "new" drug has already been criticized by Danny Carlat, a psychiatrist at Tufts University, who once used to do doctor talks for Effexor, because it doesn't work particularly well.
Meanwhile, my local supermarket--that would be QFC--has its checkers wearing "Ask me about $4 generics" ribbons. So I asked one of my checkers and, yes, Kroger (QFC's much-disliked owner) is taking a page out of Wal Mart and Costco and pressing cheap generics on customers. Not that there's anything wrong with cheap generics if they work for you, but I feel like we've reached a point in our culture where we are being pressed to buy, consider and otherwise think about pharmaceutical drugs at every turning point in our daily lives--on TV, in newspapers, on websites and now at the supermarket. In my case, I'd actually have to go to another QFC to partake since my QFC doesn't even have a pharmacy. (I checked their generics list and it includes several anti-depressants plus Haldol and Thorazine in generic forms.)
And law enforcement always paints the ugly picture of street dealers pushing drugs? Sheesh, they are children by comparison, at least when it comes to DTC marketing.
I'd planned a series of posts today on all sorts of things, but I got waylaid last night after going to an old friend's for dinner. We were sitting in her yard in some very brief evening sunshine and she told me about a new guy she'd been dating recently and how he'd gotten unaccountably weird a few days ago. They had mutual friends and the friends were concerned.
What my friend told me was that the guy had been on meds for some unknown condition at some point. She'd tried calling him twice that day, but he wasn't answering his phone, had blown off work for two days (a temp job at a high tech firm in town here), and was basically locked up in his room at a boarding house a few miles away (he'd arrived in town a few months before with very little money).
When we went back inside to make dinner, there was an email from the guy telling my friend that he was "not doing well." She emailed him back and called, but there were no responses. She called one of his friends who apparently knew a bit more about what this guy was contending with--the friend didn't know his diagnosis (his father had been killed in a place crash when the guy, now 33, was 8 years old and he talked about it all the time), didn't know what meds he had taken in the past, but that he wouldn't discuss mental health issues because they were a "conspiracy" and that he was trying to treat his condition with vitamins and visits to a counselor. We rushed through dinner, and then drove over to where this guy lived.
We found him in the street loading a late model pickup with his bicycle and other gear. It was dark and cold, and I decided to let my friend do the talking--the guy didn't know me and I didn't want to come off as a threat--and I went back to my friend's car. I didn't get a good look at the guy in the dark.
The pair talked for several minutes and then my friend came back to the car. I'd given her a few questions to ask the guy and what she told me was that the guy who'd been Mr. Friendly and all bouncy a few days before was now a wall of ice. He wouldn't tell her what he'd been diagnosed with but that in the past he'd taken Seroquel, prescribed to him by a "psychotic bitch," a psychiatrist. "A good drug when you're psychotic, but when you're not it's an evil drug." (I've heard similar accounts before from people diagnosed with schizophrenia.) He was deeply paranoid, my friend said, and was saying that everyone "lied" to him and he couldn't trust anyone.
"What's wrong?" my friend asked him.
"My dad died when I was 8," he said.
He was still loading a few things in his truck, which my friend noted he hadn't owned a few days before. She'd asked him where he got the truck since he had almost no money and he said, "They are giving them away down at the dealership." I didn't really know what to make of that--maybe his credit was good and he'd bought a new pickup, maybe something else was going on. Either way, my friend and I had no way to intervene with this guy and even if he had let us, our options for helping him were kind of limited. He was deeply paranoid and had no health insurance. And I was kind of concerned since my arm's length assessment of his situation had gone from possible bipolar disorder to one of the psychotic disorders, likely schizophrenia given his paranoia, past history on Seroquel and fixation on his father's death 25 years earlier plus his very strange recent bevahiour and the fact that he apparently hadn't slept in almost a week . But it was just a guess, too.
As my friend and I sat there in her car, we watched this guy drive off in his pickup.
"Did he say where he was going?" I asked.
"He wouldn't tell me," she said. "He said he doesn't trust me enough to tell me. I hope he just calls me later."
It was just the saddest thing. And I cannot shake my concern for this poor fellow, not that I would even begin to know what to do about it. I came home and went to bed early. It was all I could do.
BTW, I am tied up with outside work all day today, so that's it for posts today.
We have reached a very pretty pass in our culture when psych meds are a medium of exchange. From the wonderful land of Boulder, Colo. where some middle school students were trying to trade ADHD meds for alcohol:
"Three juveniles were arrested Thursday after on April 4 Boulder police had received a complaint by Nevin Platt Middle School officials who said a student had brought two prescription drugs to school to give them to another student in exchange for alcohol."The prescription drugs were Strattera and Concerta, two medicines usually prescribed in the treatment of attention deficit hyperactivity disorder.
The kids are being charged with possession and/or distribution of a controlled substance, in this case the ADHD meds. Both are felonies.
One of the students who took Strattera got sick and was taken to the hospital, and was later released.
Why are kids--and we are talking 12 to 14 year olds here--playing games with these drugs? Do they really make you dial in so hard that you'd want to goof around with them? Or are they chopping them up and snorting them? I've seen reports of enough vaguely similar cases in the last year or so--sometimes involving Seroquel, sometimes ADHD meds--among teens to where you have to think that something very odd is going on in America.
What happened to the good old days when kids used to simply steal their parents' booze? (I'm kidding.)
Eli Lilly's first quarter sales and earnings were announced today. Worldwide sales of Zyprexa were up 1 percent to $1.1 billion, but US sales of the controversial antipsychotic were down 5 percent "because of competition from newer products and worries over weight gain, which can increase risk of diabetes," according to Forbes.
Sales of the anti-depressant Cymbalta rose 37 percent to $605 million.
Silly me for missing this bit of news out of the University of North Carolina's Prescribing for Better Outcomes Center, but last week the center issued its findings concerning the use of anti-seizure drugs in bipolar disorder, types I and II. What the center's researchers found was stunning:
"No scientifically acceptable clinical trial evidence supports use of either gabapentin or topiramate in bipolar mood disorder, either as monotherapy or as an adjunct to other therapies."
Researchers also found that:
"There is limited evidence showing that gabapentin is no more, and perhaps less, efficacious than placebo in the treatment of bipolar I disorder with recent mania and rapid cycling bipolar disorder. No acceptable evidence was found to support use of gabapentin in achieving remission or preventing relapse in bipolar disorder."
Another top-selling psych med beaten by placebo? Say it ain't so! Both Neurontin and Topamax are widely-used and in fact I know someone in Seattle who was recently put on the former as a first line drug for dealing with bipolar disorder.
The center found evidence supporting the use of Depakote, Tegretol and Lamictal in treating bipolar disorder and even goes so far as to say they perform as well as Lithium. I'm not sure I buy the latter assertion, but I'm not a researcher so what do I know?
The irony in all of this is that the center is supported by funding from the big off-label settlement reached over Neurontin a few years ago in which Pfizer admitted to committing fraud. There's some evidence-based medicine for you.
Via WSJ's Health Blog and Soulful Sepulcher.
Most of you know that as critical as I am about psychopharmacology and the pharmaceutical companies that I try to occasionally tip my hat to the notion that some people--far too few, I'd argue--do benefit from anti-depressants and the like. Here's a woman from New Jersey who's so happy with her experience going on Paxil that she's written a blog entry in the form of a love letter to the drug. I pass it along because it's one of the few examples I've seen of someone praising the pill on the Net in a long while.
"Dear Paxil, Thank you. Thank you so much for the past two months. Thank you for stopping my dead in my tracks on the downward spiral of depression I was surely sinking deeper and deeper into. Thank you for giving me the clarity to consciously choose my thoughts and control my emotions. Thank you for allowing me the ability to think rationally through every situation at a slow enough pace that I can understand everything that's going on in my head. Thank you for ridding me of constant anxiety about trivial things. Thank you for chasing away the out-of-control fsense of sadness, guilt and hopelessness I've been feeling for a long, long time. Thank you for giving my tear ducts a break and for ending the scary midnight panic attacks that were depriving me of much-needed sleep."
You can read the entire post at the above link.
My primary concern for her is that she seems to be very new to the world of SSRIs and I hope she can avoid the washout phenomenon that over time can get people on a cycle of more and more meds that work less and less as time goes on.
This is one of the most disgusting examples of the use of atypical antipsychotics in the elderly I have run across. British man develops dementia, is put in nursing home, which dopes him up big time on Zyprexa. About six months later he develops tardive diskenesia and his neck is twisted and he's left staring at the floor for the rest of his life. Then he dies. (Via Atypical Antipsychotics.)
I know the usual defense for using these drugs in the elderly is that they quiet acting-out old folks who are hard for nursing home personnel to manage. I think that's a lousy defense, especially since there's very good evidence now that placebos work just as well in quieting most AD cases.
Back when I was a music critic in the early/mid-1990s, I championed the work of Alejandro Escovedo, a great songwriter from Austin who is one of the godfathers of punk rock in this country. I've interviewed him many times, know his family, am friends with his younger brother, and so on. He's never become famous per se, but other musicians have always liked him. Including The Bruce himself.
This comes from the April 14 stop in Houston on Bruce's current tour. The song is "Always A Friend." Not sure if I care for the song, but I do like seeing Alejandro get some props from Bruce.
This is one of the oddest stories I've seen on the mental health front in ages. It comes to us from Britain:
"A MAN who started a fire in his mother's home by setting fire to his medication has been jailed."Firefighters had to carry Ian Mullin out in his sleeping bag after he called them to the blaze at his mum's house in Hood Lane, Great Sankey.
"Warrington Crown Court heard on Monday that Mullin set fire to the tablets, which he was taking for depression, having put them in the bin in his bedroom because they weren't working'."
On one level, it sounds funny, but on another it doesn't sound funny at all.
"Defence barrister, Tony Rose, said he had suffered drink problems and depression since being bundled into a van and abandoned by armed robbers."Judge Nicholas Woodward sentenced Mullin to three years after hearing he had been convicted of making hoax 999 calls last year and posed a risk to himself and others."
If the defense attorney is correct about what's gone on with this man, then I'd say jail isn't what this fellow needs at all.
As I noted earlier, there's a spate of mental health blogs that are going on hiatus of some kind. Now, it's my sad duty to report that Gianna Kali's Bipolar Blast blog is going on an indefinite hiatus as well. You can read her post "Quitting?" for the details. Bottom line: all those years of very high doses of psych meds seem to have injured her body. I cannot even begin to send her enough good wishes. I cannot even begin to express my disgust with some of the bad doctors she ran into over the years.
Also, the Psych Survivor blog, written by a man I only know as Mark, was taken down a few weeks ago, and from what I gather he is in the hospital with heart problems. His was/is a good and strident voice on these issues we all care about and his work is missed.
All of this kind of makes me feel glum, since the two people above had been at the blogging game for well over a year and I sensed that they'd both be around long-term. These are people I care about and it sucks that they won't be the presence they once were.
Why is it that mental health blogs are so difficult to do and keep going? Why is it so hard for them to find the substantial audiences they deserve? The Internet is crowded with blogs about politics, technology, gadgets, gossip and parenting and many of these seem to do quite well and have huge audiences and long lives, despite the fact that many of them are merely echoes of one another. Are readers of blogs that simple-minded that all they need is the latest news and opinion on Apple's or Microsoft's latest bit of software or Obama's or Hillary's latest gaffe?
You'd think in a country where 10 percent of the population is on anti-depressants and another 5 percent to 10 percent is likely on some other psych med that there would be a substantial audience for these issues (regardless of what one makes of the dominant mental health paradigm), especially given how wildly popular neuroscience is on the Net. It makes me wonder if we all--and here I include myself--have done something wrong in how we analyze these issues (are we too contrarian?) or if we all simply haven't been crowded out of the big search engines (that's how most people find mental health information online) because the Net is so over-populated with pharma sites and allied pro-pharma health websites. I can certainly say that the mainstream media--which usually loves writing about characters on the Net who push against life's many intellectual tides--has given very little attention to sites like this one, despite the fact that sites like mine have been a very real service to many in the media.
Or maybe the mainstream approach to mental health care is right and the public is just trying to tell us something.
What do you think?
Most of you know The Trouble With Spikol blog and many of you probably know that it's been kind of spotty of late since its mistress, Liz Spikol, has had a real tough run of depression and job fun. In this post, she pretty much hints that she's either going to turn the blog into something other than mental health focused or maybe chill out altogether. She's asking for reader suggestions, so go suggest.
Personally, I'd hate to see her leave mental health work completely, but I understand how tough it is to do one of these sites every day, write about some very heavy stuff, and somehow try to keep your life together. So she should do whatever she wants. She's paid her dues.
In other blogging news, Susan S., who writes If You're Going Through Hell, Keep Going, is going through some serious hell of her own. She's in the hospital with pneumonia and is very ill. Her blog is on hiatus until her health improves, which I hope is very, very soon.
On my own front, I've had to take things slow the last couple of days. I'm beginning an outside project that will absorb a good bunch of my time the next couple of weeks or so. What's more, the weather has been awful here once again and I've learned over time that I cannot work myself into the ground when the weather is crappy. It simply wears me down too quickly at the tail end of winter (or spring, right?).
And it's been remarkably quiet on the mental health news front the last few days. I know that won't hold.
So I was watching the Mariners v. Royals game on Monday night and Dave Niehaus, the fine M's play-by-play guy (who's going into the Hall of Fame in July) dropped a bit of a bomb about Zack Greinke, the Royals' starting pitcher. Niehaus said that Greinke had social anxiety disorder and "he's on medication for that."
Greinke is a hell of a pitcher, and is 8-0 going back to last August. He's won three games already this year (in two weeks. Yikes) and his ERA is stupid--.75. He can throw 99 mph when he's in mid-season form, but was only hitting 96 the other night.
I was a bit surprised by Niehaus' revelation (it's kind of unusual to hear about any ball player's DSM status), so I did some poking around. Turns out that Greinke is fairly open about his situation, which he describes thus:
"'Depression kind of runs in my family. Supposedly, it goes down through (genetically). But I don't know if that's what I was actually going through."'The medicine I take is an antidepressant. So (depression) must have something to do with it. That and social anxiety. But I don't think it was a serious case. I mean, I never thought about killing myself.
"'It was always, once I got away from baseball, I was fine. So I didn't think about it as (an emotional disorder). I just thought that, at the baseball field, I was unhappy.'
"That misery reached such depths that Greinke often contemplated quitting baseball while still in the minors. His inability to handle the down time between starts heightened his turmoil and made him yearn to be a hitter or at least a relief pitcher.
"'I'd talk to my agent all the time and ask him: "How can I tell the Royals that I don't want to pitch? That I want to try hitting?,"' said Greinke, who added he knew there was no chance of that happening, which increased his frustration. 'I thought that was why I hated baseball. I thought it was because I wanted to hit.
"'It would be at least once a month that I'd be crying to myself while I'm going to bed with a bat in my hand, just swinging it. It's stupid. That doesn't happen anymore.'"
The guy seems to have worked it all out, much to the detriment of opposing batters who now likely have a case of SAD all their own when facing Greinke.
I'll just pinch from the UPI's account:
"The daughter of a Norwegian politician killed herself after she received negative results on a personality test by the Church of Scientology, officials said."Kaja Ballo, daughter of Norwegian politician Olav Ballo, took a personality test administered by a Scientology center in Nice, France, Aftenposten said Wednesday.
"Family and friends described the 20-year-old in a generally good mood until Friday, March 28, when she "changed" after reading the results from the test.
"She took her own life hours later.
"A Scientology spokesman called the allegations "deeply unfair" and pointed to an eating disorder and other psychological issues she experienced in her early teens.
"Critics say the break-you-down-build-you-up recruitment tool of Scientologists is controversial."
Regardless of the cause, this is tragic. I'm sure Scientology and its "technology" works just fine for some people, but the reality is that this is one weird "Church."
Most of you probably don't know of the bipolarcentral.com website, which is quite popular, and its accompanying blog, Bipolar Supporter, which is less popular, but where the main site's operator, David Oliver, shares his views on bipolar disorder and what to do about it each day. Oliver doesn't have bipolar disorder, but his mother does and his site is where he chronicles what he did to help out his mom and where he tells everyone with bipolar disorder--and their families--what they must do to ensure success. He's very much from the "scare people onto their meds" school of persuasion.
Oliver, as near as I can figure, is making a living selling various guides to successfully managing bipolar disorder--everything from how to get out of debt (that guide costs $19.99 last I looked) to how to find the right doctor to injunctions that you must be on meds all the time. I don't question the man's good intentions, even though I find the hucksterish tone of his material annoying and his clinical judgments to be useful for little more than crisis care. His site and materials are so popular that he actually has a going business and employs something like one dozen people with bipolar disorder (I admire him for that).
I've not commented on his writing before because it's generally fairly hackneyed and unsophisticated. But today he sent out an email of his latest blog post entitled "Die From Not Taking Bipolar Medication?" Here's a snippet (the formatting is his):
"If you have bipolar disorder, and you don't take medication for it,"YOU ARE GOING TO DIE.
"So, ok, I know I am going to get some
hate mail, I understand that."But maybe others will open up their
eyes and in those cases maybe I will
actually save some lives."Because it is TRUE!
"If you have bipolar disorder and you
won't take your medication, or you
don't even believe in taking
medication, YOU WILL DIE!"One example (and there are so
many others) is Michele's sister.
She was on medications for her
Bipolar disorder. Then she went
off them, and 8 months later, she
killed herself."I know that some of you are
already saying to yourself,
"Yeah, but that's not ME."
And I say, "Yeah, but it COULD
be you. And it WILL be you if
you stay off your medication!....""In my courses/systems, I go over all
the reasons that people give for going
off their medications, and the top
reason is because of the side effects:"SUPPORTING AN ADULT WITH BIPOLAR DISORDER?
Visit:
http://www.bipolarsupporter.com/report11"SUPPORTING A CHILD/TEEN WITH BIPOLAR DISORDER?
Visit:
http://www.bipolarparenting.com"HAVE BIPOLAR DISORDER?
Visit:
http://www.survivebipolar.net"But the side effects CAN be managed!
Just ask your doctor! Side effects should
NEVER be a reason for going off your
medication."Others have stopped their medications
because they believed they no longer had
Bipolar disorder. THAT IS A LIE! Once you
have been diagnosed with bipolar disorder,
you will ALWAYS HAVE BIPOLAR DISORDER!"
So there you have it. I'm not even going to waste my time refuting his nonsense, except to point out that the side effects of some of these medications for bipolar disorder can be deadly and/or disabling. Those class action lawsuits against the makers of atypical antipsychotics aren't happening for nothing.
BTW, his support program for parents of kids with alleged child bipolar disorder costs only $199.95.
So what do you all think of Oliver's arguments?
Today is the first anniversary of the massacre at Virginia Tech. Thirty two people were murdered by a deranged student with selective mutism and two handguns. I don't have anything wise or thoughtful to say, except that I am discouraged that we've had two vaguely similar rampage shootings in this country since--the Omaha mall last fall and NIU two months ago.
My own writing about the VT shooter and the media storm around his diagnosis can be found here.
I wish you all a peaceful day.
Posts will be late today. I got so chilled at the Mariners game yesterday and was so tired when I got home that I passed out, missed dinner, and had to go out for a late meal. And I still never warmed up. That was the single coldest baseball game I have been to in my life (42 degrees with a nice brisk wind on top of that) and I stayed until the bitter end. Like a fool. And now I am going to go get about eight hours sleep.
Until I catch up with you all later, please read all the news that's going round about Vioxx and Merck. Ghostwritten studies. Knowledge of the drug's dangers well in advance of Merck pulling it from the market in 2004. Everything I and many others have been saying about the psych med world for years only this time with a painkiller. In a nice twist, the second of the NEJM papers was authored by some researchers here in Seattle.
I bet this Vioxx business gets more attention than Zyprexa ever did. I think the two cases are deeply connected and similar--two big companies creating a drug that allegedly helped people when it was really a public health problem in a pill.
As Montel Williams likes to say on TV, "America's pharmaceutical research companies want to help."
Just a quick note to let you all know that I won't be approving comments from about now until 7.30 pm or so PDT this evening. Someone gave me a really nice pair of tickets to today's Mariners game--right behind home plate--so I'll be offline and freezing my butt off at my first MLB game of the year. Feel free to leave comments and I'll approve them when I get home.
Richard Friedman, a Cornell psychiatrist, opines in the New York Times about patients who've been on anti-depressants since their teens and what they bump into once they climb into adulthood--all kinds of identity questions since they have little psychological development absent a diagnosis and medications--and how medicine hasn't really tackled some of the key questions around long-term anti-depressant use.
Anyway, one of his patients pressed the subject into Friedman's forebrain:
"It was not an issue I had seriously considered before. Most of my patients, who are adults, developed their psychiatric problems after they had a pretty clear idea of who they were as individuals. During treatment, most of them could tell me whether they were back to their normal baseline."Julie could certainly remember what depression felt like, but she could not recall feeling well except during her long treatment with antidepressant medications. And since she had not grown up before getting depressed, she could not gauge the hypothetical effects of antidepressants on her emotional and psychological development."
I was fairly rough on Friedman over an earlier opinion piece a few months ago, but I am going to be more charitable this time out. He's asking the right questions, regardless of how I feel about his answers. I hope that readers won't be interested in nitpicking him to death, but will instead focus on the larger issues.
We're 20 years into the psychopharmacological party in America, and Gen X and Gen Y are the ones growing up with voodoo in their veins and brains. Regardless of your views of diagnoses and meds, we need to have a big old sociocultural reckoning on these matters. What are we setting people up for in terms of their human development and their core identities if they've spent most of their lives on anti-depressants (or mood stabilizers or antipsychotics)? What's normal human development in abnormal psychology? What's their sex life going to be like if they've hardly ever been horny due to taking anti-depressants? How do you "know thyself" when your self has been partially shaped by the fine folks at Eli Lilly and GlaxoSmithKline? And so on.
Friedman admits he doesn't have the answers--no one does at this point--and he's a whole lot sunnier about the long-term use of psych meds than I'd ever be:
"We know a lot about the course of untreated depression, probably more than we do about very long-term antidepressant use in this population. We know, for example, that depression in young people is a very serious problem; suicide is the third-leading cause of death in adolescents, not to mention the untold suffering and impaired functioning this disease exacts."By contrast, the risk of antidepressant treatment is small. A 2004 review by the Food and Drug Administration, analyzing clinical trials of the drugs, did show an elevated risk of suicidal thinking and nonlethal suicide attempts in young people taking antidepressants — 3.5 percent, compared with 1.7 percent of those taking a placebo. But since the lifetime risk of actual suicide in depressed people ranges from 2.2 to 12 percent, risk from treatment is dwarfed by the risks of the disease itself."
I wouldn't consider the risk of suicide and suicidality, on or off-meds, to be the only worrying metric for doctors and patients to consider, or by which to evaluate long-term risks and benefits. What about brain development? Sexuality? Reproductive organ damage? Drug dependence? Long-term akathesia? Kidney and liver damage? Diabetes? Muscle rigidity? We already know that antipsychotics cause brain shrinkage in non human primate studies, so we do need to take a serious look at that in our human populations or we are doing them a gross disservice. It'd make sense to be just as concerned about anti-depressants and the whole shooting gallery of psych meds, especially since we are starting children on them at much younger ages than we even did in the 1990s.
Friedman blames the lack of answers on how psych meds are tested and approved and used in our culture--short term scientific trials for approval and barely-tested long-term use in a culture that demands that these medications be used for life. I don't think it's just the culture of FDA approval that's at fault. I think doctors have been lazy about asking these questions and I think patients are just as much to blame. Too often doctors and patients accept short-term clinical success for long-term prospects.
We need to face facts: We've been conducting the largest behavioral and medical experiment in human history right here on Spaceship America (and Spaceship Britain) over the last 20 years, and few have bothered to ask the questions that needed asking. I give Friedman props for opening his mouth.
One place where I'd criticize Friedman's piece, however:
"What do I say to a depressed patient who is doing well after five years on such a drug but can’t stop without a depressive relapse and who wants reassurance that the drug has no long-term adverse effects?"
He doesn't even nod his head to the possibility that the depressive relapse might have little to do with depression and quite possibly everything to do with the medication. I know of too many cases of people who've been on Prozac since its introduction in 1987 (there is data showing that over 500,000 Americans have been on anti-depressants for over 15 years, but I cannot locate it at the moment) and cannot get off the drug because they've developed a physical need for its "chemical balance" and simply lose all their energy and human oomph when they try going off it. This is a known phenomenon and if doctors cannot appreciate its dynamics and its pressing cultural importance, then us patients are going to have to shove it in their faces. (For further reading: the wonderful Bipolar Blast blog is an ongoing account of one brave woman's attempt to get off all medications after being on them for longer than I was. And that's a long time.)
My own thinking on these issues is far from complete, just like my own off-meds experiment (a doctor approved experiment I'll add for newbies) which is now at almost nine months. I'm in no position to state whether I think what I am learning is of any use to anyone else. But I do think it's a legitimate idea that for anyone who the medical paradigm of mental health argues should be on psych meds for years and years then there should be some kind of off-meds trial built into our treatment algorithms and practice guidelines and doctors should be encouraged to help patients find out what makes them tick underneath the medicated self.
The one thing I've learned in my nine-month adventure is that I have a level of freedom now that I cannot put into words. But whatever you'd call it, it's certainly built on the freedom to succeed and fail as a human being and as a human self.
I kind of like that.
There was an excellent and exhaustive article in the St. Petersburg Times on Sunday, detailing how the newer atypical antipsychotics were deemed no betetr than older antipsychotics by the FDA, so pharma companies went out and got docs to tout the drugs for them. Along the way, the companies alleged bribed a state official in Texas to help him create the Texas Medications Algorithm Project, the infamous TMAP, as well as a state pharmacist in Pennsylvania, and in Florida Eli Lilly helped start the Florida Behavioral Health Collaborative with a $10 million grant.
Lilly defends its practices:
"According to Lilly spokeswoman Janice Chavers, the goal was not to help the company's profit margin, it was to give patients the best care: 'Patients always must be the top priority. It can't always be about the bottom line.'"The Florida collaborative convened an expert panel to recommend state standards for treating mental illness. National scholars were invited — all with financial ties to drug companies.
"To treat schizophrenia, the panel decided, doctors should try an atypical first. If that didn't work, they should try a different atypical. If that still didn't work, they should try a third atypical or, if they would rather, one of the older generation drugs."
Oh, yes, patients have always been the top priority for Lilly, as the company's marketing of Zyprexa, an unsafe drug, clearly demonstrates.
The rest of the article is excellent and details how pharma companies basically twisted the influence of just a few doctors and state officials into billions of dollars in sales--and tens of thousands of patients with diabetes.
Like PHrMA's Ken Johnson and spokesmodel Montel Williams like to say, "America's pharmaceutical research companies."
A psychologist has gone and established what many of us have long suspected--namely that ads for psych meds are often misleading and are not evidence based. This is according to a study, which I haven't seen, in the Journal of Nervous and Mental Disorders. The author, Glen Spielmans of Metropolitan State University, did speak to Chemistry World however.
"Roughly half of the adverts featured citations to primary research papers to support their claims. Yet when the team checked, they found that over a third (35 per cent) of the claims were not supported by their cited sources."'The sources are provided by the companies themselves, so it's pretty easy to cherry pick one study that backs up their claim,' Spielmans told Chemistry World. 'Despite that, many of the cited sources did not support the advertising claims.'"
"Examples include Shire's adverts for manic depression drug Equetro (carbamazepine). Shire sold the drug to Validus Pharmaceuticals in September 2007, but an ad by Shire in 2005 claimed Equetro was an effective treatment for both manic and 'mixed' episodes - when patients experience mania and depression at the same time. However, Spielmans' team found that neither of the two references cited in the ads supported the idea that mixed episode patients treated with the drug fare better than those receiving placebo."
I look forward to seeing the whole paper so I can see what else Spielmans found.
"Spielmans says his findings contradict the pharmaceutical industry's contention that drug ads serve to educate doctors about the benefits and risks of drugs. 'Education would typically be based on evidence,' he notes. 'If it's not based on evidence, it's not education.'"Responding to the findings, Ken Johnson, senior vice-president of the Pharmaceutical Research and Manufacturers of America (PhRMA) trade association, said, 'Federal safeguards are in place to help assure that the advertising and promotional material disseminated by America's pharmaceutical research companies in US publications is accurate and well-substantiated. America's pharmaceutical research companies may only disseminate promotional materials for FDA-approved indications, as noted on the pharmaceutical labelling.'"
It's ironic that Johnson would stress the "America's pharmaceutical research companies" line about now--it's the trade group's new line in the Montel Williams ads--since this study makes it pretty clear that the industry is as much about marketing as it is research. What's next Ken? "America's pharmaceutical education and research companies?"
Protests against the Church of Scientology and its practice of "disconnecting" new members from their families took place over the weekend. There were protests at CoS's headquarters in Clearwater, Fla., and elsewhere in the US including Seattle and New York City.
Clearly, the church is pissed off:
"Church spokeswoman Pat Harney said Anonymous is a terrorist group that has harassed church members and staff daily with threatening phone calls."'We have been enduring this for three months now,' Harney said. 'This is a religious hate campaign while their leaders hide behind masks of anonymity. It's not OK that they get all of this attention. We refuse to interact with them.'
"Harney said the latest protest twists the beliefs of Scientologists.
"'The Church has no policy of disconnecting members from their family, as Anonymous is plainly aware," Harney said. "We believe family is the building block of society.'"
Oh, that's rich. Back in the 1980s, I watched as the Church pulled apart the family of some of my parents friends. Their 20something daughter had joined the cult and the Church did everything it could to block the family from contacting her.
More protests are scheduled for May.
In what I consider a surprising move, the US Supreme Court today declined to review--or denied "cert" to--the sentencing of Christopher Pittman, who at 12-years-old murdered his grandparents in 2001 soon after being put on the anti-depressant Zoloft. Pittman got a 30-year-sentence and his lawyers hoped to have his case reviewed as a violation of the Constitutional principle outlawing cruel and unusual punishment.
As I understand things, any potential Supreme Court review wouldn't have examined any of the issues around Pittman's use of Zoloft or any possible connection with his behavior, but would simply have focused on the length of his sentence. It's a shame the justices walked away from the issues on this case.
That said, the Pittman case has always struck me as being one of the most profound examples of violence being connected to anti-depressant use. Twelve-year-olds don't just murder their grandparents.
I'm sure some readers are tired of reading my amazement at just how aggressively pharma companies are pushing to have their antipsychotics used for damn near every human psychological flaw between heaven and earth, but here's yet another example of just how far Big Pharma will go. Johnson & Johnson today submitted a new drug application to the FDA to have its Risperdal CONSTA--the two-week injectable version of Risperdal--approved as an adjunctive, or add-on, treatment for rapid cycling bipolar disorder.
In a release, the company claims that what it calls "frequently relapsing bipolar disorder" (aka, rapid cycling) affects 10 percent to 20 percent of people with bipolar disorder--27 million people worldwide, says J&J.
When pushing an injectable, companies usually emphasize treatment non-compliance as justification for use of an injectable, but not so here. And since J&J is seeking approval as an add-on treatment, then it's safe to assume that patients are likely already on some other meds. So I am at a loss to explain what the advantage might be in using an injectable over, say, an antipsychotic in pill form. Not that I am a fan of Risperdal or any other antipsychotic in pill form--these drugs are dangerous used long-term and there is ample evidence of that.
What's also weird here is that a patient with rapid cycling bipolar has likely already been trialed on an antipsychotic, so it's hard to understand how the company plans to market an injectable version of Risperdal for patients for whom pill form Risperdal likely didn't work.
What discouraging to me is that we know that a fair number of cases of rapid cycling can be linked to the use of anti-depressants in treating bipolar disorder and that some leading psych researchers are calling into question the use of anti-depressants in treating bipolar disorder. So you'd hope that a smart doctor would insist that his or her patient get off whatever anti-depressants they are taking first before addressing matters with CONSTA.
Whatever you all make of this new drug application, I continue to be staggered at the push by pharma companies to get antipsychotics embedded into American life.
I've gotten a few emails recently about the radio program "The Infinite Mind," which is a public radio show here in the US. I don't catch the program on-air anymore since it's not broadcast in the Seattle area these days. And maybe that's just as well, because during the week of March 26 the program's host, Fred Goodwin, did a program called "Prozac Nation: Revisited," which was essentially his response to what he says what the wrong-headed coverage of the NIU shooting and the connection of anti-depressants to the shooter's actions. Goodwin was joined by guests Andrew Leuchter, a UCLA psychiatrist, Nada Stotland, incoming president of the American Psychiatric Association and Peter Pitts, a former FDA associate commissioner and president of the Center for Medicine in the Public Interest (which runs the drugwonks.com blog).
In the course of the program, Goodwin and his guests delivered an incredible series of lies and half-truths concerning anti-depressant use and connections with violence, suicide, suicidality, FDA black box warnings and how the media does its job. While I respect Goodwin's standing in the profession and his years of service to the mentally ill, I take exception to his using his program--which is heard by some 500,000 people each week--to propound a host of misinformation, especially since his program is carried on public airwaves that are taxpayer-financed and listener-supported. In other words, he needed to present a balanced set of information on these issues and he failed. Ironically, Goodwin argued that it's the media that's being excessive. I think Goodwin is the one overreacting here.
I won't give you a blow by blow of the program. You can download it here and listen for yourself. Click on the "Listen Now" link.
It did amuse me that Goodwin spent so much time emphasizing that the media was out of control in emphasizing a Prozac connection to the NIU shooting. I don't think the media hyped than angle very much and as I pointed out on this site numerous times, I didn't think then--and don't now--that the Prozac withdrawal explanation for the shooting is particularly strong (such connections are much stronger in other cases of violence and the courts have agreed with me). But it was enough for Goodwin to have an opening to advance his views of anti-depressants.
In the introduction he states, "There is not credible scientific evidence linking anti-depressants to violence or suicide." That's simply wrong.
During his segment with Goodwin, Leuchter says "suicide rates go down" when anti-depressant use goes up. I guess he hasn't been reading the BMJ lately. Leuchter also claimed that there is no risk of suicidality in adults aged over 24. That's bullshit, pure and simple.
Then comes a howler when Leuchter says, "It is clear anti-depressant prescriptions have gone down." That's wrong. There was a slight dip in 2005, but Rxs were back up in 2006 and 2007. Over 232 million prescriptions were written for anti-depressants in 2007, making these the most prescribed class of drugs in America.
At several points, Goodwin interjects that suicide and suicidality are not connected and that there is no scientific evidence for the phenomenon. That's simply offensive. Someone who commits suicide is obviously experiencing suidicality, ipso facto and prima facie, and its embarrassing for Goodwin and Leuchter to commit such freshman year errors.
Goodwin, as he interviews Stotland, says and I assume he's referring to 2004, there was a "huge decrease in the use of anti-depressants and an actual increase in suicides." That's wrong. The decrease came in 2005 and wasn't especially large and that same year, according to CDC data, there was a decrease in the suicide rate in America.
Stotland states, "There was no good reason for the black box warning." This is crazy talk and quite troubling coming out of the mouth of the head of the psych profession.
Peter Pitts is even more fun, claiming that a link between anti-depressant use and suicidality was "never proven." Hey, Peter, why don't you call me and we can talk?
Pitts alleges that the black box warning and media coverage of it is "keeping the right treatment from patients."
Anyhow, listen to the program yourself and decide for yourself. For an alleged science program, it was pretty non-scientific and deeply religious.
A read left a comment yesterday describing hers and her husband's experience with Chantix, Pfizer's star-crossed stop smoking drug:
"My husband and I started taking Chantix Jan 7, 08. Quit smoking Jan 29, 08. Quit Chantix Feb 18, 08 due to problems. I am never a "down" or depressed person. I have been depressed, agitated (also not like me), just felt pyschotic. Husband felt strange also and developed tremors. We both don't smoke, but also get no pleasure from just about anything any longer. We had always been an extremely sexual couple, that is just about gone. Still feel "strange". Have been to our doctor and spoke with our pharmacist. Both have said it is out of our system now, but we still have the same feelings ie: depression, agression, decreased libido. We are concerned about permanent damage, don't know where to go for help. Would rather have taken my chances with cigarettes than feel like this. Try another stop smoking method!"
I continue to be fascinated and alarmed by the range of experiences people have who take this drug--everything from wonderful experiences such as a friend of mine had (who nonetheless bummed a smoke from me the other night) to suicides and depression to decreased libido. A strange drug indeed.
It reminds me of Paxil.
The British Food Standards Agency yesterday moved to ban six food colors that are apparently linked to ADHD is some kids. The colors are: tartrazine (E102), quinoline yellow (E104), sunset yellow (E110), carmoisine (E122), ponceau 4R (E124) and allura red (E129) and are found in all kinds of food products including mushy peas and confections.
"The researchers estimated that 30 per cent of cases of attention deficit hyperactivity disorder (ADHD) would be prevented if companies removed the colours used in the £13bn-a-year global additives industry."
Thirty percent? That's quite a claim. I'm no fan of banning foods and additives, but if these food colors are as tightly-linked to ADHD as researchers claim to have proven in a Lancet study last year, then go right ahead. Folks can just have their mushy peas gray-green instead.
On the other hand, I know that in America researchers have looked into this same issue and not found similarly strong evidence to support the food-colorings-make-kids-hyper theory. Guess we'll have to see how this ban works out in the UK.
Danny Carlat, whom many of you know through his website and his "Dr. Drug Rep" article of last year, is a clinical professor of psychiatry at Tufts University and is in private practice. Anyhow, Carlat recently had a visit from some AstraZeneca reps, pushing Seroquel for bipolar depression and using some of the most asinine sales patter ever.
"Yes, until today, I was seeing reps a few times a month for 5 minute visits in order to keep up on trends in drug company marketing techniques. But today, an Astra Zeneca rep and his district manager came in to push Seroquel for bipolar depression. They came armed with the two studies that won Seroquel its FDA approval. The studies have their limitations, but somehow these reps didn't bring these up."
Those studies would be BOLDER I and BOLDER II, which CL Psych and I have had much fun carving up previously. A letter of mine challenging some of the statistics in BOLDER II will be published in the Journal of Clinical Psychopharmacology in June.
Back to Carlat:
"[W]hat I got was a ridiculous hard sell: 'Dr. Carlat, given this data, would you choose Seroquel over the other atypical antipsychotics for bipolar depression?' I asked them if Astra Zeneca had done any head-to-head studies comparing Seroquel with the others. The rep adopted a pseudo-confused look, and said, 'I'm not even sure that kind of study would be ethical--would the FDA even allow you to compare an approved drug with an unapproved drug?' I pointed out that the FDA, in fact, requires that drugs be compared with placebo, the ultimate in 'unapproved' drugs, and that they deem this ethical enough."
His encounter with the reps goes from there. Were these guys so dumb that they didn't know who they were dealing with in advance? Are reps still being taught and using that absurd Zerox sales training dialogue? I was smarter than that when I was a pharma rep 20 years ago.
As a result of the visit, Carlat has banned pharma reps from his office. Good for him. I wish other doctors would follow suit. I also wish doctors would be a hell of a lot more skeptical about how they hand out Seroquel. In my opinion, it is not a good drug for anything other than short-term use--and even in short-term use it's pretty nasty stuff. Your mileage may vary, however. I'll leave it at that.
This is one of the best satires I've read in a while and it's on the Superlative In All Things blog. It begins:
"COLUMBUS, OH. –Jake and Mandi Donaldson were overjoyed when they learned that their dream of building a family would soon be realized. That joy rapidly turned to concern when the fetus began to exhibit bizarre behaviors that kept Mandi Donaldson awake late into the night. Doctors could not explain these episodes, despite numerous ultrasounds and maternal serum testing. The expectant couple finally found answers to their questions when the fetus was diagnosed with Fetal Bipolar Disorder."The fetus, who Mandi Donaldson has named Piper, demonstrated extreme mood swings as early as 20 weeks. 'Sometimes she would just lie there for hours, and other times she just couldn’t be still. She was completely erratic.' The symptoms worsened as the weeks went by with Piper’s agitation growing progressively stronger. 'She started kicking me in the kidney over and over again. I knew something was definitely wrong, but I never suspected mental illness. I thought she was just a little shit.'
"Dr. Matthew Pearson, chair of the newly developed Fetal Psychiatry Department at Johns Hopkins, says this type of behavior is characteristic of Fetal Bipolar Disorder. 'These fetuses are very sick and very difficult to care for. They rapidly cycle between depression and mania, causing extreme distress for their mothers, including heartburn and frequent urge to urinate.'"
And it goes from there.
This could easily become an Internet classic. The rest is here.
I'm just going to ask the question in light of a comment left earlier today by a mother about her son. I'll come to that in a second.
Something on the order of 2 percent to 3 percent of American kids are now taking antipsychotics--not anti-depressants, not stimulants, but instead the nuclear weapons of psychiatry. Regardless of what you think of psych meds or of psych diagnoses, something very real and tragic is going on here in our culture: 1 out of every 150 newborns is autistic, 4 percent or so of kids are supposedly ADHD, and so on. I promise you this was not the case in the 1960s, 1970s and 1980s and I don't think we are seeing such increased prevalence simply as a result of "better" diagnostic criteria.
Something else has happened. But what? Is this nature? Is it nurture? Are we reaping the whirlwind of something we don't even know?
And what the hell are parents supposed to do? Here's what the mom I mentioned above is having to do:
"You know, as a parent of a mentally ill child, one is left with very little in the way of resources.Here's a description of my son at age 5:
1. Consistant sleep disturbances--awake with nightmares on average 6 nights out of seven. Takes 1-3 hours to fall back asleep. Has never, cince infancy,consitantly slept through the night, even with implementation of medical/behavioral sleep programs.
2. Phobic since he was able to speak--the phobias change over time, but there is always an illogical, dominating fear of something--spiderwebs, tunnels, thunderstorms, the possibility of trees falling on the house, the possibility of the trunk of the car opening while driving. True panic attacks often occur.
3. A variety of compulsive behaviors that change over time, but are always present--must have shoes tied in a specific way, must stop and run outside when an airplane passes overhead, no matter what else he is involved with, must say the same phrases at the same time of day.
4. Not autistic or Aspergers. Superior IQ, attached to parents, good social skills.
5. Sensory dysfunctions--wears shoes so tight his feet have blisters. Reacts to exposure to loud noises --parties, stores, with complete meltdown.
6. Explosive rages--his older siblings are afraid of him. His parents have bite-marks and bruises from restraining him.
7. "Consequnces" and structured behavioral interventions do not diminish explosive behavior. Child consistently expresses deep remorse for bad behavior.
8.Lots of verbalization--child does not stop talking,and topics appear to reflect racing thoughts: A typical "conversation": Mom, to ants, grass looks like trees. How long does it take copper to turn green? Do you know how tall the Statue of Lberty is? When we drive to New York we can see the planes.
9.Incompletely toilet-trained.
10. Physically healthy--no seizure disorder, no genetic disorder.
12.Little to no regard for his own safety.
13. Bouts of impulsive, sexually inappropriate behavior, and cannot ever be left unsupervised with other children.
14. Little to no benefit from intensive therapy.
It frosts me when folks claim that kids like these just need structure, discipline, and the understanding that kids are kids.
Parenting a child this disabled, and keeping them safe, means exclusion from much of everyday life. There's no childcare for a kid like this. You have groceries delivered when your kid is going through a bad patch, because they can't handle being in a store. You make sure your 7 year old has a bedroom door that locks from the inside so that they can be safe.
So, yes: I drug my child.
So he can go to school. So he can have friends. So that he doesn't deliberately run into traffic, or jump from a second-story window just to see if he can.
So that he can live at home, and not in an institutional setting, which is where he would be, now, 4 years later, when he is faster than I am, and nearly as strong.
And he still has intensive therapy, 2-3 times a week, gets his blood sugars checked regularly, gets his heart monitored.
If there's a better option out there, I haven't found it.
Sorry this is so long, but I get so ticked off by the assumption that parents are somehow too stupid or careless or gullible to know better than to give their kids dangerous medications. some of us do it because the options are more dangerous."
This is simply heartbreaking. And it's going on all over America.
Here's a study fresh out of the Canadian Medical Association Journal asserting that the rate of youth suicide in the Canadian province of Manitoba increased dramatically following government warnings in 2004 of risks of suicide and suicidality in youths associated with the use of anti-depressants. Prescriptions of anti-depressants to kids dropped and suicides went up, according to Canadian researchers.
That's exactly the opposite of what a recent British study found--a drop in suicides among British youth at the same time that anti-depressant warnings were hitting the UK and prescriptions for anti-depressants went down. It's also at variance with experience in the US where a study attempting to link decreased anti-depressant use to increased suicides has largely been discredited.
Still, the Canadian data is concerning not simply because of an increase in the rate of suicide among youths from .04 suicides per 1,000 people before the warning to .15 suicides per 1,000 people after the warning, but also because kids with depression didn't see doctors as often as before (the rate dropped by 10 percent), essentially cutting them off from any therapeutic intervention such as psychotherapy much less medications.
Why the Canadian data is at variance from the UK and the US is beyond me. Although I can't access the full paper and am not aware of the absolute number of suicides in Manitoba among this age group, it's likely a small number (an estimated 1.2 million people live in the province, most of them in and around Winnipeg), so a sudden uptick in suicides can skew the data quite a bit. What's more, Manitoba may well be an outlier province in terms of social behavior from the rest of Canada, so it'll be interesting to see if these same sort of changes are reflected in the youth suicide rates in other provinces. Keep in mind that Manitoba's population comprises about 3.6 percent of the total population of Canada, so I don't want to read too much into this study.
But a suicide is still a suicide and I am beginning to wonder if we will ever sort out the great anti-depressant/suicide question. Population based studies tell us different things each time out or so it seems.
Here's how the lead Canadian researcher, Laurence Katz, makes sense of things:
""We can't say the warning, or the change in anti-depressant use or the physician office visits caused changes in suicide rates," says Katz....""Katz says he didn't have a problem with the warnings themselves. But he says some people leaped to the assumption 'that these medications lead people to kill themselves.'
"'We don't know that yet. What we do know from those randomized controlled trials, that there may well be a small subgroup of children and teenagers with depression who when they receive a medication do experience an increase in suicidal thoughts, or even suicidal behaviour.'"
This whole matter is one of the diciest in all of medicine. It certainly deserves a more complete answer than the mixed evidence we have these days.
Thoughts?
That's the broad question posed by Stephen Dubner, who is co-author of the bestselling Freakonomics and a blog of the same name at the New York Times. He asked a collection of big shots in the psych and neuroscience worlds, including Peter Kramer, and the mother of a suicide victim who'd been diagnosed with bipolar disorder:
"How much progress have psychology and psychiatry really made in the last century? Do we know enough about the human psyche to prescribe the medication that we do?"
The answers are worth reading and although most of the people defend the basic biopsych model, they also admit that, as far as we've come in both psychology and psychiatry over the last 100 years, we still haven't gone so far. I don't agree with Kramer's continued obsession with criticizing psychoanalysis, for example, because psychoanalysis isn't exactly a field with much influence in mental health care these days. I do agree with the respondents, however, that we have come a long way in both psychology and psychiatry compared with where we were in 1900 or so. It's just that we have so much further to go.
I liked Dubner's post for another reason, as it opens with this lede:
"The debate about the effectiveness and safety of psychiatric drugs rambles on while new (if not conclusive) psychological studies come out with the frequency of fad diets."
If you go to his post, you'll see that "effectiveness" is a link back to the article I recently had published in Willamette Week on Erick Turner's study showing that pharma companies had hidden negative clinical trials data on anti-depressants for two decades. Always nice to have my work get some attention, especially coming as it did two days after my best shot at a full time job in journalism went down the tubes--the Seattle Times laid off 200 people on Monday, including 40 newsroom personnel and, yes, they are people I know and admire--and mere hours before I got a thumbs down for a different writing job outside of journalism (I was deemed a "bad fit" for the latter, which means someone didn't like me).
So, yes, dear readers, I continue to run into the brick wall of non-employment and after 14 years as a journalist with two masters degrees, I simply shake my head at why there seems to be no way to make a decent living in or out of journalism. And, yes, it is bugging the hell out of me. I'm far from alone among reporters facing this same quandary, of course, but it sure makes it no easier to handle.
Maybe, I'll go become a pharma rep.
I wanted to update you all a bit on the recent ruling by the Third Circuit Court of Appeals, which I wrote about earlier today. The ruling essentially hands a huge victory to Big Pharma--it can claim that FDA approval of a drug preempts state laws concerning drugs--and puts a lot of pressure on a grossly understaffed, underfunded FDA that already has its rules written for it by Big Pharma. Nice scam, I'd say.
The case involved a lack of suicide warnings on Paxil and Zoloft. It's not clear to me how broadly this ruling might be applied, but methinks the pharma lawyers will go whole hog and try to get it applied to any outstanding suit faced by pharma companies.
Anyhow, one of the lawyers who lost his case before the court said this:
"The opinion drew a passionate response today from Sol H. Weiss, a Philadelphia lawyer who represented one of the plaintiffs."'The drug companies get a free ride here,' Weiss said. 'They interpret data in a way that's not scientifically valid. The FDA may not ever know that, and so the drug companies get away with it for six, seven or eight years. People get injured and die because of it. You should have the right at least to expose this stuff to sunshine.'"
Precisely. Why Big Pharma has a problem with this...well, you know. Sunshine drives down drug sales I guess.
The Wall Street Journal has more on this here.
I'm just learning that the fabulous Wikileaks.org website has made available documents that are reportedly the "bible" of Scientology. Known as the Operating Thetan (OT) documents, the Church has long kept them secret and apparently has gone after anyone who'd released them in the past.
But that was then. The CoS has reportedly asked that the documents be pulled from Wikileaks due to their confidential nature. Wikileaks has responded by saying it hasn't backed down in other cases and won't here.
Read more here. Documents are here.
Yesterday, the Third Circuit Court of Appeals made big news when it ruled that the makers of Paxil and Zoloft could not be sued for failing to warn of suicide risks attached to the use of their drugs because the FDA had deemed such warnings unneeded, according to Law.com.
I haven't read the entire ruling, but I assume the court is dealing with cases concerning a lack of suicide warnings on these drugs prior to 2004 after which the FDA did require suicide warnings on the drugs. Anyway, the ruling is a big one for Big Pharma, and especially GlaxoSmithKline and Pfizer. In some circumstances, pharma companies can now get away with behaving badly because of a ticklish clash between federal and state laws. Similarly happy rulings have come down recently in California and elsewhere.
We all know that pharma companies dream about little but money and will go to damn near any length to create a market, hide problems with their drugs from the public and regulators, and manipulate their way to the latest blockbuster. The history of Big Pharma over the last two decades is filled with so many examples of twisted behavior--think Zyprexa and Vioxx here--that its like these guys have a different corporate genetic code than most corporations. Unlike oil companies, pharma companies are dinking around with human lives when they lie, cheat, obfuscate and so on. I'd like to say this isn't the case, but I know of little evidence to the contrary.
For almost as long as pharma has been behaving badly (and sadly the companies almost always do, especially in the world of psych meds), regular folks have been able to drag their butts into state or federal courts to answer all manner of product liability claims and the like. Often, such suits have ended in legal settlements for billions of dollars--again, think Zyprexa and Vioxx.
Predictably, pharma doesn't like this too much and they and the FDA and the Bush Administration have been arguing throughout the courts--state and federal--that the rule of federal preemption should apply. I won't even try to walk you through preemption, since some of what's going on here is based in the US Constitution and some of it is from case law and its all adding up to a big mess for consumers and a big old money shot for Big Pharma.
What preemption--as pharma, the FDA and the Bush Administration have argued for it--boils down to is this: If a drug is approved by the FDA, then citizens don't have a right to sue the manufacturer for flaws in the drug on a state level applying state laws because federal law trumps state law on this matter. In other words, if the FDA says a drug is safe, then tough for you if you are injured by it. Take your claim to federal court, where the standards for challenging big companies are much tougher than on the state level.
I think this argument is legal horse shit. Quite a few states have in their constitutions greater protections for citizens than are afforded under the federal Constitution--think of Oregon's free speech laws--and in these cases I know from my experience writing about these issues that a state's constitution is allowed to trump the federal one. I'm a bit lost as to why that same standard doesn't apply to these pharma cases. I don't know each and every state's constitution, but I would assume that there is some level of law that would address this situation.
Anyhow, this whole mess is headed to the US Supreme Court, as the New York Times reports in a fine article the other day, and it's beginning to look as though Big Pharma is going to get its way with the public. They clearly just did in the Third Circuit, although one suspects that case will be appealed, especially when one judge on the three-judge panel opines in his dissent that:
"In dissent, 3rd Circuit Judge Thomas L. Ambro said he would have allowed both cases to go forward."'The FDA has for over three-quarters of a century viewed state tort law as complementary to its warning regulations. Only for the last two years has it claimed otherwise,' Ambro wrote.
"Ambro said the 'sea change' in the FDA's position on pre-emption did not come in the form of a formal regulation that was subject to notice and comment, but in a 'preamble' to a regulation. The majority, Ambro said, decided to defer to the FDA because the agency has expertise in deciding the 'optimal warnings" drug labels should carry -- not too lax, not too alarmist -- and that "state tort lawsuits would disrupt this fine system.'
"But Ambro said there is 'an important contrary view that has prevailed until recently: state tort law complements FDA provisions on drug warnings, in part by eliciting more information than the FDA would glean otherwise from pharmaceutical manufacturers.'"
To extrapolate, what he's saying is that Big Pharma so often cooks the results of its clinical trials and they are such short duration that it's impossible for FDA approval to be the gold standard for safety evaluation of drugs and that under our current system state courts are essential.
Now, here's why the other judges ruled as they did:
"Writing for the majority, 3rd Circuit Judge Dolores K. Sloviter said the FDA has 'actively monitored' the possible risk of suicide from taking the class of antidepressant drugs known as selective serotonin re-uptake inhibitors, or SSRIs, for two decades, and concluded that the suicide warnings demanded by plaintiffs 'are without scientific basis and would therefore be false and misleading.'"
I assume her honor is referring to a time period before the 2004 black box warnings. But, regardless, her reasoning is deeply flawed. The FDA did a horrible job of monitoring suicidality data following the introduction of SSRIs in the late-1980s. Maybe the judge is just deeply innocent about the real world--judges often are. Federal appeals court judges are also often more supportive of the rights of corporations than they are of regular citizens, despite the fact that both parties are supposed to have equal standing.
Anyway, this whole business is a lousy knot of legal problems, and also deeply affects human lives. It's hard to know if Congress could clear this up somehow, or if it will be left to the various states to address this in their state constitutions, but I do fear where the US Supreme Court will take this. I guess we'll know soon enough.
Evelyn Pringle has a lot more on this in this article and has information about how GlaxoSmithKline is working hand-in-glove with the Bushies. Nice.
I recently did an interview with Will Hall of the Freedom Center/Icarus Project who also does a very interesting radio program called "Madness Radio." It's now online. We discussed pretty much everything there is to discuss about forced medication and controversies with the same. It's an hour long and downloadable. Let me know what you think.
PBS is rerunning its January "Frontline" piece on the bipolar child paradigm called "The Medciated Child." The piece airs this evening at 9 p.m. on many PBS stations. Check your local listings for the time in your area.
There was a huge response to the piece the first time out. PBS tells me it got over 1,000 and emails and comments to its website. So for those of you who haven't seen it, watch the show, which is pretty well done and gets at most of the major issues around kids with alleged mental illnesses. In pacticular, you can have fun watching how the doctors of Harvard University refused to respond to "Frontline" and passed off duties for defending the paradigm they created on a doc at Stanford. You can also watch the show online here.
PBS is also hosting a web conversation about all the issues around kids with alleged bipolar disorder and other mental disorders in conjunction with the forces of the unquestioning mainstream at WebMD.com. You can add your thoughts here. Just look for the comments section after each post. Or comment right on my little old website.
I'd hoped to have several new posts up around now, but some precipitous events took place late yesterday that will likely have a dramatic effect on my landing a reporting job anytime soon, if ever, so I went out and had dinner with some friends and said, "Ah, hell" a lot. As a result, I'll be delayed with most posts today. I should have something up mid-morning West Coast time, aside from the reminder on the PBS show above this post.
I'll just pluck from this article in the Guardian (UK), since it echoes so much of what I've written on this site:
"Antipsychotic drugs for children have taken off in the US on the back of a willingness to diagnose those with behavioural problems as having manic depression. Even children barely out of babyhood are getting a diagnosis of bipolar disorder, the modern term for the condition."The chief symptoms are mood swings, which, however, are common in children of any age.
"David Healy, an expert on bipolar disorder, said there were now 2.5 million American children on antipsychotics. However, the UK guidelines on the disorder, from the National Institute for Health and Clinical Excellence, urge caution."
I'm not sure where Healy's numbers are coming from--and whether they are counting children and teens under 18 years of age or just "kids"--but the numbers don't surprise me. They also work out to about 2.5 percent of all Americans under the age of 18. That alarms me for reasons I won't even bother to repeat, but certainly include this sort of concern:
"Sami Timimi, a child psychiatrist, criticises the 'social trend of using powerful, largely ineffective medicines to control the behaviour of [children] who have never had a say in what is imposed on them.'"
Exactly. The article is actually a sidebar to this article, which details soon to be published research by Ian Wong, professor of pediatric medicines research at the London School of Pharmacy showing that thousands of UK kids--very young ones--are on antipsychotics and ADHD drugs now. But what could be the problem there?
"David Healy, professor of psychological medicine at Cardiff University, says the drugs may cause heart, circulation and breathing problems. 'There is a real question over whether the drugs can kill for a number of reasons. One is that all anti-psychotics act on [the brain chemical] dopamine.' He said dopamine was known to have a role in cardiovascular regulation. A number of children in the US, given stimulants - which also act on the dopamine system - after being diagnosed with ADHD (attention deficit hyperactivity disorder), have suddenly died, said Healy. He was asked by lawyers in the US to give an opinion on a child who was diagnosed when she was a baby first with ADHD, then depression and finally bipolar disorder (manic depression). 'Having spent 75% of her life on one of these drugs, she dropped dead at the age of two,' he said."
So a child was diagnosed with ADHD in the US at about six months of age? How? By whom? Based on what? How could a child that young be diagnosed with any psychiatric disorder? This simply makes no sense whatsoever.
Who the hell are these doctors making these diagnoses and writing these scripts?
Toxicologists at Clemson University in South Carolina are studying the effects of pharmaceutcials and other chemicals that have made their way into our nation's water supply. It should shock no one that they are testing anti-depressants, Prozac in this case.
"One of Klaine's graduate students, Kristen Gaworecki, is looking at Prozac. She exposed bass to the drug, though at higher levels than those found in surface water, and found the fish had no desire to eat. They also behaved abnormally--swimming vertically as opposed to horizontally or with their backs out of the water."
That's so discouraging and worrying to read--and sort of knocks down the alleged "better than well" phenomenon attached to Prozac use--and I really have to think that having trace amounts of anti-depressants (and other crap) in water systems around this country simply cannot be good for any of us. Much less the fish.
An EPA official has a more bureaucratic take on this:
"'What has been detected is very trace level, well below therapeutic dose,' said Jim Lazorchak, acting chief of EPA's Molecular Indicator Research Branch. 'The occurrence of this in the environment does not necessarily mean there is a human health risk. We don't know. Until we get more information, there's nothing definitive we can say--other than we need to continue to take a look at what's out there.'"
I hope they keep looking, but I wonder when the day will come that a government official tries to make the argument that having anti-depressants at trace levels in our water supply is of no concern.
A few readers altered me over the weekend to the latest issue of US magazine and its cover story on Britney Spears entitled "Living with Mental Illness." I've been following the Spears story for quite some time now not because I am interested in pop divas and their weird antics, but because I am fascinated by the social dynamics of it all. The article isn't online, so I thumbed a copy last evening at my supermarket.
The article's lede focused on the financial pain caused celeb photographers because Britney isn't doing crazy things in public anymore--did an editor think this was really the best lede?--and then moved onto the fact that Spears has been diagnosed with bipolar disorder and has been taking gobs of meds. It's not clear what she's taking, but "insiders" cited by the magazine report that Spears is doped and looks "vacant." Anyone who saw her on TV recently knows that Spears has put on a bit of weight as well.
Sounds like the meds are working just great!
The article was your basic simple-minded stuff when describing bipolar disorder--a lifetime struggle with extreme mood swings. I'm always amused by the media's description of the mood swing dynamic especially against the reality many of us know--our moods aren't exactly light switches. And, we mostly a long way from being crazy, at least as I understand the term.
I was puzzled by the article in other respects, too. No one from the Spears camp has ever confirmed on the record that the singer, dancer and occasional woo-woo flasher has ever been diagnosed with bipolar disorder. Spears has been silent on this herself. I continue to think it's unfair for someone who is in a situation where they need all the calm and privacy they can get to be batted about in the press that way. Does the entertainment media hound cancer patients?
But I assume at some point the truth will come out and Spears will say something. And, as I have said before, Spears will become the face of bipolar disorder in our culture.
Does that bother you as much as it does me?
A bizarre incident in Mississippi: a middle school student gave the antipsychotic Seroquel to several friends, the friends took the drug, the students began acting oddly, the students were taken to a hospital, and the student who gave them the drug is in big trouble.
Then this from a press account:
"Seroquel is an antidepressant drug used to treat manic depression, schizophrenia and bipolar disorder, according to the Web site www.Seroquel.com."
Where the hell does AstraZeneca get off describing the drug, which is not approved for depression, as an anti-depressant? The drug is approved for bipolar depression, but it's most common use is as an antipsychotic, shut-people-up drug. If it's an anti-depressant, then I am Zeus.
Here's the Seroquel website.
The parents of Rebecca Riley, the four-year-old Massachusetts girl diagnosed with ADHD and alleged child bipolar disorder who died in 2006 from an overdose of psych meds, have sued the psychiatrist who made the diagnoses and wrote prescriptions for the girl.
"A medical malpractice suit filed yesterday asserts that a Tufts Medical Center psychiatrist who diagnosed the girl as bipolar when she was 28 months old and then treated her for two years with a regimen of powerful drugs is to blame for her death."'This child was subject to mostly telephone prescriptions and a slipshod diagnosis,' said Boston lawyer Andrew C. Meyer Jr., who represents Rebecca Riley's estate and filed the suit against Dr. Kayoko Kifuji in Suffolk Superior Court.
"Six weeks before Rebecca Riley was found dead on Dec. 13, 2006, in a Hull house shared by her parents and other relatives, a nurse at her Weymouth preschool warned Kifuji that she suspected the child was overmedicated because she was often too tired to participate in school activities and appeared like a 'floppy doll,' according to Meyer. Kifuji did not reduce her medication after examining the child, he said.
"'They made her a 4-year-old zombie,' said Meyer, whose Boston law firm Lubin & Meyer specializes in medical malpractice cases. 'We don't believe that she did suffer from bipolar or that this was the appropriate medication.'"
Riley's parents continue to await trial on second-degree murder charges. They are being held in jail without bail. I continue to be outraged by the behavior of the prosecutors in this case, who apparently believe that the Rileys are a danger to the community. That's simply bizarre, since I think the chances of them giving psych meds to any more kids is pretty limited at this point.
Their trial date has still not been set. Prosecutors are appealing a ruling by the trial judge who tossed out first-degree murder charges--premeditated murder.
Previous coverage of the Riley case is here.
Last evening, I received this email:
"Dear Mr. Dawdy, "I read your article in the Willamette Week about Erick Turner, Professor of Psychiatry at OHSU. I liked it. We have a traveling exhibit: Psychiatry: An Industry of Death, showing in Portland through this Sunday, April 6th. This presentation includes interviews with health care professionals, attorneys, educators and other experts; both historical and modern-day footage of psychiatry's barbaric treatments; as well as interviews with victims of psychiatric brutalities ranging from electroshock therapy and involuntary commitment to the devastating effects of psychotropic drugs prescribed to children. I believe you would find this exhibit very interesting and informative."Sincerely, Barb Hogan, Citizens Commission on Human Rights Oregon"
Hogan refers to this article of mine. The CCHR is a Church of Scientology front group, dedicated to smashing psychiatry and revealing to the world that our mood and behavioral afflictions derive from some kind of flare up with space aliens long ago. Something like that.
I replied:
Dear Ms. Hogan:
Thanks for the invitation, but I think I will pass. Although the psychiatry profession has its share of charlatans, I think "Industry of Death" is a bit much. If CCHR took a look into how other medical specialists behave, we might come away with "Gynecology: Industry of Rape," given how many odd cases we've had in the Northwest the last few years involving OB/GYNs and sexual assault on patients.
I know CCHR believes that mental illness is a fallacy--so says your sidekick Thomas Szasz--but I'm afraid that is not the case. Depression is real, so is schizophrenia and so on. Sure, there are some groaners in the DSM (social anxiety disorder, intermittent explosive disorder, etc.), but in the main mental disorders do describe actual, real world conditions.
How we treat them is, of course, open to debate. So far, none of the magical solutions proposed by Science or Scientology seem to work very well.
BTW, I wondered if you could do a small favor for me. CoS president Mr. David Miscavige gave a Scientology year in review speech of some sort not long ago in which he took credit on behalf of CoS and CCHR for all of the press coverage and black box warnings that have cropped up around anti-depressants in recent years. It offends the many activists and writers who spent years shoving evidence about anti-depressants in the face of the FDA and the mainstream media to have CoS try to claim credit for their work. Could you ask Dave to stop taking credit for the work of others?
Thanks.
Sincerely,
Philip Dawdy
Many of you know that a paper appeared in the New England Journal of Medicine in January asserting that pharma companies had covered up negative clinical trials results of anti-depressants for decades by simply not publishing the negative trials. This allowed the companies to overstate the efficacy of the drugs by about 31 percent and the paper established that anti-depressants don't work nearly as well as anyone thought, at least in the mainstream world, or wished. In other words, the evidence base supporting the use of anti-depressants is deeply flawed, much more so than almost anyone previously admitted publicly.
The paper, authored by Erick Turner of OHSU, got tons of press attention and I knew there had to be an interesting story behind how the paper came to be and the doctor who wrote it.
Today, a long article of mine on Turner and the NEJM paper was published in Willamette Week, the Pulitzer-winning alt-weekly in Portland, Ore., where I was the city hall reporter once upon a time. You can read it here.
Several interesting things popped up in the course of my reporting. One is that Turner himself was once a paid speaker for Eli Lilly and Bristol Myers-Squibb and, in fact, went to work on collecting data for the NEJM paper soon after breaking off his relationship with those companies in 2005. Two is that almost no one in the psych world I interviewed for the story offered much in the way of a ringing defense of anti-depressants. Turner himself, in a line that got cut from the final version of my piece, admitted that using anti-depressants in treating bipolar disorder scared him. Even Peter Kramer, as staunch a defender of anti-depressants as there is, allowed that Turner's paper was damaging to the reputation of anti-depressants. And so on.
Anyway, I thought I'd make readers aware of the article, which I hope some of you find a worthwhile read. BTW, I have a hunch that we'll hear more from Turner in the future.
Here's yet another study, this one from PLoS Medicine, establishing that the long-term use of antipsychotics is detrimental to the health of dementia patients. And by dementia, I mean Alzheimer's.
"The researchers, from Kings College London and the Universities of Oxford and Newcastle, found that neuroleptics undermined Alzheimer’s patients’ verbal skills, and offered most patients with mild symptoms of disturbed behavior no long-term benefit. In fact, they found that a deterioration in verbal skills happened within six months of taking the medications. Neuroleptics are drugs used for treating schizophrenia as well as some other serious mental illnesses."In this study, researchers looked at 165 Alzheimer’s patients from four different nursing homes in Oxfordshire, Newcastle, Edinburgh and London. Approximately 60% of UK Alzheimer’s patients are given medications to control their often aggressive behavior. There are indications that neuroleptics may also up the death rates of Alzheimer’s patients."
The drugs used in this study were Risperdal, Mellaril, Thorazine, Haldol and trifluoperazine.
I would say that coupled with yesterday's news from Britain that antipsychotics are killing some elderly patients, as well as results from the CATIE study last fall showing that placebo beat these drugs in dealing with agitation, that any doctor who puts a dementia patient on one of these drugs is risking a serious consequence in their patient and a nice fat lawsuit.
Both Eli Lilly and J&J/Janssen face lawsuits by several states asserting that the companies illegally marketed their antipsychotics, Zyprexa and Risperdal, for using in nursing home patients, among other charges. The drugs all carry black box warnings about their use in elderly patients as well.
So why the hell is anyone prescribing them for anything but the most extreme cases of dementia? Ah, the mysteries of medicine and health care delivery.
Once again I ask: Why do so many doctors believe that these drugs are useful for noisome children and adults with agitation? Would any doctor care to explain to me the casual use of these drugs in our culture?
Some of you may remember Mr. B., a friend of mine in the neighborhood, who's diagnosed with paranoid schizophrenia and has been since the 1960s. He spent time in prison at one point for assault, has been in numerous state hospitals here and back in Maryland, and has been on the Haldol injectable for at least 20 years. He's 62 years old and, unlike a lot of people in his situation, he doesn't hide out in his apartment, but goes out and tries to be actively social. He's a remarkable human being, especially given that various lowlifes occasionally attack him near the dump of an apartment his social worker moved him to last year.
B. has known for several months that his mother, who lived in Florida, was dying. She was 85 years old. B. wasn't able to fly Back East to see her (he decided, he told me, that he was way too paranoid of planes and overly crowded situations for that), so he talked to her every week or so, as he has for years. Yesterday, his mother died.
Me and a local shop owner are pretty much the only people B. confides in and we both knew he was pretty shaky recently. We were both concerned that when his mother died, B. would become so depressed or paranoid--or both--and be unreachable and deteriorate. He's told both of us of his deep fear of being forced into a nursing home at some point and losing his freedom. There's no chance of him going off his meds, but we both worried about B. not eating and of getting so paranoid about someday ending up in a nursing home that he'd follow through on his oft-repated threat of buying a bus ticket and moving to Portland or Baltimore.
I ran into B. last evening where he usually hangs out. We talked. He seemed to be taking things as well as he could. "She was so old," he said. "It's better for her. I don't like old people."
His spirits were OK, so I just told him I was sorry about his mother. He's apparently going to get a small amount of money from his mother's estate and last night he asked me to help him buy a bond or something to squirrel it away. I old him to come talk to me or the shop owner if he was thinking off leaving town.
"Oh, I won't leave," he said. "I have to take care of my mouse."
B., you see, has a mouse in his apartment--not a pet, but a varmint he takes care of. He named it Mrs. Thomas, in honor, he once told me, of a nurse at a state hospital in Maryland in the 1960s who used to hit him with a broom.
He is a remarkable man.
A report by a British MP, Paul Burstow, claims that the use of antipsychotics in patients with dementia is leading to 23,000 deaths a year in the UK, according to this account of the report in the Telegraph (London). This makes you wonder how the wide use of drugs like Zyprexa, Risperdal and Seroquel is playing out in America, or what a similar report here would find. Burstow's report is here.
"Mr Burstow cited a yet-to-be published study by King's College London that gave a placebo to one group of Alzheimer's patients and anti-psychotics to another for 12 months."The study, funded by the Alzheimer's Research Trust, found that after 24 months, the placebo group had a 78 per cent survival rate compared with 54.5 per cent for the rest; after 42 months the survival rates were 60 per cent versus 28 per cent.
"Mr Burstow said: "There are around 244,000 people with dementia living in care homes, and the Alzheimer's Society estimates 100,000 are being given anti-psychotic drugs. Of those, I am saying that 23.5 per cent could be dying prematurely as a result of being prescribed anti-psychotic drugs - or 23,500 people a year."
"Neil Hunt, of the Alzheimer's Society, said: "The over-prescription of anti-psychotic drugs to people with dementia is a serious abuse of human rights. Anti-psychotics should be used as a last resort."
Mr Burstow's report, which will be debated in the Commons today, calls for urgent police action and a ban on routine prescribing."
That unpublished study cited above should send shivers down anyone's spine because not only are we using lots of antipsychotics on older folks in America--and the UK--but we are using tons of the same drugs on children (mostly boys) and on adults for conditions that have nothing to do with psychosis. Bipolar disorder type II, depression, anxiety and ADHD.
I don't often use terms like "scandal" and "scam," but I think the way antipsychotics are being handed out by doctors and the way they are pushed by pharma companies amounts to a scandal and a scam. I am at the point where I really don't even know what to suggest as a means of addressing this situation.
"Mr Burstow said: 'Using drugs to restrain vulnerable older people with dementia is no different to strapping them to a chair. It is an abuse of their human rights. Ministers are guilty of being complacent. There should a ban on prescribing anti-psychotic drugs in all but the most severe cases of dementia.'"
While I am not a fan of banning the use of drugs of any kind, I am beginning to think that we really, really need to go back to the good old days of mental health care (OK, they weren't that good) when there was essentially a taboo on the use of antipsychotics for anything other than treating psychosis.
BTW, if anyone thinks I am joking about how widespread the use of these drugs have become, then they should consider that antipsychotics are now the third largest class of drugs sold in the US in terms of revenue, outpacing even anti-depressants which now sit in fourth place.
Burstow is correct that there is simply far too much complacency around the use of antipsychotics. I wonder what it's going to take to shock this country and the UK out of their complacency.
Thoughts?
(Via Atypical Antipsychotics.)
It's snowed three of the last four days in Seattle, a city in which it generally snows once or twice a year. We've had snow maybe seven times this year, it's been a very cloudy winter when it hasn't been raining otherwise, and people are literally crawling out of their skin. I ran into someone the other night who insisted half of her friends were on anti-depressants. The other half were drunk. A few days ago, I ran into a relation of a woman I know and she dragged me aside to tell me that the woman had been drinking so much and had been so depressed that she finally dragged herself to a doctor, who promptly gave her an anti-depressant that had her bouncing off the walls.
"So we called the nurse and they think she's bipolar. What do you think?"
I told her that the woman needed to be off that anti-depressant right away (she'd only been on it four days), that she needed to not drink, and that they somehow needed to get her evaluated by a competent doctor. She wasn't suicidal, so I was comfortable leaving it at that.
All of which is to say that it's been a very rough winter in the Northwest and I am hearing the stories of suicides, suicide attempts and people having trouble with anti-depressants. (I assume that there are good stories and I just don't get told about them.) The end of winter is really tough here because we simply don't transition to spring the way much of America does. Here we count ourselves lucky if we even use the term before mid-May.
I usually hear about all of these troubles from a friend of whomever is going throw rough seas, and I want to offer some advice to all of those friends who get caught up in being the helper and, in particular, are trying to sort out whether their friend might be having problems with an anti-depressant. You've got to know what medication your friend is on, at what dose, when they began taking it and what sort of behavioral baseline they had before they began the drug. You need to know all of those things--and probably a few others as well--in order to sort out whether an anti-depressant is at the root of a problem. And your friend does need to be seen by a competent doctor or therapist in short order.
The civic mood in Seattle has been really nasty lately what with the continued cold and gray skies. There are people who literally hibernate all winter in this city, but somehow drag themselves to work each day. I've been watching this weird winter trudge for nine years in the Northwest and I am always amazed that, once the weather warms up to the 60s, you'll see all these people walking around the neighborhood whom you've only rarely seen before. They've literally been in hiding since the prior October.
The only bright spots in all of this are that it looks like we're headed for a small break in the weather, baseball began yesterday with a 5-3 Mariners victory at home (they play under a retractable roof), and sooner or later someone is going to figure out the riddle of depression and seasonal affective disorder (a term I hate, but it sure is accurate).
That won't come a moment too soon.
Many of you know that Charles Barber has a book, Comfortably Numb, that's recently come out and I wanted to offer my thoughts on it. I've held off doing so until now since a lot of readers were tied up with various spring breaks and such.
Barber's is an important book and deserves to get the same kind of attention Listening to Prozac got in 1993. What Barber has done is no less than introduce America to psychotherapy--or would that be re-introduce?--and show it works as powerfully in treating depression as do anti-depressants. The book begins with several chapters detailing where we have been in this country with treating depression over the last 20 years and how anti-depressants have literally crept into so many corners of American life, often in places where they were not needed or where their use was essentially created by pharmaceutical companies. Barber writes from the perspective of a frustrated caregiver--he's worked with the homeless and low-income mentally ill for years and is now an instructor in the psychiatry department at Yale--but his account of America's embrace of psychopharmacology isn't as bitter as you might expect (or maybe it's not as bitter as mine would be) and is all pretty much setting the table for the book's second half.
The book is at its most engaging when it takes on cognitive behavioral therapy (CBT), as well as Motivational Interviewing and the Stages of Change psychosocial model. The latter two may not be familiar to most, but at this point CBT is becoming more widely known in America and is a well-researched effective treatment for depression (very severe depression would be an exception) that is sadly not used much in America. I'm sure most people can guess at the reasons why. What amuses me is that some reviewers have written off Barber's work on grounds that the psychotherapies he discusses in the book are unresearched and wooly-minded. I think these writers likely need to check their facts a bit more carefully before penning their reviews.
In the case of Peter Kramer, author of Listening to Prozac, who chopped up Barber's work on slate.com a few weeks ago, I think he was just arrogantly responding to a book that had taken a few shots--well-aimed ones--at his own book. Why slate.com let him review the book is beyond me (he sure didn't mention in the review that Barber had knifed him up). Why Judith Warner wrote about Barber's book without having read past the introduction is an even scarier concept. Sorry, folks, but the evidence on CBT as a treatment for depression is quite well hammered out at this point. It's likely a better first line treatment for depression (as opposed to what Barber calls Depression, as in severe clinical depression, where meds as a frontline defense are better suited) than are anti-depressants, but it does require the kind of work and mental self-discipline that most Americans will say they are too busy to do (I'd say they are too lazy).
Anyhow, Barber also deftly handles issues in neuroscience and shows how psychotherapy can actually change people's brains and cognitive systems in much the same way we've long been told that Prozac and its cousins do (even when they don't). I won't belabor the neuroscience part of his book or CBT any further. They speak for themselves. Regardless of what Kramer and Warner believe.
Let me address something else: I've heard from a few readers that they are disappointed that Barber doesn't tackle bipolar disorder and schizophrenia and that he is too "pro meds" for these conditions. The reality is that Barber's perspective is shaped by his years as a social worker in some very intense homeless shelters and low income housing facilities in New York City and Connecticut. Having reported on and worked in some of the same sorts of facilities out this way, I understand where he's coming from. There's a large chunk of one of the book's later chapters devoted to a man diagnosed with schizophrenia who goes from freaking on the streets and smoking crack to taking Haldol and getting a whole bunch of "environmental enrichment," for lack of a better term, and then suddenly he gets stable enough for housing and then he winds up as foreman of a jury. It's a truly remarkable story and, yes, antipsychotics were a big part of this man's success. So was not smoking crack. If anyone has trouble wrapping their minds around the fact that the folks who show up at homeless shelters with mental disorders are so ill that antipsychotics are the only way to reach them effectively, then they are kidding themselves. I've seen this myself.
Barber is quite clear when he writes about schizophrenia that 10 percent to 20 percent of all people diagnosed with schizophrenia are simply not helped at all by psych meds. He's honest about that (and most people who broach the subject of schizophrenia in print are not honest about that point), but this isn't really a book about schizophrenia. It's not a book about bipolar disorder. It's about depression. And, in my mind, it's probably the best single book I've ever read about depression.
So there you have it. This is an excellent, readable book that people should consider buying. Here's the Amazon.com link. Barber's own website is here.