Furious Seasons

Spring Fundraiser--Weekend Update

Things picked up yesterday and today with a whole bunch of donations by PayPal and mail bringing the total so far to $835. Thanks so much for your contributions and for improving my weekend.

The goal for the fundraiser is $2,500, so it's one-third of the way there. Hope you are all having a fine weekend.

Spring Fundraiser--Day Three

Another $55 came in yesterday, bringing the total to $175. I know there are a few things headed my way via snail mail. I won't count them till they get here though. The overall goal for this fundraiser is $2,500, and I'd be lying if I didn't tell that I wish things would pick up.

Most everyone compliments me on this site and tells me what a fine service it is. Well, the truth is that this service relies upon your contributions to keep it going because there simply isn't an advertising model--yet--to support work like this. Maybe someday. But everything about how the media works in this country and how it's funded is undergoing a sea change. From what I hear, several big newspapers have scaled back their health coverage significantly and that means mental health will get less and less specialized attention. That's why I'd argue sites like this and readers like you are important.

What's odd to me is that this sluggish response is going on when this site is setting readership records. I don't want to sound like a braggart, but in May I have already eclipsed this site's former monthly visits record and have also passed a goal I had set for this site back at the end of December of clearing 25,000 visits in a one-month period at some point during the year. I figured it wouldn't happen until October, since it represented close to a 50 percent growth rate. It actually happened yesterday. Yes, I will buy myself a beer.

My point is that there are lots and lots of regular and semi-regular readers of this site--on the order of 10,000 plus 6,000 or so occasional looky-loos--and I need you guys to step up to the plate and help keep this site charging forward. Otherwise, I can go find something else to do with my time.

As usual, the PayPal button is on the right and if you prefer snail mail, drop me an email and I'll shoot you a mailing address.

Thanks for your support.

Peter Kramer Again Defends Anti-Depressants

There was an interesting and odd article on MSN Health yesterday. Interesting because it examined the question of why different people have such wildly different responses to anti-depressants--everything from the classic "better than well" response to no response to violence and suicide. Peter Kramer of Listening to Prozac fame makes an appearance in the article which I'll untangle in a second. The response/non-response issue is one of the most ticklish and important questions in all of medicine, especially since anti-depressants are the most prescribed class of drugs in America. It's a question that the article tries to sort out, but unfortunately researchers haven't hit upon anything less than a suite of answers, so the article does end up tasting like an interesting bowl of mush by its end.

Still, it is an important question and one I'd personally love to know the answer to someday. Just for fun. Why, for example, did 10 mgs of Lexapro work so-so for me yet when I went off the drug about six months later, suffered from rebound depression and, then, went back on the drug at the same dose, it damn near exploded my heart and had me so agitated I couldn't think? Why did 20 mgs of Prozac initially work quite well for me, then later make me feel stony, then wash out altogether and then at higher doses damn near cost me my life? I don't even pretend to know the answer or answers, although my broad hunch is that it's got something to do with small strips of genetic code that some people have and some people don't. Just a guess though. Researchers have not been able to come up with a consistent, replicable set of answers to date.

Anyhow, the article references the Kirsch paper from PLoS which appeared in February and asserted that several anti-depressants were no effective than placebo based upon their approval studies that were submitted to the FDA, but remained unpublished. If I were writing the piece I would've referenced as well the Turner paper in the New England Journal of Medicine from January which reached the conclusion that non-publication of FDA approval studies with negative results for all 12 "modern" anti-depressants had led to an incredible overstatement of anti-depressant efficacy by pharma companies. In my mind, it was more damaging than the Kirsch paper since it looked at the entire class of anti-depressants.

Ever since, some researchers have gone out of their way to defend and attempt to rehabilitate anti-depressants in the media (i.e., the recent Fred Goodwin program on "The Infinite Mind" radio show), operating on what one presumes is the assumption that legitimate researchers and clinicians like Kirsch and Turner are trying to scare people off their meds. No one I know of has spoken out more on this issue than Kramer.

He first took a swing at the Turner paper on Slate back in January. Later, he defended anti-depressants again on Slate as he set about attacking Charles Barber's Comfortably Numb, in which Barber had aimed several shots at Kramer for Listening to Prozac wherein case studies of seven of Kramer's patients had all of America rushing to doctors to get their serotonin back in "balance." Perhaps, Kramer defends anti-depressants so aggressively because he has so much to answer for. In his book, for example, he's completely dismissive of the idea that SSRIs can be linked to incidents of violence. He's even defended anti-depressant efficacy to me personally and there he was yesterday in the MSN Health piece.

"Two other complications are noted by psychiatrist Peter Kramer, author of Listening to Prozac. First, early data-—of the kind included in the meta-analysis which found antidepressants no better than placebo—-often fails to show results for drugs that later prove very effective. 'We have medications that show effectiveness in post-stroke depression, in the elderly with multiple brain lesions, in people with chronic, intractable depression. Why do they only not work in the early trials?' he asks.

"Second, people get excellent care in clinical trials, which makes the placebo effect especially strong. This means it’s harder to show a difference, even if a drug works well. 'We may be losing effective substances, not approving ineffective ones,' Kramer notes."

I wonder what anti-depressants Kramer thinks are going unapproved. I cannot think of a single anti-depressant, submitted to the FDA for approval, that has been rejected in recent years. That strikes me as a baseless statement on Kramer's part and makes me wonder exactly who the hell is editing articles like this at MSN Health. It's one of those things a judicious editor would've cut.

When I interviewed Kramer for an article a few months back, he admitted that the Turner paper in the New England Journal of Medicine injured the reputation of anti-depressants, but then proceeded to criticize how clinical trials were done and told me that there were studies showing that anti-depressants worked 80 percent of the time. I asked what studies. He told me studies of anti-depressants in post-stroke depression. I was tempted to say "Whatever," but I respect Kramer too much as a writer and thinker on these issues to be dismissive. All the same, his point was moot. We were discussing anti-depressant use culture-wide not in small cohorts. I almost quoted him on this point in my article just to show the nearly-religious degree people will go to to defend anti-depressants, but I figured it was too much of a sidebar to the main point. I suppose I should've asked him what response placebo got in the same trial, so I could get a sense of what effect size he was talking about. Oh, well, it was a more hurried conversation than I would've wished for.

Still, I must begin to wonder how Kramer can use post-stroke depression to justify the efficacy of anti-depressants in non-post-stroke depression. I suspect they are entirely different animals. Perhaps, he'll write about this on his blog someday soon and enlighten us all. I'd really like to know how post-stoke depression resembles garden variety major depression and why the experiences of those patients should speak to how I--and maybe you--care for myself. It's ironic that last week Kramer's blog entry on the bipolar child article in Newsweek was entitled "Not The Politics, The Experience." It would seem that Kramer is not as open to the experiences of millions of Americans, Brits and others who've had rotten experiences on these drugs as he should be, preferring instead the politics.

I must admit that back when I first read Kramer's book in 1993 it was when I was beginning to have some serious problems with Prozac. I went to his book looking for answers and became enthralled with the response his seven patients had to the drug. I so wanted to be like them. But I never was. I stayed on the drug several months more, at increasingly higher doses until I experienced such suicidality on the drug that my then-doctor switched me to Paxil. Fifteen years later and after many bad experiences with anti-depressants, I will never take an anti-depressant again in my life absent a gun at my head and a court order in my face. And I'll appeal the court order.

I know however that anti-depressants work well for some people and I congratulate those lucky few.

Aussie Toddlers On Ritalin

Here's a startling report from New South Wales, one of Australia's states, where the Daily Telegraph reports that children as young as two-years-old are being given Ritalin. Keep in mind that Australia is nowhere near as populous as the US and that these figures only represent kids in part of the public health system.

"Figures obtained by The Daily Telegraph reveal 311 children in NSW aged five and under depend on controversial medication, including 58 four-year-olds and 13 three-year-olds....As well as the three and four-year-olds, there are 240 five-year-olds on subsidised ADHD drugs in NSW. There are 6692 6- to 10-year-olds, 9006 11- to 15-year-old and 2584 16- to 18-year-olds.

"The figures follow the State Government's ADHD review which found there was no overprescribing of drugs."

Governments generally think this sort of thing represents no problem. The kids of course are getting a range of ADHD drugs, not just Ritalin.

One child psychiatrist was critical of the situation:

"But child psychiatrist Jon Jureidini said he was disappointed at the number of preschoolers on the list. 'I would be confident that they (the drugs) are being inappropriately used in most cases of preschool children,' Dr Jureidini said. 'ADHD is not a good explanation for putting these children on drugs. I have seen children of that age displaying very disturbed behaviour but it is usually a medical problem or significant family circumstances that are undermining their well-being.'"

I'm sure someone will box my ears for saying this, but two-years-old is simply way too young for a child to receive medications like these--even though it goes on in the US and UK--much less a diagnosis of ADHD. At two, children are barely able to walk. How the hell are they getting diagnosed at such a tender age?

Author Blames Bipolar Disorder For Robberies

Well, this is an interesting story in the Providence Journal today.

"A brain disorder drove historian Edward Renehan Jr. to record an album with folk legend Pete Seeger, work with New York publishers and write six books, including one on the Kennedys, the author says.

"But that same illness –– diagnosed last year as bipolar disorder –– may have pushed Renehan to steal and sell rare letters written by George Washington and Abraham Lincoln, a federal crime that could send him to jail or force him to pay up to $250,000 in fines."

Obviously, the letter were incredibly valuable.

I never quite know what to make of cases like this one. I know plenty of people with bipolar disorder who have experienced full-blown mania and they haven't stolen a thing. That said, Renehan has no previous criminal record, so one assumes something goofy went on here.

Still, blaming things on bipolar disorder is kind of a weak defense, in my opinion.

Army Suicides Up Again In 2007

Another war is hell item: suicides among Army personnel were up last year to 108 deaths, an increase of six over 2006. One-fourth of the suicides occurred in Iraq.

"The overall toll was the highest in many years, and it was unclear when, if ever, it was previously that high. Immediately available Army records go back only to 1990 and the figure then was lower - at 102 - for that year as well as 1991."

More on this later, when a full report is released later today by the Army.

Lilly Submits Cymbalta For Chronic Pain Indication

Eli Lilly today announced that it has submitted a supplemental new drug application to the FDA for Cymbalta, its newish blockbuster anti-depressant, for the treatment of chronic pain. The drug is already approved for treating depression and diabetic neuropathic pain, and racked up over $2 billion in sales last year, its third full year on the market.

The company did not announce results of chronic pain studies it was submitting to the FDA. Previously, some of Lilly's pain-treating claims for the drug have been challenged in academic papers as being wildly overstated. Personally, I don't know what to make of this new paradigm of anti-depressants to treat pain, except to say that I am fairly skeptical. But anything to keep the DEA happy in its attempt to keep doctors from using legitimate pain killers such as opiates and medical marijuana.

Spring Fundraiser--Day Two

The first day of the fundraiser brought in $120, on the way to the goal of $2,500. Thanks for your contributions.

For those of you who didn't see the notice yesterday, I am doing another quarterly fundraiser to support the work I do on this site for the next few months. So if you have $5, $10, $25, or even $50 to give, I'd appreciate your support.

As before, there's a PayPal button on the right. Or if you prefer snail mail, send me an email and I'll send you a mailing address. Thanks.

Two Psychiatrists On Newsweek's Bipolar Child

Recently, Newsweek had a cover story on a young kid diagnosed with alleged bipolar disorder. I've already ripped the piece apart. I felt it failed to deal with the lack of evidence for the disorder in children and didn't even bother to quote critics within psychiatry of the controversial diagnosis. It lacked the level of balance I would've expected from the magazine.

My views, of course, are one thing. Those of psychiatrists are another thing entirely. Last week, Peter Breggin, a critic of much of current psychiatry who happens to be a psychiatrist, was a bit over the top when he wrote that psychiatry had declared "war" on the boy, Max. I understand his frustrations, but war is a bit much. Then he makes an extremely valuable point about what this boy, who's been on 38 different meds, and his parents will be up against:

"From now on, Max, his family and his doctors will almost certainly have to face an increasingly impossible dilemma common to children who are prescribed multiple psychiatric drugs for a period of years. When trying to withdraw these children from multiple psychiatric medications, they almost certainly go through severe withdrawal problems with extreme emotional instability and the risk of worsening violence and suicidality. In fact, we are told that an attempt to take Max off his medications resulted in his displaying hallucinations and delusions, which Newsweek attributes to his worsening condition and his need for drugs. The odds are overwhelming, instead, that he went through a severe withdrawal reaction. So it can be very difficult to withdraw children like Max from multiple psychiaric drugs, but if they are kept on drugs indefinitely, their brain, mind and overall condition is almost certain to deteriorate."

Regardless of what you make of the bp kids paradigm, Breggin is precisely right about withdrawal problems and that some of this kid's symptoms could well be generated by a reaction to medication withdrawal, or to the meds themselves. Maybe he magazine will do a follow up article someday.

I was intrigued by Peter Kramer's views on the article on his blog at Psychology Today. Kramer is of course the author of Listening to Prozac, which just passed its 15th Anniversary in print, a stunning accomplishment, regardless of what you think of the book (my views are mixed). Kramer, who globally seems to like the article, raises an interesting point:

"A note regarding diagnosis: Yes, the Newsweek text and headlines are pitched to an interest in bipolar disorder, but who knows what this kid has? Mary writes that Max’s secondary symptoms include hyperactivity, anxiety, obsessionality, attention deficits, dyslexia, and pronounced elements of oppositional-defiant disorder. A current movement in psychiatry favors “dimensional” diagnosis, cataloging scattered problems rather than grasping for syndromes. This trend can be taken too far, but especially in the case of children, whose disorders are often protean, the approach can signal an appropriate agnosticism."

His subtle point is that he thinks the magazine shouldn't have pushed the bipolar angle on this kid so hard because "who knows what this kid has." I wish the magazine had been a bit more sensible as well, given the many controversies in the field over this matter. It's clear that something is up with little boys like this, but what it is no one really seems to know with anything approaching certainty.

For those of you who want to read the thoughts of a defender of the disorder in kids, you can do no worse than John McManamy's post over at Health Central. He's been an extremely harsh critic of anyone who questions bipolar disorder in children, and his tone is often one of religious conviction. I've noticed that tone to be consistent in late-diagnosis bipolars, as McManamy is. You've got to wonder what's driving that.

Maybe he can take on Breggin and Kramer now.

Pfizer To Roll Out Chantix Ads Today

Looking to counter the very bad publicity its very tricky stop smoking drug, Chantix, has received the last two weeks, Pfizer will roll out special ads in five big newspapers today, including the Wall Street Journal and New York Times. In the ads, according to Bloomberg, the company will emphasize the dangers of smoking and the benefits of Chantix. That sounds like a desperate strategy. But then the drug over the last two weeks has received a public health warning from the FDA, its use by pilots, air traffic controllers, truckers and bus drivers has been banned, so maybe this is to be expected. After all, sales in the first quarter were down by 30 percent for the drug. It'll be interesting to see its second quarter results.

And, it'll be interesting to see if Pfizer's ad has any effect at all.

Pharma Companies May Get Patient Records In California

This lovely bit of news from my native land:

"Pharmacies in California would be allowed to sell confidential patient prescription information to third-party marketing firms working for drug companies under a bill expected to be voted on Thursday by the state Senate.

"The legislation would allow pharmaceutical firms to send mailings directly to patients. Supporters of the proposal say the intent is to remind patients to take their medicine and order refills. But consumer privacy advocates are outraged."

Is there simply no quit in the sales tactics of the pharma companies? I doubt that too many adults need to be sent reminders to take their meds each day. It's time for "America's pharmaceutical research companies," as Montel Williams puts it, to get the hell out of peoples' private lives. They already know what our docs prescribe anyway. Enough is enough.

We ban drug dealers and users to keep them away from schools. Why would we let these drug pushers into our homes and medical records?

PTSD Cases Up 50 Percent In 2007 Among US War Troops

From today's war is hell department comes this discouraging article from the AP. New PTSD diagnoses among troops in Iraq were up 50 percent in 2007, some of it inevitably connected to last summer's "surge" in forces around Baghdad. What with troops seeing increased rotations into battle zones and lengthier deployments, I doubt this will get better any time soon.

Whatever the next President does about the war, we are going to be paying the price for all of this in our culture for a long time to come. I hope we can do better by this generation of troops than we did th Vietnam generation.

From The Frontlines Of Bipolar Disorder Overdiagnosis

Earlier this month, a study came out asserting that bipolar disorder was being overdiagnosed. About 50 percent of the patients diagnosed with bipolar disorder in a study in Rhode Island turned out to have been wrongly diagnosed once they were put through an appropriate clinical interview. This study hasn't generated anything close to the press response I would've expected to date, but it did lead to this interesting blog post at Psychology Today by Nassir Ghaemi, a psychiatrist at Emory University, asserting that the methodology behind the Rhode Island study was flawed. You can read it for your self and see if you can understand what he's talking about. (here's what I also wrote earlier about the Rhode Island study.)

But the bigger question is of how this sort of thing is playing out in the America the rest of us live in. J. R. White at Brain Blogger offers his own account of himself and some co-workers being misdiagnosed with bipolar disorder and how it happened.

"Let me illustrate this [the sloppiness of some diagnosing] with a pretty 'funny' situation that happened a few years ago. I visited a mental health facility for the first time and was seen by someone we’ll call Wanda. She was not a doctor; she was working towards some certificate or degree and was being 'mentored' by a psychiatrist at the facility. Well, after talking to me she gave me a brand new diagnosis, one that had never even been suggested to me before. It was a type of low-level bipolar disorder and she prescribed medicine to treat it. Turns out I didn’t feel comfortable with this diagnosis and didn’t continue with her suggested treatment plan.

"I became friends with two people who worked at my company and had been seen by Wanda within the same time frame. (Since we all lived in the same part of town and had the same insurance company, this wasn’t too odd.) What was odd about it was that after talking we realized that all three of us had been given the exact same diagnosis. And, stranger yet, none of us believed in the diagnosis so we all three stayed away from the medication and promptly either found someone else to see or found other ways of coping with the anxiety/depression/mood swings."

That's some nice mentoring there by the psychiatrist. It's interesting and not a bit funny that this happened to three separate people in the same town with the same caregiver, one who was still in training. It's just as interesting to me that all three newly-minted bipolars turned their backs on the diagnosis and the treatment. Since White does offer any information to the contrary, I assume they are doing fine.

What's discouraging to me is that this situation is roughly what the researchers in Rhode Island highlighted in their paper. People presenting to docs with symptomologies that spoke of depression and a certain unsettled moodiness and they wind up getting diagnosed with either bipolar disorder 2 or bipolar disorder NOS (not otherwise specified), get prescribed meds, and, later, learn that they aren't bipolar at all.

From where I sit, this speaks to what a bad idea it was to rebrand manic-depression (which generally required full-blown mania for someone to get the diagnosis) as bipolar disorder in DSM-IV in 1994 and, then, create several subtypes of the disorder--BP1 (the old school manic depression), BP2, BP NOS and cyclothymia (which had always kind of been around as a proxy diagnosis). The non-BP1 subtypes are much softer forms of the disorder, somewhere between depression and BP1 on the mood continuum. Part of the idea of rebranding manic depression back then is that the name change would be magical and would lead to less social stigma for people diagnosed with the disorder versus the really intense stigma that greeted folks diagnosed with manic depression. I think we all know how that bit of wishful thinking has turned out.

Even more troubling is how a misdiagnosis of bipolar disorder can lead to many years of treatment with medications that aren't particularly kind to the human body. Any doctor or mental health worker who does not recognize that this is an appropriate concern should get out of the business of diagnosing--especially the casual diagnosing that seems to be afoot in the land--until they get their bearings straight.

Why is this important? Because many millions of people in this country, from the young to the middle-aged, have been diagnosed with one of the types of bipolar disorder in the last decade or so. They've been put on very aggressive medications, including antipsychotics which are being handed out like candy in our culture (how else would Seroquel be winding up as a street drug?). Some of those diagnoses are now clearly in doubt, and so are the treatments these people are taking, in many cases unnecessarily. That's why.

Spring Fundraiser

Just as I did in late February, I am asking readers to make a financial contribution to my work on this site. Your contribution of $5, $10, $25 or what you wish will help fund my work here--which I already subsidize through freelance work, of which there's never enough that pays well--and help me keep a roof over my head for the next couple of months. The February fundraiser brought in $2,500 and I'd appreciate your help in hitting that total again over the next two weeks. May has already been a record month for this site in terms of readers and visits. I appreciate the attention because it has been built over time without the aid of mentions in the mainstream media or via links from mega-blogs.

I think most of you already have an idea of just how many hours I put into this site each day, so I'd appreciate your support. As usual, the PayPal button is over on the right. If you prefer snail mail, shoot me an email and I'll pass along my mailing address.

Thanks for reading and supporting this site.

Prozac For 8-Year-Olds In Europe

I'm just going to pass this along without comment.

"Children as young as eight may soon be able to use the antidepressant drug, Prozac, following a recommendation by the European Medicines Agency (EMEA).

"Prozac (fluoxetine) is an SSRI (selective serotonin reuptake inhibitors). SSRIs are the most commonly prescribed class of antidepressant.

"The drug is authorised for the treatment of major depressive episodes, obsessive compulsive disorder and bulimia nervosa. Currently in Ireland, its use is not recommended in children and adolescents under the age of 18.

"However the European Medicines Agency has now said that Prozac should be considered in the treatment of children aged eight or older who suffer from moderate to severe depression and who do not respond to psychological therapy."

New ADHD Study Pimps ADHD Workplace Screening

Most of you probably saw somewhere in the news yesterday that a new study (here's the pdf) is out asserting that adults with ADHD cost their employers 22 work days a year in lost productivity. The study asserts as well that the prevalence of ADHD in the 10 countries studied runs at 3.5 percent with men being the primary diagnosees. One of the study co-authors is Ronald Kessler, a psychiatrist and public health policy big shot at Harvard.

Then the study researchers went on to say some things that really played into my fears that some of the public health sorts in the mental health world would really love to create a nanny state where governmental and public health paternalism reign supreme and citizens obey their commandments. I'll come to all of that in a second.

There are plenty of reasons to not lend much credence to the findings of the study. First, any time Kessler gets a hold of a disorder, its prevalence is always underestimated and work days are being needlessly lost (I tend not to trust researchers who always issue the same cry). Not long ago, it was Kessler who cranked out a study asserting that 50 percent of Americans have a DSM condition, a fairly preposterous assertion that gives new meaning to "abnormal psychology." Second, this current study uses a self-reported survey method to pick apart folks' psychological health and job performance. It's not the most reliable arrow in the psych researcher's quiver. Third, this study was supported by a grant from Eli Lilly (see the disclosures at the end of the paper). Say no more.

What amused the hell out of me was watching the US and British press jump all over this study as if it contained buried treasure.

Health Day News: "Dr. David W. Goodman, director of the Adult Attention Deficit Disorder Center in Luthersville, Md., agreed that ADHD is an 'under-diagnosed and under-recognized psychiatric condition that causes a tremendous amount of disability in the work environment.'

"And while he supports the idea of screening workers for ADHD, Goodman, who is also an assistant professor of psychiatry at Johns Hopkins University, worries that "identifying workers with ADHD raises the possibility for discrimination.'"

WebMD: "'People with ADHD have more sick days and lower performance when they work,' Kessler tells WebMD. 'This is one of those hidden illnesses in the workplace.'"

And so it went through newspapers, wires and websites. Apparently, reporters don't read studies in their entirety and since I am a reporter that kind of bugs me. Why?

Right at the end of the paper, there was this assessment of the "policy implications" from the authors, which sent chills down my civil libertarian spine:

"The above results raise the question whether adult ADHD is a candidate for targeted workplace screening and treatment programs. Short screening scales that are both sensitive and specific for adult ADHD exist. It might be cost-effective from the employer perspective to implement workplace screening programs with such a scale to detect and provide treatment for workers with ADHD. The thinking here is that ADHD among workers has non-trivial prevalence, high impairment and a low rate of treatment, whereas cost-effective therapies exist that are related to improvements in some objective aspects of role performance. The obvious next step from a public health perspective, given these findings, is to evaluate the extent to which best-practices outreach and treatment would result in improvement in functioning that might have a positive return-on-investment for employers." (Emphasis mine.)

No, Dr. Kessler those kinds of policy implications just aren't where you should be taking your nanny state express. You are asking a question that's just stupid and you are poking into private realms that you shouldn't touch. If workers aren't super-productive at all times and it's OK with their bosses, then who cares? I've been watching researchers like Kessler wrap their medicate-the-masses arguments in the cloak of we're-helping-business-productivity for years. I'm growing tired of it.

But what worries me about studies like these--part of the WHO's World Mental Health Survey Initiative--is that they seem to have no boundaries. Because what Kessler is driving at is a universe where there would be ADHD screenings as part of pre-employment interviews and, maybe, to get a promotion. If you want the job, then you'll take Adderall. Then come the mandatory drug tests. If you aren't taking your Adderall, you get fired. If you think I am joking, I recall back when workplace drug testing became standard at some companies and they went looking for pot use among employees (some even test for alcohol). I thought for sure that the courts would never support such an intrusion into peoples' private lives, but they sure did. I worry about a similar dynamic erupting here as well. It creeps me out even more that the United Nations is somehow involved in this push.

For some reason, I am more concerned about this sort of intrusion into everyday Americans' lives than I am by the specter of discrimination against people with ADHD (I'm concerned about that too, but by comparison with what goes down for people with schizophrenia or bipolar disorder, it's not even in the same ball park).

Isn't America already the most (or second most) productive country in the world? Don't Americans already work more hours per week than just about any people on Earth? We're already working our butts off, the price of everything is going up dramatically, our wages are largely stagnant. Why do we need to perform even more? Who is this kind of policy wonk talk really serving? Workers? Eli Lilly? Harvard? Boeing?

I'm not sure I want to live in a world that the Ron Kesslers of the world imagine, where every little slip in performance becomes an occasion to be sent to the company psychologist.

What about you?

Prozac Over The Counter? Oh, Hell No!

You know those "let's do a thought experiment" features that run in some mags and newspapers? There's an interesting one on Time's website this week and I suppose it made its way to the print edition as well. Does anyone read print editions anymore?

The question: "Should antidepressants ever be sold over the counter?" The fact that such a question is even being asked in such a way tells you a lot about where America is as a culture. Time isn't exactly an out-there publication posing questions that have little connection to day-to-day America. Their charge is to be thoroughly in touch with what's under the skin of the mainstream. So the question spooks me.

Answering the query is Josephine Johnston, associate for law and bioethics at the Hastings Center. I was intrigued by some of her answer:

"The trouble, I guess, is there's a lot of concern that if you start providing needed medicine to clinically depressed individuals over the counter, it will pretty quickly become a drug that's used much more like alcohol or some other kind of what we might call recreational drugs."

And discouraged by her apparent ignorance of what's up with anti-depressants:

"But if you take the libertarian argument, 'Why shouldn't people be free to treat their own problems?' then there is no good argument against it. Antidepressants are not that dangerous."

Not that dangerous? OK, how about risky and dangerous for some?

"Overall I can sort of see both sides, but, in the end, it's hard for me to go completely with free choice. I think the interesting thing about this thought experiment is that it doesn't feel very far-fetched. While you can't buy antidepressants over the counter now, it's pretty easy to get a prescription from your doctor."

No, I suppose none of this is very far-fetched at all.

Regardless of what you make of anti-depressants and how to treat depression, the larger question to me is, "Would you make a drug available over the counter that's not particularly effective for most people and which some people kill themselves on while others get hooked on it and still others go through the Jones of withdrawal?" If you answer "Yes," then you'd have a tough time making a case against the legalization of some other drugs.

Me? I'm not in favor of OTC anti-depressants. If their performance and safety were in line with aspirin or antibiotics, then I'd be fine with the idea. But they aren't and I'm not.

Mindfulness Meditation: Fad Or Fix For Depression, Anxiety?

An interesting piece in today's New York Times on mindfulness meditation, which comes to us by way of Buddhism and likely comes in many flavors and forms. Ben Carey, the NYT's reporter on mental health issues, raises appropriate concerns about whether meditation is a fad or a legitimate treatment:

"It is catching the attention of talk therapists of all stripes, including academic researchers, Freudian analysts in private practice and skeptics who see all the hallmarks of another fad....

"At workshops and conferences across the country, students, counselors and psychologists in private practice throng lectures on mindfulness. The National Institutes of Health is financing more than 50 studies testing mindfulness techniques, up from 3 in 2000, to help relieve stress, soothe addictive cravings, improve attention, lift despair and reduce hot flashes.

"Some proponents say Buddha’s arrival in psychotherapy signals a broader opening in the culture at large — a way to access deeper healing, a hidden path revealed.

"Yet so far, the evidence that mindfulness meditation helps relieve psychiatric symptoms is thin, and in some cases, it may make people worse, some studies suggest. Many researchers now worry that the enthusiasm for Buddhist practice will run so far ahead of the science that this promising psychological tool could turn into another fad.

"'I’m very open to the possibility that this approach could be effective, and it certainly should be studied,' said Scott Lilienfeld, a psychology professor at Emory. 'What concerns me is the hype, the talk about changing the world, this allure of the guru that the field of psychotherapy has a tendency to cultivate.'"

It's no surprise to me that meditation is gaining so much attention: CBT can be pretty rigid stuff while Buddhist approaches change in the hands of each practitioner, and, besides, the Zen has the reputation of being damn cool (I've heard the sex is better too). The trouble I've noticed with meditation over the years is that most people simply cannot get to that deep place of transcendence that you've got to get to in order to justify it as a treatment. That said, I know people for whom this sort of thing has been profoundly healing and life changing. So if it works for you, congratulations. If it doesn't, move onto something else.

I think Carey was smart to point to concerns that the use of meditation in psychotherapy could be racing ahead of the evidence. But, whatever, it's free country. Sure would be nice to see some more large-scale controlled studies.

I'm just as concerned as the prof I quoted above when it comes to possible guruism is the psych world (not that our culture's chemical gods are particularly helpful either). But maybe that's because the social history of my native land, California, is littered with hundreds of sleazy stories of gurus, many of them Buddha-based, run amok and I've bumped into my share of human wreckage from such groups over the years. My experience dealing with quasi-religious groups around certain gurus over the years--both in California and Washington State, where I wrote about one cult--is that people are turning to such outlets to salve their distress over being human in a complex culture at a complex time in human history and that many of them in the "personal growth" movement--as it was called once--were huge suckers for cult leaders. You do remember the Hale-Bopp comet suicide cult?

I'm certainly not saying that's the way meditation psychotherapy gets practiced. One just worries that it could be.

Study: Antipsychotics Killing, Injuring Elderly With Dementia At Shocking Rate

I really don't know what other headline to put on this Archives of Internal Medicine paper that came out yesterday from researchers showing that patients with dementia face a risk of death or other serious event at more than 3 times the rate of other elderly with dementia who don't get an antipsychotic. Given that recent studies (such as CATIE or this British study from January or this Dutch study from March) have found that giving antipsychotics to such patients is less effective than placebo, you've got to wonder what the rationale continues to be for pressing these meds on the elderly. I can kind of understand this in select cases, but as a standard of practice I cannot understand this medical approach. It's not playing out well clinically at all.

Of course, allegations of off-label marketing of second generation antipsychotics for use in the elderly is at the heart of several states' lawsuits against makers of these drugs. Strangely, that bit of context and the CATIE results didn't find their way into this piece in the Washington Post by Health Day News, which I guess is becoming part of the paper's health reporting team, itself the reported victim of a major shakeup coming out of the paper's recent buyouts cum layoffs.

Anyway, the reporter offered this:

"However, the problems underlying the need for such medications, behavioral problems such as aggression and agitation, are very real, and the alternatives to antipsychotics are limited, the researchers added.

"'A misreading of the findings would be we don't need to do something for these nursing home residents,' said study author Dr. Gary J. Kennedy, head of geriatric psychiatry for Montefiore Medical Center in New York City.

"Many experts feel behavioral interventions should be tried first and antipsychotics used as a last resort, 'when the behavior or the psychiatric symptoms are really out of control and causing complete distress not only for the person suffering from Alzheimer's, but for caregivers all around them,' said Maria Carrillo, director of medical and scientific affairs at the Alzheimer's Association in Chicago. 'It's important to work these things out with the physician and, of course, do follow-up very closely together, so you can make sure these antipsychotics are having the effect you want and, if not, discontinue them immediately.'"

The study was broken down into two main groups--those living in the community and those in nursing homes--and three subgroups--those getting no antipsychotics, those getting second generation antipsychotics and those getting first generation antipsychotics. The study was based upon the medical records of about 43,000 patients with dementia between 1997 and 2004.

Dementia patients who lived in the community and got a second generation antipsychotic were 3.2 times more likely to die or be hospitalized than patients who got no antipsychotic. With a first generation antipsychotic the rate jumped to 3.8 times. And the deaths and hospitalizations were occurring within 30 days of getting the drugs. That's just shocking to me.

As for nursing home patients with dementia, the rates of deaths or serious problems were 1.9 times for the newer drugs and 2.4 times for the older ones.

These findings simply amaze me. A reader who shot me an email last night posed an interesting irony:

"I can't help wondering how parents who strongly advocate for their children (including adult children) to take antipsychotics, view second generation anti-psychotics as miracle drugs, use extortion to achieve medication compliance, or insist on injectable anti-psychotics would feel if they realized that they face a future which might involve these very medications."

Anyone care to take a crack at that?

Separately, what with continued scientific evidence of health consequences for elderly patients getting antipsychotics, you've got to wonder what the health consequences are for people diagnosed with schizophrenia and bipolar disorder and why there is not more of a hew and cry on that front. We already know that antipsychotic use shortens the lifespan of people with schizophrenia. I don't know of similar evidence for people with bipolar disorder, but I'd be surprised if the evidence were appreciably different. What's interesting is that dementia patients generally get these drugs at lower doses than schizophrenics and bipolars. All of this also makes you wonder what outcomes will be like for patients who will get Seroquel for depression under its forthcoming FDA approval.

Or am I wondering too much here?

Chantix Causes Traffic Accident, Passengers Almost Die

Troubling news just keeps rolling on Chantix, the stop smoking drug, which was last week banned for use by pilots and air traffic controllers by the FAA and was also banned for use by commercial bus and trucks drivers due to the recent warnings about erratic behavior caused by this drug.

Now, the Los Angeles Times reports about a Louisiana man who, two days after starting the drug, had his eyes roll back in his head while he was driving his truck with a woman. Then he steered the truck right into a bayou and the pair likely came close to losing their lives.

The LAT also reports that there were some very quiet advisories issued to docs by Pfizer last summer about problems with the drug. Apparently, plenty of docs either didn't read the warnings or blew them off as a trivial "it'll never happen in my practice" thing. Even the FDA thinks that's a problem:

"But such admonitions apparently didn't get much notice from busy doctors. Even some government transportation agencies missed them.

"The Federal Aviation Administration continued, until last week, to list the drug as approved for pilots. The federal truck safety agency was also unaware of the risk.

"'That is a problem,' said Janet Woodcock, head of the FDA's drug evaluation center, adding that her office needs to find ways to communicate safety information more effectively."

Do you think?

Meanwhile, the blog Fat Jewish Guy reports that Chantix has been making him utterly nutso after three days on the drug:

"OK, so today was a little better.

"Yes, my skin was crawling, but at least there were no violent thoughts.

"I’m lying.

"When I was on the phone with Pfizer, I definitely wanted to kill the snarky guy on the phone with me."

How strange that a drug being pressed upon patients by doctors to address a public health problem is turning into a public health health problem. Where have we heard of this before? SSRIs anyone?

British Docs Reevaluating Anti-Depressant Rxs

Out of Britain comes this interesting survey from OnMedica.com. Keep in mind that it's just a survey:

"Almost half of doctors are reconsidering prescribing selective serotonin reuptake inhibitors to patients with depression after research found that they were not as effective as expected.

"Of the 490 doctors questioned by OnMedica, 44% said they would consider other treatments to SSRIs because of doubts over their effectiveness."

Survey or not, that's still telling and likely a big shift in doctor attitudes in the last few years. It'd be interesting to see where American docs line up on this issue. The rethink is coming because of studies published in the New England Journal of Medicine and PLoS in recent months showing that the efficacy of anti-depressants isn't anywhere near what the public and docs have been told by pharma companies over the years.

I've also written about the NEJM study in Willamette Week.

12 Year Old Arrested For Dealing Chantix, Anti-Anxiety Med

Read it and gasp. From upstate New York:

"Chittenango Middle School arrested for selling prescription drugs to students. On May 8th, school officials found pills, including Chantix and anti-anxiety medicine, in the possession of some students who were selling and giving out pills to other students.

"State Police arrested a 12 year-old juvenile Sullivan for 3 counts of Criminal Sale of a Controlled Substance in or near school grounds, a Class B Felony and 3 counts of Endangering the Welfare of a Child , a Class A Misdemeanor.

"He has been released into the custody of his parents and to appear Madison County Family Court.

"State Police say more arrests could be coming.

Where the hell did a 12-year-old get his or her hands on Chantix and Xanax or Ativan? Had to be the parents. People have clearly got to start locking up the meds. And why the hell would kids so young be handing psych meds around in the school yard? Have they heard they can get high?

Whatever happened to the days when the bad kids stuck with cigarettes and weed?

Today Being The Front End Of A Holiday

I'll be out of town doing some outside work much of today after about Noon PDT. I think Puckett may handle comment approval in my stead, but if not it'll be evening before I am back at the computer.

BTW, it's Memorial Day weekend, so I hope you all have a nice holiday, unless you aren't in the US in which case have a nice weekend.

ADHD, Food Additive Link Taken Seriously Again

Last month I wrote about British health officials seeking to ban certain food colorings over alleged connections to ADHD in kids. Now, WebMD.com reports that some US researchers are taking a look at the additive/ADHD connection elsewhere.

"In a newly published editorial appearing in BMJ, pediatrics professor Andrew Kemp, MD, of the University of Sydney, called for removal of food additives from the diet to be part of standard initial treatment for kids with attention deficit hyperactivity disorder (ADHD)....

"Kemp tells WebMD that practitioners have largely ignored the clinical evidence suggesting that dietary modification improves ADHD symptoms in some children.

"'Clearly it doesn't work for everybody, but very few treatments do,' he says. '(Dietary modification) is certainly something that parents who want to avoid drugs could try for a month or six weeks.'"

As a first line approach to dealing with ADHD this makes sense, although elimination diets, as they are known, have been around since the 1970s and met with varying levels of success. And cold water has been thrown on the link between additives and ADHD before.

WebMD.com cites recent CDC stats on the prevalence of ADHD among American kiddos: "In the United States, 4.7 million children, including 9.5% of boys and 5.9% of girls, have ever been diagnosed with ADHD, according to the latest statistics from the CDC."

Ten percent of boys and 6 percent of girls? That's a remarkably high number of kids and certainly points to the need to figure out what is going on, regardless of whether additives are source of the problem. British researchers have estimated that about 30 percent of all ADHD cases can be tied to issues with additives. If true, there are 1.5 million or so kids in this country who could be affected.

We'll see how this turns out.

Truckers Banned From Chantix Use

The Federal Motor Carrier Safety Administration, which regulates commercial trucking and bus driver licenses interstate, today issued a warning about Chantix, the stop smoking drug which yesterday was the subject of a ban by the FAA. The warning advised medical examiners for the agency "to not qualify anyone currently using this medication for commercial motor vehicle licenses."

Looks like I wasn't wrong when I guessed yesterday that bus drivers could be next for a ban.

Tough week for Pfizer. I bet you they are hard at work on another version of this drug.

Chantix's Ugly Side Effects And Pfizer's Responsible Behavior

I've had a look at the report by the Institute for Safe Medication Practices that spurred yesterday's FAA ban on the use of Chantix, the stop smoking drug, by pilots and air traffic controllers and that report is a doozy. From Bloomberg:

"Among the psychological side effects reported to the FDA were 28 suicides, 41 cases of homicidal thinking, 224 reports of heart trouble, 525 reports of hostility or aggression, and 397 cases of possible psychosis. There were also 173 serious injuries, including traffic accidents often associated with unconsciousness, dizziness, muscle spasms, or mental confusion."

Last year, when I wrote that this drug was acting like a bad old SSRI, I was attacked for making the association. Now, it's apparent that the report, based on the FDA's adverse events database, backs my concerns about the drug. In its two years of market life, the drug has generated more than 3,000 reports to the FDA (of course, the public and docs are a bit more attuned to the fact that they can report problems with drugs to the FDA these days than they were a few years ago). In a 10-year period, Paxil generated about 8,000 adverse events reports. By comparison, Chantix is like the Son of Frankenstein. Of course, it's never 100 percent clear if a drug is responsible for problem X, but based upon the many accounts of Chantix users who've written to this site, I'd say the drug has the unique ability to make regular folks crazy. And, it says quite a bit that the FAA banned the drug's use. That's not an agency that's prone to overreaction.

The rolling set of warnings the FDA has placed on the drug and Pfizer's own warning label (in advance of what would've been an almost certain black box warning by the FDA) have knocked sales of the drug down by one-third and financial analysts have downgraded future sales for the drug as well.

"The new report prompted Sanford C. Bernstein & Co. analyst Tim Anderson to cut his sales estimates for the drug by 42 percent, to $758 million from $1.31 billion, in 2009 and by 60 percent, to $720 million from $1.82 billion, in 2015."

That's a whole bunch of change going down the sewer. I often bang on the behavior of pharmaceutical companies in relation to hiding problems or non-performance issues with their drugs, but in this case Pfizer gets high marks from me for its behavior and its willingness to be proactive while inevitably knowing that it was hurting itself on the revenue front. The first very public reports of problems with the drug came in from late-September through early November of last year. Only a few months later, the FDA had issued warnings and Pfizer had voluntarily stepped up to the plate and issued its own version of a black box warning (after spending a few months trying to blame some of the effects of the drug on the effects of quitting smoking). Compared with how Eli Lilly covered up known problems from the late-90s onward with Zyprexa and then spent two years negotiating terms of the FDA black box warning, insisting all along that the drug was no problem, this is about as ethical as it gets in the pharma world.

Then again, company officials likely knew that if they didn't respond, the FDA would force a black box down its throat, and the company would be sued into infinity by plaintiff's attorneys. It still might be for all I know.

It's a pity Lilly wasn't as upfront with Prozac and Zyprexa. Lives would've been spared. But then you could say the same about the companies that make Paxil and Zoloft and Effexor and, well, you get the picture.

PBS Depression Special: Troubled, But Not So Bad

So I just finished watching the PBS "Depression: Out Of The Shadows" special and it had its problems, which I'll get to, but overall it was not terrible, except when it came to ECT which I think the show gave a free pass to while almost completely ignoring CBT. I think the producers were a bit too unwilling to be adult about the problems with anti-depressants and meds in general, although the subject is broached and, then, quickly backed away from several times during the program (which you can catch during upcoming repeats). I also think the program engaged in at least some fallacies as well.

Marissa Miller at depression introspection live blogged the show last night and has a nice rundown of it up. And her own analysis.

Globally, however, I think the program was OK, as in B-minus/C-plus OK. That's probably because its "faces of depression" were mostly sympathetic characters and genuine humans who had to grapple with some dicey depression and addressed it the way they addressed it and had it work out the way that it's worked out and were fairly articulate about their own experiences, and the loss, grief and flat out human loss that is somehow tangled up in the blue that is Depression and is often its grave enabler. I give them credit for that. All of them. I must admit to feeling worried about some of them, since I have a fairly good sense of where they've been and where they are. But then maybe I walked away semi-happy because I am damn glad that the I who was once Them is now Me.

Poor Andrew Solomon is on Remeron, Wellbutrin, Zoloft, Zyprexa (for the anxiety, he said, that accompanies his depression) and a couple of other meds for Alzheimer's to help stave off weight gain and cognitive impairment from the meds plus two kinds of fish oil. "That's my morning," he jokes with the camera, as he doles out his pills. He also exercises with a personal trainer and has a kitchen that no one could ever be depressed in (OK, I exaggerate a bit there) and does weekly talk therapy, apparently with Richard Friedman, who writes for the New York Times along with being a psych doc. How could you not be concerned for someone with that much voodoo in his system? I know he's made some very adult choices, and one hopes he might be a in a position to make a choices in different directions as time goes on. He's kind of become a spokesman for Depression (yep, the capital letter kind) and I hope he gets to speak up for other solutions as his life goes on. He's certainly a thoughtful and articulate man.

Of course, it was rough watching the two teens and the former Bloods gang member, Dashaun, talk about their experiences. And there was a mother who'd had postpartum depression who's now on a low dose of some unidentified anti-depressant in preparation for having a second child. This is apparently to prevent another bout of depression.

That's one of many places where the show fell apart a bit for me, where I felt it wasn't being entirely honest with its audience. The proof for meds preventing future episodes of depression is fairly weak, at least by my yardstick, although I know there is a lucky crowd who eventually find the proper mix of meds and don't have depression anymore. Sadly, this is perhaps 30 percent of the people who take anti-depressants--and perhaps it's a bit higher--and I am kind of surprised that Tom Insel, the head of NIMH, didn't bring that up when he was on camera. He's certainly said something close to that publicly before. Anyway, I feel the show should've been more honest about this point.

I was also staggered by how much time the show spent on ECT and deep brain stimulation, an experimental technique. I understand that this was in the context of discussing refractory or treatment resistant major Depression, but to spend about 10 minutes on these two controversial procedures while almost no time was spent on talk therapy, except in snippets throughout the program, and CBT, which made about a 10-second appearance, is a bit beyond my sense of what's fair and judicious in what was basically a depression for the uninitiated sort of program. Where the hell were Aaron and Judith Beck? Where was Charles Barber, or someone like him? Nowhere.

I was a bit frustrated that the program basically said, "ECT got a bad rap because of 'One Flew Over The Cuckoo's Nest'" and then showed a clip of Jack Nicholson's face as he was getting forcibly zapped and then said, in effect, "It's not like that anymore." If it's not like "that" anymore, then why not show the face of the woman who was having ECT performed on her instead of her feet? Why not a spend a wee bit more time discussing the pitfalls of ECT?

ECT is not a harm free procedure for everyone and that's a fact. It's also a fact that I am biased on this issue. But if it's OK for PBS to be baised, then it's OK for me.

I was pleased that the show spent some time talking about fast-acting depression treatment, especially ketamine, although it ignored the similar research on MDMA and marijuana. I think all three of these drugs should be researched until their molecules have nothing left to give in search of fast-acting treatments because there is something special about these molecules that the extant research is trying to tell us. But then I've been saying that for three years. It's nice to see ketamine make a brief appearance as the club drug that could.

To its credit, the show did chip gently at the idea that meds don't work for everyone. In a segment where Philip Burguieres, vice chair of the Houston Texans football team, was talking on the phone with someone he openly said that meds never worked for him and agitated him, but it was half-drowned out by the narrator. But it was there. Emma, a teen who'd been so depressed she was sent to a hospital in a neighboring state, refused to give the unidentified anti-depressant she takes much credit for her recovery. Dashaun flat out refuses to take meds.

Another thing that knocked me over the head was the insistence throughout the program that Depression is a disease and a medical problem. I don't have to time to go into this kind of beatdown right now, because it's a "Yes, it is, No, it isn't" dichotomy. To its credit, the program didn't hype the chemical imbalance theory of Depression. By the standards of the last 20 years, that's progress.

The most ticklish of the fallacies that gnawed at me in the show was the claim that Depression (and depression) are more untreated than treated in our culture. The show offered no evidence to back this assertion and, from where I sit, its claim is nothing more than opinion. It's certainly no more defensible than my opinion that the crisis in depression (and Depression) treatment isn't a lack of treatment or of people getting treatment (be it meds of therapy), but a lack of medical treatments that work well without beating up the depressive or not working at all.

And, finally, I don't think the show did a careful job of pointing out that almost all of its patient faces were sufferers of very severe major Depression (most had required hospitalization), when the fact is that the faces of depression in American aren't even close to all being like that.

And that's healthy for all of us.

What did you think of the show? If others of you have written about it, let me know.

FAA Bans Chantix Use By Pilots, Controllers

The FAA has banned the use of the stop smoking drug Chantix after numerous reports of erratic behavior associated with use of the drug that have resulted in a public health warning from the FDA. Pilots and air traffic controllers are banned from using the drug.

"FAA spokesman Les Dorr says the ban is effective immediately and that the agency was notifying unions representing pilots and controllers.

"The FAA decision comes a day after its officials were briefed on the side effects by the Institute for Safe Medication Practices.

"A representative from Chantix maker Pfizer Inc. did not immediately comment Wednesday afternoon."

Hm, today pilots. Tomorrow bus drivers?

Arkansas Sues AstraZeneca Over Seroquel For Illegal Marketing And Fraud

UPDATED: 1:48 p.m. PST with AZ's response.

Arkansas State AG Dustin McDaniel yesterday brought suit against AstraZeneca for illegal marketing and fraud, among other charges, in its sales of Seroquel to various agencies in the State. The suit, which somewhat echoes a lawsuit filed by McDaniel last fall against Janssen/J&J over its handling of Risperdal, another atypical antipsychotic, alleges that the company knew of risks associated with the use of the drug, primarily diabetes and weight gain, but did not properly warn physicians or the public. McDaniel alleges that the drug was unreasonably hazardous and dangerous.

Jim Minnick, a spokesman for AstraZeneca, responded to the suit in an email. "AstraZeneca denies the allegations brought by these lawyers. Seroquel has helped millions of people suffering from a variety of debilitating mental illnesses, and allowed them to lead meaningful lives. AstraZeneca will vigorously defend itself in this lawsuit."

The lawsuit is online here (1.5 MB .pdf).

There are several stinging accusations in the lawsuit, which primarily focuses on promotion of the drug for use in children and the elderly. Not that the state is ignoring accusations for how the drug may have been aimed at people diagnosed with schizophrenia.

"Seroquel's premarketing clinical trials did not support an assertion that it was less likely to cause extra pyramidal symptoms than traditional antipsychotics....Defendant's trials were designed to produce similar rates of EPS in patients sorted into placebo groups and those taking Seroquel."

And concerning diabetes and hyperglycemia:

"[T]hey implemented marketing strategies that blamed diabetes and hyperglycemia on the schizophrenic population at large rather than on Seroquel...despite the fact that defendant's own internal studies and adverse event data revealed that Seroquel increased the risk of diabetes, even among schizophrenics."

Among other things, the suit alleges that the company sought ghostwritten research and paid thought leaders to support AZ's marketing aims, that AZ failed to reveal material facts about hypotension and cataracts, that AZ knew the drug to be unreasonably hazardous and dangerous, that it illegally marketed Seroquel for use in children and elderly and for depression and other psychological conditions, that the company engaged in an "elaborate and clandestine promotion of Seroquel for non medically necessary uses," that AZ engaged in "illegal direct solicitation of physicians."

In addition to recovering costs of care for people who developed diabetes and other injuries, the state is seeking an injunction against AZ to stop its off label marketing of the drug.

I reported earlier today that the state had also sued Eli Lilly over Zyprexa. A spokesman for the AG tells me that that was an erroneous media report in Arkansas and that the state has not yet sued Lilly.

Arkansas AG Sues AstraZeneca Over Seroquel

I'm just hearing now that Arkansas State AG Dustin McDaniel has filed suit against AstraZeneca claiming that the drugmaker pressed doctors to prescribe Seroquel even where it wasn't required. The state has previously sued the makers of Risperdal and Zyprexa.

More on this when I see the lawsuit itself.

Study: Some Schizophrenics Do Better Without Antipsychotics

Last week, Gianna Kali who authors Bipolar Blast brought an academic study to my attention that left me speechless. It's a paper by Martin Harrow, PhD, and Thomas H. Jobe, MD, both of the University of Illinois College of Medicine's psychiatry department, and was published last year in the Journal of Nervous and Mental Disease. Its subject is what were the outcomes for people diagnosed with schizophrenia at a Chicago area psychiatric hospital 15 years after their initial diagnosis and treatment. It also takes up the tricky question of who fared better, patients who took antipsychotics consistently or patients who didn't take antipsychotics at all.

The quick, untricky answer is that the people diagnosed with schizophrenia who didn't take antisychotics had better outcomes 15 years later than the patients who did take antipsychotics. Yes, you read that right.

Before I launch into a discussion of the paper, I wanted to offer a brief disclaimer since I know this is a very emotionally charged subject. I am not trying to make an argument that anyone should be off-meds or should be on-meds. I am not interested in having that fight. I'm also not going to fly off and declare the medical model of treating schizophrenia defunct (I've noted many times, however, that it does not work very well) and that schizophrenia doesn't exist. This isn't about that.

This is about yet another tantalizing piece of evidence in how alternatives to the standard medical model for treating schizophrenia have worked out. Unfortunately, the study group in the paper simply isn't large enough to draw the kind of broad conclusions that many of us would like to draw. It is nonetheless fascinating work and joins other studies that show outcomes for people diagnosed with schizophrenia can be better for patients who step outside of the standard medical model (for whatever reason). I am thinking in particular of the WHO study of outcomes for schizophrenics in developing nations as opposed to developed nations (much better outcomes in developing nations) and a 1988 paper by Courtenay Harding, which examined outcomes of people with schizophrenia who were deinstitutionalized in Vermont in the 1950s and were sent out into the community, many of them to medication free lives (they did better than counterparts in Maine). There are other examples in the literature, of course, but for now I'll leave it at that.

And, since this paper does discuss unmedicated schizophrenia, let's be clear that the people in this study group who succeeded sans meds fell into a relatively special cohort and it's pretty clear that they didn't go off-meds willy-nilly after walking outside the locked unit door. Please keep this in mind.

Now, onto the Harrow and Jobe paper. For some reason, I was not able to get a copy uploaded onto my site this morning. I'll fix this as soon as I can. (Paper is now online here.)

"Patients with schizophrenia who had removed themselves or been removed from antipsychotic medications showed significantly better global functioning and outcome than those still being treated with antipsychotics. Detailed analyses of those patients with schizophrenia on antipsychotic medications versus those not on medications at the 15-year follow-ups also were conducted. These analyses indicated that in addition to the significant differences in global functioning between these groups, 19 of the 23 schizophrenia patients (83 percent) with uniformly poor outcome at the 15-year follow-ups were on antipsychotic medications. The data on psychosis in Figure 1 show that at the 10-year follow-ups, 79 percent of the patients with schizophrenia on antipsychotics had psychotic activity, whereas 23 percent of those not on any medications had psychotic activity. Sixty-four percent of the schizophrenia patients treated with antipsychotic medications at the 15-year follow-ups had psychotic activity, whereas 28 percent of those not on any medications had signs of psychotic activity.

That data doesn't exactly offer much support to the generally-accepted notion that antipsychotics prevent psychosis and improve global functioning and that everyone diagnosed with schizophrenia should be on them at all times. But people diangosed with schizophrenia were not the only ones who came into the psych unit with psychosis. There were people with psychotic depression, bipolar disorder (the most aggressive kind, one assumes) and other psychotic disorders. The authors don't go into their experiences in much detail, but offer this global assessment:

"The results for the nonschizophrenia patients who had psychotic disorders at index hospitalization also showed very large significant differences; patients with other types of psychotic disorders not on any medications at the 15-year follow-ups showed better outcome than those on medications."

So it's almost the same story there: no meds means better outcomes. So why is there such a huge emphasis on all-meds, all-the-time in American's mental health system much less in the broader culture? The authors state:

"A certain number of schizophrenia patients who go off antipsychotic medications and relapse are quickly brought to the attention of psychiatrists and other mental health workers when they return for treatment and/or rehospitalization; these relapsing patients are the ones from whom opinions by some about the absolute necessity of continual antipsychotic medications for all patients with schizophrenia are formed."

In other words, if researchers and key opinion leaders and such never see other types of patients with schizophrenia, then their world view is very narrow, as is their research base and so is their opinion of what modalities should guide treatment. Keep in mind, that's the authors' opinion and since they are on the faculty at a major medical school, I'd say they may have a basis for their view.

Someone needs to get this paper into the hands of Fuller Torrey stat.

So why did some people with schizophrenia do well without meds? There's a discussion of this in the paper, but it basically boils down to two key factors: "the unmedicated patients were more likely to be more resilient patients with better prognostic potential, better developmental achievements, and more internal resources" as well as, here's number two, self-esteem. Internal resources and self-esteem can be nebulous terms and I wouldn't even begin to guess at how a clinician can apply them to a patient. Nonetheless, they are the classic you know 'em when you see 'ems. Developmental achievements would, I assume, relate to learning and language acquisition (did they graduate from high school? on time?).

Then the authors offer this:

"Recommendations regarding the use of medications at various phases of illness are often based on a risk-benefit analysis involving, as in many other areas of modern medicine, the probability of success rather than certainty. The current data identify a clear subgroup of schizophrenia patients not being treated, a number of whom experienced periods of recovery, with the data indicating that on average, those patients not on any medications at the 15-year follow-ups had significantly better current and previous global adjustment than those on antipsychotics. There also has been some indication that as our patient sample is getting older, there may be some tendency for improvement among schizophrenia patients. Our overall analysis indicates that many schizophrenia patients not on antipsychotic medications played some role themselves in the decision for them to stop taking medication and leave treatment at a relatively early phase of their posthospital course. Thus, most of the subgroup of schizophrenia patients not on any medications who were in a period of recovery at the 15-year follow-ups had been taken off or removed themselves from antipsychotic medications over 10 years earlier by the 2-year or 4.5-year follow-ups."

Although the study doesn't get into social service-y details such as housing and aftercare, the Vermont study mentioned above does (the study first came to my attention in Charles Barber's Comfortably Numb). I don't have access to the complete paper--thanks APA!--but there is an account of it in the American Psychological Association's Monitor from 2000. The basic story is that long after being released from the state hospital, about two-thirds of the patients were recovered, often without medication at all. Much of the credit for that is given to community integration.

I'm going to leave my assessment of the Harrow and Jobe paper at that for now. For me, it has a lot of personal significance. I have two relatively close friends who are diagnosed with schizophrenia. One currently sits in a psych unit, doped to the point of slurring her words, after her psychiatrist tried an "innovative" new medication regime with her and it had very bad outcomes. The other is a man in his 60s who's been on the injectable Haldol for two decades or more and often looks like a dead man walking. I'd like both of them to have better futures, no matter how they are won.

PBS Special On Depression Airs This Evening, ECT Among Touted Treatments

There's been a lot of advance press for this evening's PBS special, "Depression: Out Of The Shadows." NAMI, which is a sponsor of the show, has done a very good job of seeding the media with information about the show, which features a number of profiles of depression sufferers, including Andrew Solomon, author of the Noonday Demon, and an after show featuring Jane Pauley discussing depression research. There have been lots of advance print pieces on the show's airing, so I'm sure loads of people will be tuning in. It's not like depression is a small problem in the US and elsewhere.

Not everyone reviewing the show in advance is in love with its results:

"Opening with lonely cinematography and sad, minor-key music not unlike a Cymbalta ad, the documentary "Depression: Out of the Shadows" (CPTV, 9 p.m.) attempts an overview on what is actually various maladies, from bipolar disorder to postpartum depression, usually lumped under one name.

"A number of case studies are followed in the two-hour film, along with a glimpse of current treatment (in one, electroshock treatment is presented as a treatment that has gotten a bad rap; lobotomies don't get a similar resurrection).

"The show provides almost too much information. Even so, it's followed by a panel discussion, "Out of the Shadow" (CPTV, 9 p.m.), in which interviewer Jane Pauley dominates the discussion, speaking of her own bipolar disorder, diagnosed at age 50."

Electroshock? ECT? On PBS? Oh my. Here's a transcript of researcher Charles Nemeroff calling the procedure "the heavyweight champion."

I've poked through the show's website a bit--every show must have a website these days!--but it's not clear to me whether PBS is taking us all to a big old SSRI party or if there's going to be some emphasis on psychotherapies such as CBT. It's telling to me that the show's producers have lined up psychiatrists such as Charles Nemeroff and Tom Insel to participate, but where the heck are Aaron and Judith Beck? If you are doing a show on depression, it'd kind of make sense to include them.

Anyway, interviews with some of the depression sufferers are already posted here and you can read them for yourself. Apparently, one woman who will appear and who suffered from postpartum depression after her first child was born is now pregnant with a second child and is taking an anti-depressant. I hope to God it's not Paxil. I don't want to prejudge the show's tenor too much, but advance news that electroshock and pregnant women taking anti-depressants will be in the mix sure send shivers up my spine.

You can find out where the program airs in your area by using this handy schedule finder.

I'll have a report on the show tomorrow. Feel free to leave comments on it in the meantime, if you are viewing it in time zones ahead of mine.

Is Seroquel To Become The New "Roofie?"

I've complained on this site before about the odd phenomenon of Google searches for "seroquel snorting," "shooting seroquel" and the like coming to this site, principally because I have made stray mentions in the past of the drug's underground status as a drug of abuse. I think I was the first in the mental health blgosphere to write about Seroquel's misuse in this fashion in January 2007. And, the hits haven't let up since, sadly, because something is up in American society.

It's surely not AstraZeneca's fault, but its star antipsychotic is apparently becoming a new breed of hillbilly heroin, a la Oxycontin (which can also be crushed and snorted, or melted down and injected). The $4 billion a year in sales drug is set for FDA approval for depression and anxiety, meaning there will be even more of it out there to divert into underground uses. Lovely.

Last evening, however, I was visited by someone in the US looking for information on "seroquel 'date rape.'" Yes, the very concept is sickening, but I did a Google search myself using the term and found that Bipolar Chicks Blogging had had similar visits as well. Apparently, some very major criminals out there are using Seroquel as a drug to turn women--likely teens, given that that's the age group where the drug seems abused the most--into rape victims by slipping them a Seroquel. I have no idea if the perps are crushing the medication and mixing it into a drink or somehow slipping their victim the drug in pill form, but you can imagine the effect this sedating drug could have on someone. I can find no record of any arrests of anyone using the drug in this fashion.

Sadly, this is how "Roofies" or rohypnol gained infamy in the 1980s. As sick as I find all of this, I thought it was necessary to point out just how weirdly embedded antipsychotics are becoming in our culture and how they are being put to very sad uses. For those of you who bump into this post long after it's published, don't even think about doing what you are thinking about doing. Rape isn't just a crime. It can mess up its victims--female or male--for many, many years to come. So don't do it.

Abilify Ad All Over TV

The fine folks at Bristol-Myers Squibb are running new TV ads for Abilify, its super-expensive, chock full of side effects atypical antipsychotics. I saw it air last night during "The Tonight Show." The new ad--which hasn't made its way to YouTube yet--is aimed at adult women with bipolar disorder who experience "racing thoughts" and bursts of energy. Once again, that sounds like symptoms of bipolar disorder 2 and hypomania, not the big old serious mania that folks are taught to fear. The ad is pretty much your typical Big Pharma "improve your lifestyle" ad and features a woman with curly hair wandering the cliffs in what's got to be Mendocino County. At the end of her wandering, she meets up with a vaguely handsome 30something man who gives the putative Abilify taker a welcoming hug. Then they go for a walk.

Abilify will get you acceptance from the opposite sex! It will also put you at risk for a whole raft of side effects which the voiceover trots out as the pair walk a long planked path toward the sea. Maybe they'll see Venus in the sea foam. Target marketing at its finest and aimed squarely at a class of potential users who, according to recent research, may actually be wrongly diagnosed with bipolar disorder at about a 50 percent rate.

You can view the ad on BMS's website for the drug. Just click on "view the TV spot."

I am simply beside myself that as a culture we are now advertising antipsychotics--the sledgehammers of psychiatry--on national TV. What could possibly be next?

Oh, wait: Abilify has been approved for use in children as young as 10. I see a play date at the beach advertisement in our future.

$88 Million From Big Pharma To Minnesota Psychiatrists

Yes, you read that correctly. State records in Minnesota--which requires public disclosure of payouts to docs---indicate that psychiatrists in the state have received $88 million in gifts, grants and fees from Big Pharma since 2002. This comes from the St. Paul Pioneer-Press, which is running a kickass series in the wake of a patient committing suicide in a clinical trial of Seroquel in 2004.

"The amounts aren't unusual, according to the payment records collected by the Minnesota Board of Pharmacy. The records, which were updated this month to include 2007 figures, show 167 Minnesota doctors who have received $100,000 or more since 2002. One in four psychiatrists has received funding from pharmaceutical companies, averaging about $50,000 over the six years."

I'm sure all of these docs diagnose disorders and prescribe drugs in a completely unbiased manner as a result. If the payments are this lofty in Minnesota, then you've got to wonder what they are in California and New York. But we don't know because those states don't require payments to be reported publicly. The two doctors in the Seroquel trial got $782,000 from pharma companies.

"A growing body of research suggests that drug company money has an influence on study outcomes. One analysis found that industry-funded research was four to five times more likely to produce positive outcomes for a paying company's drug than federally funded research. A report last year found that drug company-funded studies of cholesterol medications were much more likely to produce results that favored their own drugs as well."

This ugly little system needs to be stopped. It's not like psychiatrists are starving in the streets. The average American psych doc pulls in $180,000 a year already.

AstraZeneca, which makes Seroquel, offered this response to the paper:

"AstraZeneca declined to discuss documents from the case, but brand corporate affairs manager Abigail Baron said the company's financial arrangements with doctors are necessary to improve health through drug discovery.

"'That mission cannot be fulfilled," she said, 'without close partnership with those on the front lines of patient care and ... research.'"

I'd say the money AZ and others are throwing around buys them all kinds of partnership.

Audio: Glaxo CEO Defends Its Handling of Paxil, Walks Out On BBC

Yesterday, I noted that outgoing GlaxoSmithKline CEO JP Garnier had walked out on the BBC after facing tough questions over the company's handling of various accusations around Paxil (Seroxat in the UK). I'll let the audio speak for itself. It's about a six-minute exchange between the BBC's reporter and Garnier and it's well worth listening to a Big Pharma CEO defend his company and claim that it's been open and transparent with the public in its handling of allegations that Paxil caused suicidality (among other things) in patients, that the company knew what was going on from its own clinical trials, that the company then hid this information from regulators in the UK (and the US), that they hid this same information from the public and that many, many patients needlessly took an anti-depressant of limited efficacy that did all manner of rotten things to them and that they had a bitch of a time withdrawing from. Think I am joking? Go look at these photos of a newborn in an NICU in Seattle four years ago. The baby is withdrawing from effects of Paxil that was given to her mother while the child was in utero. Some Paxil users have never been able to get off the drug.

Keep these things in mind when listening to Garnier and the BBC do the hokey-pokey: People died from taking Paxil. There are over 800 reported deaths associated with the use of this drug in the FDA's adverse events database. There are over 8,900 other adverse events in the FDA's adverse events database associated with the use of this drug.

Here's the audio which someone has superimposed a few points upon. Garnier begins by answering questions about Glaxo's new avian flu vaccine, then the reporter begins pressing him on Paxil (Seroxat) at about the 4:50 mark. Scroll forward and hear the sound of one CEO who flunked his PR classes.

I haven't the faintest whom the BBC reporter is questioning Garnier, but he puts the boots to the evasive CEO in fine fashion. Thanks to my many British friends (you know who you are) for getting this radio moment online in listenable form. Are Americans as pissed off about this drug as are the Brits?

So new readers know my bias on Paxil, here's how I once described my short stay on this drug many years ago:

"When 80 mgs. of Prozac didn't fix what ailed me, my doctor dropped that in favor of Paxil and lowered my dose of Lithium. I am convinced that Prozac made me pretty damn suicidal, but Paxil was a whole other ball game. The shit gave me akathesia and spun me up. I wound up desperate and alone, sitting in my apartment night after night trying to figure out what the hell was going on with me. I didn't last long on Paxil. Even my sorry ass doctor figured it was not benefitting me so he took me off it, this at a time before the Paxil withdrawal syndrome business was acknowledged. Let me tell you: everything people say about how bad it is coming off of Paxil is true. Mostly, I felt like a dead lump as I was being weaned and had those lightning bolt zaps in my brain. Not pleasant. "

BTW, everyone knows there are loads of Paxil documents out there in the US and UK that have never seen the light of day. It's time that they did.

Teen On Lamictal For Epilepsy Commits Suicide

This is a very sad story from South Carolina. It speaks for itself.

"Back in February, Zach Langan, a 15-year-old scholar at Battery Creek High School chose to end his life by stepping in front of a cement truck traveling a busy highway. He left a note behind.

"Zach was four months into taking Lamictal, a drug prescribed to treat his seizures for Epilepsy. His dosage increased about a week before his death. Ironically, that's also when the Federal Drug Administration released serious warnings about 11 antiepileptic medications, including Lamictal. After an in-depth study, the FDA alerted health professionals about an increased risk of suicidal thoughts and behaviors in patients who take these drugs to treat epilepsy, bipolar disorder, migraine headaches and other conditions."

I wrote about these warnings when they came out in February. This same class of anti-seizure drugs is used by millions of Americans diagnosed with bipolar disorder. Most of the suicidality noise in the FDA's data seemed to relate to people being treated for a seizure disorder, but there was a slightly elevated risk of suicidality for people taking the drug for "mood stabilization.

Langan's mother offers this sad irony:

"'The only explanation I can find for the morning my son died is the medication,' she said.

"Four months shy of his death, the optimistic teen who shared dreams of one day becoming president started his treatment for epilepsy. His mother, a nurse, kept a close watch.

"'I actually did a lot of research on it. I didn't see anything about suicide in any of the research that I read. The first time that I became aware of it was a week before he died,' Langan said.

"That's when the FDA issued a warning citing a study where patients receiving antiepileptic drugs had approximately twice the risk of suicidal ideation compared to patients receiving placebo.

"'So I called him into the living room and I said, "Hey, Zach, I just heard this on TV." And he said, "I’m good Mom, I'm good." I said, "Okay honey, if anything changes, you need to tell me." But he never did,' Langan remembered."

Two doctors said:

"'There are definitely times when there are no signs that someone may be ready to commit suicide or about to commit suicide,' Dr. Shannon Drayton, Assistant Professor at MUSC said.

"Drayton, who works with students at the Medical University of South Carolina's Institute of Psychiatry called this a sticky issue.

"'Unfortunately, with Epilepsy, it's not something we have a cure for yet and so patients have to be treated,' Drayton said. 'And with all the medications, there are 11 that have the warning on them now and all of them eventually may have this warning. You know, there's really not a lot clinicians can do but educate their patients about the warning signs of suicide and risk factors.'"

"But Dr. Bryant Welch says one of the greatest risk factors is how patients often react to the warnings.

"'Yes, the medication will put some people at increased risk,' Welch said. 'But the problem is, there are a lot of people it will but at a decreased risk. So, it's not a reason not to use the medication. It's a reason to use the medication with greater awareness, and to stay in close contact with your doctor about any changes.'"

The FDA and GlaxoSmithKline, the drug's maker, responded after a fashion.

"Both the FDA and Lamictal's maker Glaxo-Smith-Kline refused our on-camera interview requests. But both wrote us their reaction to the study's findings.

"GSK said 'Our own analysis of clinical trial data with Lamictal showed a similar trend but the actual numbers were too small to draw conclusions.'

"An FDA spokesperson says, 'The FDA will work with manufacturers of marketed anti-epileptic drugs to include information about the increased risk of suicidal thoughts and behaviors in the labeling of these products.'"

Sad stuff.

Obama First In Big Pharma Contributions

Much has been made by Sen. Barack Obama's supporters of the fact that he stands for integrity, "new politics," "reform" and cannot be bought by any special interest. That may be so, but the new politics are sure beginning to look a bit like the old politics.

CNBC.com reports that Obama is numero uno among presidential candidates, current and former, in contributions received from pharmaceutical companies and health care companies at $636,000 through the end of April. Sen. Hillary Clinton is second at $568,000. Sen. John McCain has taken in $173,000.

If he's elected President, you have to wonder what health care reform would look like under Obama. You also have to wonder why an alleged reformer is taking in so much money from Big Pharma.

Glaxo CEO Walks Out On BBC Over Paxil Questions

Via Pharmalot comes news that JP Garnier, the CEO of GlaxoSmithKline, walked out on a BBC radio show earlier today due to repeated questions about whether the company would release documents related to its handling of Paxil (Seroxat in the UK) and allegations that the company hid important side effect information from UK regulators, including data on suicidality. Garnier was on the program to discuss Glaxo's new avian flu vaccine and apparently wasn't expecting the Paxil questions. Good work by the BBC. You can hear the program here, but you need to go to the little iPlayer in the top left corner and scroll to 1:32:00 in the program to hear Garnier's interview. I suspect that the feed is only good for today, so listen while you can.

I wish the US press would push Glaxo as hard as the BBC has. Paxil has caused just as many, if not more, problems for patients in this country.

Garnier has previously blamed the press for all of Glaxo's troubles.

Man In Seroquel Study Commits Suicide

Two excellent articles in the St. Paul Pioneer-Press today examining the very ugly case of a young man who had a first episode of psychosis and was admitted to care by a doctor who basically shoehorned him into a study of Seroquel for treating schizophrenia. I won't even attempt to summarize much, so you should just read the pieces for yourself. I think there are serious questions about how the doctor may have manipulated the patient to keep him in the study even though he wasn't doing well on the drug. The patient, Dan Markingson, later committed suicide.

There are also serious questions about how the University of Minnesota's institutional review board performed.

All in all, a sad discouraging story and some excellent journalism. (Via Pharmalot.)

Lexapro Induced Paranoia Possibly Linked To Tragedy

This is a sad story out of Fresno, Calif. On April 16, Jesus "Jesse" Carrizales, 17, who was supposedly taking Lexapro and one of a number of antipsychotics (Geodon, Risperdal or Seroquel) for depression attacked a campus police officer with a bat at his high school. After being knocked to the ground, the cop saw the teen winding up with the bat, so the cop shot the kid dead.

Now, what's come out of autopsy results is that Carrizales was likely taking far too much Lexapro to the point where the drug induced paranoia into the youngster. That's the opinion of the medical examiner's office. The entire story is tragic and you can read it here.

You can draw your own conclusions about what role Lexapro may have played in this tragedy. It's not clear if there were any antipsychotics in his blood at the time of his death.

Here's what the county coroner said:

"The autopsy showed Carrizales' blood had a "lethal level" of Lexapro....In general, "lethal level" means that in some people, that amount would kill them, [Coroner] Hadden said. A toxic level of Lexapro also could cause paranoia in some people, but not everyone. The drug's effect would depend on whether Carrizales had built up a tolerance to the antidepressant, Hadden said."

Here's what one psychiatrist said of the Lexapro connection:

"Dr. Barry Chaitin, chair of the department of psychiatry at the University of California at Irvine, said in general, Lexapro is 'pretty safe' even at high doses. The lack of antipsychotic medicine in Carrizales' system, however, is troubling -- those drugs are typically prescribed to help people cope with aggression, psychosis, hostility and hallucinations, he said.

"Carrizales' behavior is difficult to explain, said Chaitin. On one hand, Carrizales' family has said that the medication helped him become more sociable. But police say Carrizales sneaked up on Perry from behind and attacked the officer without provocation.

"'His conduct appears way out of the ordinary because the attack sounds premeditated,' Chaitin said. 'He must have had a misperception that the officer was a threat to him.'"

Back in 2003, my then-doctor had me restart a Lexapro prescription after being off the drug for four months. Within hours of taking the 10 mg. pill, I was so agitated and my heart was racing so fast that I literally thought I was going to die. I almost took myself to an ER to be monitored. Two days later, I took myself off the drug. Lexapro sure can be weird stuff.

Newsweek Takes On The Bipolar Child

The new issue of Newsweek has a cover story on a child who allegedly has bipolar disorder and, while it is an article filled with lots of detail and heart, it is also one of the worst pieces of journalism on the alleged disorder that I have ever seen. I'll return to the media criticism in a second.

The article concerns a boy named Max, who was diagnosed with bipolar disorder and hyperactivity when he was two. He's been on 38 different meds, including Zyprexa at two years old. He's been hospitalized. He's been in therapy (still is). He's made suicide attempts. His parents, seemingly educated and fairly normal, have tried everything. He even had an off-meds trial that lasted for one month (probably not long enough to assess things, but then I wasn't there). Their son is 10 years old now. He's not doing particularly well. There's an accompanying video which I cannot make myself watch.

It's a very sad and rough story to read. It takes place in the Boston area (why are so many of the stories about out of control kids centered in the Boston area?). And, yes, the kid's doctors come the realm of the Harvard bipolar child army. While I am critical of the bipolar child paradigm, it's very clear that there is something the matter with kids like Max. We're a generation now into diagnosing young children with serious mental illnesses and I don't think we have many answers for what's up. That's discouraging.

We'd all like answers, but my global hunch is that child bipolar disorder is not anything other than an intermediate explanation of what's going on. Maybe I'll be proven wrong someday.

Even more discouraging is the magazine's handling of the most controversial diagnosis in all of psychiatry and psychology. The author, Mary Carmichael, admits a few times in the piece that the diagnosis of bipolar disorder in kids is controversial and that some doctors feel it's overdiagnosed (since it doesn't even exist in the DSM, it's overdiagnosed by definition). However, Carmichael doesn't include a single quote from a single critic of the child bipolar disorder paradigm. These critics exist, have medical degrees, teach at major medical schools and are easy to find through the miracle of search engines. Why Carmichael didn't include any dissenting views is hard to understand. Why her editors at the mag didn't insist upon the same is beyond comprehension for a news magazine that is supposed to adhere, at least somewhat, to the basic journalistic principles of fairness. Unless the editors and Carmichael have swallowed the Kool-Aid of the child bipolar paradigm and are now becoming its primary advocates in the press. If so, they should run an editorial announcing and defending the magazine's stance on the issue. Otherwise, they are misinforming and duping their readership and violating their trust. They are also being lazy.

Even more staggering are Carmichael's descriptions of the disorder. Here are a few:

"Yet untreated bipolar disorder can be disastrous; 10 percent of sufferers commit suicide."

That's nonsense, as I've written about previously and it's time for the American media to stop using inflated suicide statistics to scare people.

"Max's life, of course, is rarely easy. During a recent appointment at Frazier's office, he went into full-fledged mania. Laughing wildly, he rolled on the floor, then crawled over to his parents and grabbed an empty medication bottle, yelling, 'Drugs! I've got drugs! It's child safety!'"

If that's what counts as full-fledged mania these days, God help us all.

"Max will never truly be OK."

How does the reporter even know this? Sigh.

The web page of resources for families that the magazine provides is pretty much just a series of links to various proponents of the bp kids business although, interestingly, it includes a link to Robert Whitaker's website for Mad In America, a very critical look at how America has treated mental illnesses in the past (the book's narrative stops many years ago). As I recall, the book doesn't even take up the bipolar child controversy, so its inclusion, while nice to see, is sort of confusing. But whatever.

The mag's website also has a page tackling "the biology of bipolar disorder." Whitaker is quoted there and criticizes the use of psychotropic drugs in children, particularly in how they might affect brain development. Other than that, it's just the usual talking heads of the bipolar child paradigm.

There's an already lengthy comment thread on the magazine's website.

Anyway, I pass all of this along for whatever it's worth to anyone. Happy reading.

FDA Issues Public Health Warning On Chantix, The Stop Smoking Drug

On Friday, the FDA issued a formal public health advisory on Chantix, the stop smoking drug made by Pfizer that's been leading to all manner of suicides, suicidality, erratic behavior and reported cases of drug-induced depression. It's like the strangest SSRI ever engineered by Big Pharma. It's interesting that a drug given to address what public health officials consider a public health problem--that would be smoking--is turning out to cause public health problems of its own. But since they are public health authorities and are, therefore, humorless, it's not likely that they'll understand the irony.

Anyway, the FDA advisory specifies:

"Patients should tell their doctor about any history of psychiatric illness prior to starting Chantix. Chantix may cause worsening of a current psychiatric illness even if it is currently under control and may cause an old psychiatric illness to reoccur.

"Healthcare professionals, patients, patients’ families, and caregivers should be alert to and monitor for changes in mood and behavior in patients treated with Chantix. Symptoms may include anxiety, nervousness, tension, depressed mood, unusual behaviors and thinking about or attempting suicide. In most cases, neuropsychiatric symptoms developed during Chantix treatment, but in others, symptoms developed following withdrawal of varenicline therapy.

"Patients taking Chantix should immediately report changes in mood and behavior to their doctor.

"Patients taking Chantix may experience vivid, unusual, or strange dreams.

"Patients taking Chantix may experience impairment of the ability to drive or operate heavy machinery.

Much of this echoes what I've been writing about this drug on this website since last September right down to the fact that the problems seem to appear mostly in people with underlying DSM conditions, past or present. I'm not bragging, but I am pointing out that I was right. And, I thank the many, many people who experienced problems on Chantix for helping alert me and others to the problems with this drug.

I'd be remiss if I didn't point out that this warning is going to cost Pfizer sales of Chantix. That's because doctors have been trying for years to get their patients diagnosed with schizophrenia, bipolar disorder and depression to stop smoking and these groups of people tend to smoke at rates much higher than the general population. I'd say that any doctor with brains who knows his or her patient has a DSM diagnosis is not going to even bring up the possibility of his or her patient taking this drug. Looks like we are going to find out how many smart doctors there are out there.

Stop Smoking Drug Chantix Starts Bipolar Disorder In Woman

This is a remarkable account of a woman in Texas who'd smoked for 33 years and was pressed to take Chantix, Pfizer's stop smoking pill that sure keeps acting like the worst of the SSRIs, by her doctor. The woman hadn't had a psych diagnosis before taking the drug. Can I just stress that first episodes of mania are virtually non-existent once one is out of their 30s?

"I took 1 mg of Chantix for more than 90 days. Honestly, I could have taken more than that but I don’t remember; I also had short-term memory loss and I was paranoid about everything. Then a voice in my head told me it was time to check out; that I was worthless. I had spent the weekend with my husband and had my youngest grandson with me. My family told me that I was doing oddball stuff all weekend.

"The next day at work, apparently I flipped out. One of my co-workers told me that I threatened to blow my brains out. My boss took me to a psychiatric hospital; I was brought there in a manic state, threatening suicide. That happened about seven days after I stopped taking Chantix. I was diagnosed and treated for bi-polar disorder, type 1, and I was admitted for two weeks. It scared the hell out of me.

"All along, I suspected it was Chantix; I even made a call to a lawyer before I went to the hospital. I have never been depressed in my life nor have I ever been treated for any mental disorders. During those two weeks I was drugged on Seroquel. When I was released, I went to counselors, and my family doctor and I have a follow-up appointment with the psychiatrist on June 4th.

"I am still taking meds for bi-polar disorder and I wasn’t taking anything before Chantix. Not one doctor has admitted that Chantix could be to blame but while I was in the hospital I met several people having the same problems as me and they had taken Chantix. I told my daughter about this and she found people with the same problems on the internet—-why can’t the doctors understand how dangerous this drug is?"

Why? Because doctors, especially the younger ones, hate smoking so much--on a level that approaches the fervor of the temperance movement. That's why they will hand out quit smoking drugs that endanger some of the people who take them and, then, deny that the drug had anything to do with it.

I feel terribly sorry for this woman and hope she understands that she's probably not got bipolar disorder at all.

For the record, I know Chantix works for some people and I know people personally who've quit smoking using the drug. But I'll continue to point out the problems with this drug--which Pfizer slapped its own warnings on earlier this year--because it's clear that there are a decent percentage of people who take Chantix who get ripped apart by taking the drug. Just as with SSRIs. Doctors need to be far more judicious in handing out this drug.

Obesity Causes Global Warming?

There's a new study out in The Lancet which argues that obesity contributes to global warming. I've not been able to locate the study on the journal's website, but from what John Tierney reports in the New York Times, it looks like the usual public health researcher overreach:

"The Lancet authors, Dr. Phil Edwards and Dr. Ian Roberts of the London School of Hygiene and Tropical Medicine, crunch the numbers and conclude:

'Compared with the normal weight population, the obese population consumes 18% more food energy. Additionally, more transportation fuel energy will be used to transport the increased mass of the obese population, which will increase even further if, as is likely, the overweight people in response to their increased body mass choose to walk less and drive more.

'Urban transport policies that promote walking and cycling would reduce food prices by reducing the global demand for oil, and promotion of a normal distribution of B.M.I. [Body Mass Index] would reduce the global demand for, and thus the price of, food. Decreased car use would reduce greenhouse gas emissions and thus the need for biofuels, and increased physical activity levels, would reduce injury risk and air pollution, improving population health.'"

I'm not even going to begin to pick these claims apart because if this underlies the thinking of the "fat police," then how far off are we from creating a world where we are forced to step onto a scale each day and engage in forced exercise programs? I understand that public health officials really "care" and are "compassionate" and know what's best for each individual, but does anyone want to live in that world? I don't. But, then, I actually like human diversity.

This is all about as ludicrous as Al Gore's claim a couple of years ago that cigarette smoking causes global warming. But, then, if there's one thing I've noticed over the years of watching how public health sorts attack mental health issues, it's that they are often wrong and will go to any length (including fear-mongering) to "educate" the public. And, the performance of their much-touted treatments for depression have proven to be pretty unimpressive, their campaign to cut the rate of suicide in half in America by 2010 hasn't budged that rate one percentage point, and their various screening programs to catch depression are reportedly not working out so swell.

So pardon me while I go cause some global warming.

The Pure Gift Of "Pure" Hypomania

Via my friend Vaughan Bell at Mindhacks.com comes news of a study examining a group of 23 "pure" hypomanics, which is to say people who experience hypomania but remain untouched by major or minor depression. Lucky bastards. The study will appear in a forthcoming issue of the Journal of Affective Disorders, but was recently put online. Study conclusions from the small cohort:

"They overlapped minimally with and were clearly different from subjects with DSM-IV defined hypomanic episodes, most of whom had a bipolar disorder. Pure hypomanics were characterised by physical and social overactivity, elevated and irritable mood, as well as increases in extraversion, sexual interest, and risk-taking behaviors. They had higher monthly incomes and were more often married than controls. Subjective distress due to hypomanic symptoms was virtually absent. Quality of life and treatment rates for mood and anxiety were not different from controls, although sleep disturbances, substance abuse and binge eating were more frequent."

No subjective distress? That's not a surprise at all since the archetypal "pure" hypomanic is pretty much running around high on life or whatever natural cocaine they've got in their system. It'll be interesting to see the full study. John Gartner, a psychologist at Johns Hopkins University, has written an entire book about how such characters were the makers and shapers of America. It's called The Hypomanic Edge and is a decent read.

Speaking of hypomania--since going off meds last year, I haven't had a moment of anything resembling hypomania (or mania just to be clear). I miss it. But I also have to wonder if the meds I was taking all those years caused the little episodes I once had or if something else was at work.

I may never know.

Lithium Again Beats Other "Mood Stabilizers" At Suicide Prevention

An interesting study in a recent issue of the Journal of Affective Disorders finds that, once again, Lithium beats the anti-seizure drugs at preventing suicide attempts and, presumably, suicidality. The study, done by researchers at Oregon Health & Science University, examined suicide attempts and completed suicides among 12,662 Oregon Medicaid patients diagnosed with bipolar disorder and treated with medication between 1998 and 2003.

For suicide attempts, patients taking divalproex (Depakote) had 2.7 times the risk of a suicide attempt as Lithium users, for gabapentin (Neurontin) users the risk was 1.6 times and for carbamazepine (Tegretol) users the risk was 2.8 times greater than for Lithium users. Results for the latter two drugs were considered not statistically significant, however.

It's interesting that so many years after Lithium has fallen out of favor among some clinicians that it remains something of the world heavyweight champ at suicide prevention, as shown by earlier research where the Lithium v. Depakote disparity was about the same. Of course, that assumes a patient can tolerate the drug. Not everyone can. For some people, it's a downright nasty drug. For some, it's like taking water.

Ah, the confounding world of psych meds.

Mostly Offline Today

Just a heads-up that the weather forecast is calling for hot weather in Seattle today, upwards of 88 degrees. Anytime it gets over 85, my apartment becomes far too hot since I am under a roof and my window face South and there's no cross breeze and three fans sure don't help much, and it's best for all concerned if I go do something else till it all cools down. So I expect to be mostly offline after noon and comment approval will likely suffer somewhat.

But it sure is nice to use the words "Seattle" and "hot" and "weather" in a sentence together. It's been almost a year since that's happened.

You all have a nice day and weekend. And thanks for reading.

Charges In MySpace Suicide, Harassment Case

Wired.com is reporting that a federal indictment has been returned in the horrifying case of Megan Meier, a Missouri 14-year-old who was allegedly hectored and harassed in 2006 until she hanged herself. Charged with one count for conspiracy and three counts "for accessing protected computers without authorization to obtain information to inflict emotional distress" (this all relates to alleged violations of MySpace's terms of service) was Lori Drew, the mother of a teen girl who'd apparently had a conflict with Meier. Drew could be looking at as much as 20 years in the pokey for her actions, if convicted.

"'This adult woman allegedly used the internet to target a young teenage girl, with horrendous ramifications,' said United States Attorney Thomas P. O'Brien. 'After a thorough investigation, we have charged Ms. Drew with criminally accessing MySpace and violating rules established to protect young, vulnerable people. Any adult who uses the internet or a social-gathering website to bully or harass another person, particularly a young teenage girl, needs to realize that their actions can have serious consequences.'"

The Meier-Drew case is one of the most disgusting cases of Internet misbehavior I've ever encountered and I'm glad to see that there are finally some charges in the case. I wrote about the case and my own experience being harassed on MySpace when the Meier story first surfaced last fall.

Mel Gibson Is "Manic Depressive"

This came as a bit of surprise to me, but Mel Gibson--yep, the prone to outbursts actor--revealed in a 2002 documentary on an acting class he was in years ago that he is a diagnosed manic depressive (his term, as opposed to the more modern bipolar). The documentary is just now becoming public.

From the Sydney Morning Herald:

"'I had really good highs but some very low lows,' Gibson said. 'I found out recently I'm manic depressive.'

"While the interview dates back to 2002, the actor and director, who made headlines with a drunken outburst two years ago, has rarely talked about the condition."

What's interesting is that none of this came out two years ago when Gibson went on that very odd tirade after being busted for drunk driving.

Mich. Judge Tells Young Man To Commit Suicide

I've run into stories over the years of judges saying remarkably stupid things to people in court, but this one utterly takes the cake:

"Novi District Court Judge Brian MacKenzie said Wednesday his office still is looking into comments made April 10 by Judith Holtz.

"Holtz had told Michael Robert Dickey of Farmington Hills that it would be cheaper, faster and less painful for the people who cared about him if he took his own life.

"Court transcripts obtained by WXYZ-TV in Detroit show Holtz suggested Dickey jump from the roof of his house or slash his wrists as she chastised the 20-year-old for a third charge involving alcohol. He was being sentenced for being a minor in possession."

That all kind of speaks for itself and is beyond outrageous.

What amazes me is that this over a charge of being a minor in possession of alcohol, very small potatoes as the world turns. I hope the judge is disciplined both by the presiding judge of the court and the Michigan State Bar Association.

Sexual Dysfunction On Anti-Depressants Higher Than Thought, Longer Lasting

Thanks to CL Psych who flagged this issue the other day and posted one academic paper acknowledging that not only are there weird problems such as genital anesthesia--such a polite term--connected with anti-depressant use in some cases, but that the rate of sexual dysfunction on the happy pills isn't very happy at all. In fact, it's much higher than doctors have commonly assumed and than pharma companies have been willing to admit. There's a reason of course: admitting that taking Prozac, for example, could cause sexual dysfunction in a high percentage of cases would utterly crater sales.

Let me offer a disclaimer before I dig into all of this: I am not denying that some people experience benefits from taking anti-depressants. I am not saying depression should not be treated. I am not looking for a fight on those fronts. I am simply raising some separate issues that should be of prime concern to anyone who takes or might take an anti-depressant and might want complete information about possible effects of taking these drugs.

Classically, the pharma companies have admitted to dysfunction in 10 percent or fewer of cases (I can remember in the early 1990s reading some Lilly literature on Prozac that claimed a rate of less than 5 percent). I think it's generally accepted wisdom among anti-depressant users, current or former, that it's more like 30 percent. And maybe higher, according to this recent study by a psychologist at the University of Pittsburgh:

"In postmarket studies, clinicians have more systematically solicited information about SSRI-associated sexual problems such as lowered libido and difficulties with arousal or orgasm, via structured clinical interviews or validated sexual functioning questionnaires and found that they are present at dramatically higher rates, at frequencies as high as 98 percent. While these dysfunctions are very common, and while they typically endure for as long as the individual is taking the medication, it has been generally assumed that these side effects always resolve after discontinuing treatment."

Apparently, such side effects don't ebb with discontinuation. That's kind of a problem. What's more, two case reports in the forthcoming Journal of Clinical Psychopharmacology report on sexual problems generated by using Celexa (see pages 16 and 18 of this .pdf). In one case, a patient experienced episodes of spontaneous ejaculation. That's got to be a messy and sad situation. While I don't necessarily believe that sexual dysfunction occurs 98 percent of the time in anti-depressant use--if it did then the word on the street about the problem would be so loud that almost no one would take the drugs and it's clear that about 30 million people take these drugs each year--it's still fairly evident that these problems occur at rates well above 10 percent.

Doctors have long told patients, "Oh, it won't happen to you" or words to that effect. They've also told patients that the effects of delayed ejaculation, anorgasmia and libido loss--two of the more common side effects--will go away once a patient is off that particular drug. Unfortunately, the Pitt study reports that this is not always the case and that some patients' sexual functioning never returns to normal. And, the researcher, Antonei Csoka, makes it clear that patients are not being told about this phenomenon.

"It is important that patients are informed about the high probability of sexual side effects while on SSRI medications. It is worth noting that none of the three patients received adequate informed consent with regards to the known risks of sexual side effects, so as to be able to consider those risks in their decision to take the medications. Patients should also be told that there are indications that in an unknown number of cases, the side effects may not resolve with cessation of the medication, and could be potentially irreversible."

It's absolutely imperative that doctors begin telling their patients about the potential for these problems as part of the informed consent process. I know doctors probably won't like the fact that these papers are being written by psychologists--who not only noticed these kinds of issues cropping up in therapy sessions, but have investigated the various Internet forums devoted to these issues--but it's time that they woke up to the fact that they are supposed to be serving their patients and not a treatment paradigm that refuses to acknowledge significant problems with anti-depressants. What's more, researchers need to actively begin researching these issues, especially in regards to long-term use, and stop acting like this isn't a problem. It would also be swell if they looked into how these drugs might effect the development of sexual function in children and teens who take these drugs.

DISCLOSURE: So you all know my personal bias on this matter, here comes the full disclosure. I generally did not experience sexual side effects as a result of anti-depressant use with one exception worth noting. For a time, I experienced a complete lack of interest in sex while taking Prozac (very annoying in retrospect). Luckily, this problem ebbed with time. My experience with the other anti-depressants I've taken--Paxil, Zoloft, Celexa, Wellbutin, Lexapro and Luvox as well as those lovely anti-depressant adjuncts Risperdal and Seroquel--was more positive on this front.

America The Medicated Nation

A report out by Medco Health Solutions, a pharmacy benefits management company, claims that over half of all insured Americans are taking prescription drugs of some kind. That's the first time the percentage has ever passed 50 percent.

The most commonly used drugs according to Medco were blood pressure and cholesterol drugs. That goes against what IMS Health reported earlier this year when its own figures showed that anti-depressants were the most widely used class of drugs in America. I assume they are looking at different datasets of drug use. I wasn't able to locate a copy of the Medco report.

Anyhow, America has sure become a medicated nation and you can read this AP account of the report for opinions on what's driving all of this. Medill Reports dug into the data a bit more and found that psych meds were stars:

"Nearly half of women ages 20 to 44 are being treated for a chronic condition, according to the research. Antidepressants are the most commonly used medication among this group, consumed by 16 percent of the demographic.

"While 16 percent is a substantial statistic, more evaluation needs to be done to determine if this drug category is being properly prescribed, [Caleb] Alexander [University of Chicago expert] said. Many people are on antidepressants who do not need them, but ironically many people need to be on them who are not, he said, adding that advertising might have a role in overall increased prescription drug use."

Sixteen percent is an extremely high number. Just as striking was a reported explosion of ADHD med use among girls:

"For youth age 19 and under, the research ranks asthma and allergy drugs as the most commonly prescribed, followed by medications for attention-deficit hyperactivity disorder and antidepressants. The number of girls taking ADHD medication rose 72 percent from 2001 to 2007, a spike Alexander said is staggering.

"'There’s no question that there is a subset of children … that require these [ADHD drugs],' Alexander said, 'but I think it’s a legitimate concern that some of these medicines may be overused in children to treat conditions that don’t truly represent a serious deviation from normal adolescence.'"

Staggering doesn't even begin to describe that jump in ADHD med use amongst girls.

Leading Bipolar Disorder Researcher Refers To Me As "Doctor"

Some of you may recall that in late 2006 I wrote a series of posts casting doubt on some of the statistics in the BOLDER II trial of Seroquel. The trial was a part of the drug's approval for bipolar depression. You can read these posts here and here.

As it turned out, I submitted a letter to the editor of the Journal of Clinical Psychopharmacology, which published the study, asking for clarification of the statistics from Michael Thase, a professor of psychiatry at the University of Pittsburgh and lead author of the study. It took almost 18 months--man, academic publishing moves far too slowly in the Internet age--but I've received a copy of the letter and Thase's response. I thank Thase for his reply and the journal for publishing my query. It's fairly uncommon for a mere patient to have anything published in a medical journal.

But perhaps I am a mere patient no more.

In the letter, Thase writes:

"The points raised by Dr Dawdy were the topic of a flurry of Internet commentary in 2006 and 2007 and are easily answered, at least on the surface."

While I am not a doctor--and would never dream of playing one on TV--and my letter doesn't identify me as one, I'll take the compliment from Dr. Thase. I also thank him for his answer to my query. You can read the rest of the exchange on this .pdf (pages 23 and 24).

I guess I now have to pen a letter to the journal clarifying the reference to me in his letter. Ah, the ironies of running a website.

Speaking of ironies, this is the same Michael Thase who recently supported a study asserting that bipolar disorder in being overdiagnosed.

US Government Ignores Human Rights, Injects Immigration Deportees With Antipsychotics

This is an official holy-shit story from the Washington Post:

"The U.S. government has injected hundreds of foreigners it has deported with dangerous psychotropic drugs against their will to keep them sedated during the trip back to their home country, according to medical records, internal documents and interviews with people who have been drugged."

I first wrote about this phenomenon last October when the Los Angeles Times reported on similar doings in the LA area. I'll be blunt: what's going on here is a major human rights violation, regardless of what one thinks of immigration issues:

"Involuntary chemical restraint of detainees, unless there is a medical justification, is a violation of some international human rights codes. The practice is banned by several countries where, confidential documents make clear, U.S. escorts have been unable to inject deportees with extra doses of drugs during layovers en route to faraway places."

The paper reports that one detainee was given an injection of Haldol, one of the harshest psych meds there is, and Ativan, an anti-anxiety drug. Doping detainees on the Haldol absent a medical indication of schizophrenia is utterly barbaric--and it's pretty damn barbaric even with the proper indication.

This practice, which disgusts me as an American, simply must stop.

Seroquel Approved As New Lithium, Depression Next

AstraZeneca announced today the FDA has approved Seroquel, its $4 billion year in sales atypical antipsychotic, as a maintenance treatment for bipolar disorder used in conjunction with either Lithium of valproic acid (aka Depakote). Getting the drug approved as a maintenance treatment is tantamount to the FDA declaring it the new Lithium, the longtime "gold standard" maintenance drug for bipolar disorder. I congratulate AZ on getting this nasty little drug approved in such a way that they can now market it as a "forever" treatment and cannot wait to see the new ads. It's a drug the company has been researching for literally every condition under the sun--anxiety, depression, public speaking phobia, you name it--and it's now cropping up on America's streets as a drug of abuse, either snorted or mainlined. Nice.

Ever nicer, one analyst interviewed by Bloomberg noted:

"'Seroquel is increasingly being rolled out for additional indications and may, in due course, become the go-to product for depressive disorders,' Charles Stanley analyst Jeremy Batstone-Carr said in an e-mail."

The go-to drug for depression? How about the stay-away-from drug for depression? Or the take-once-in-a-blue-moon drug for depression?

Anyhow, Seroquel is set for FDA approval as a standalone maintenance treatment for depression and anxiety and I expect it to sail through the FDA approval process despite the fact that this drug really knocks people out. Good to those of you who take or will take this drug.

1,500th Post

I'd just like to take this opportunity to let you all know that this is the 1,500th post on this site. That's kind of a landmark. To date, those 1,500 posts have gotten about 8,900 comments, or about 6 comments per post. Considering that not many people commented the first year or so that this site was in existence, that's purty good. Keep 'em coming. And thanks.

Just for fun, this site's first post on Sept. 25, 2005 was gloriously entitled "Testing 1...2...3." Yes, it was a test post.

Teenage Depressionland, Circa Now And Then

SAMSHA--and I can never make myself type out that acronym--released results of a survey yesterday asserting that 8.5 percent of American teens experience a major depressive episode each year from 2004 through 2006. That loosely tracks with the national average among adults of about 7 percent.

According to USA Today, 12.7 percent of teen girls experienced depression compared to 4.6 percent of boys (the SAMHSA study the paper links to doesn't break out the gender differences). That's fairly close to the adult dynamic also--i.e., depression affecting women more than men until later in life when it evens out. Not that it's a good thing.

It's difficult to know what to make of these numbers. Are they better or worse or about the same as, say, 1995? Or earlier? As a depressed former teen circa 1980, I certainly remember my fair share of depressed and bummed out teens. We just didn't talk about it then or take medication for it and we seemed to get along probably about the same as teens do today.

What would be interesting to know is how this rate has varied over time--the SAMSHA survey doesn't say and the agencies database isn't exactly friendly--because if you are making a big public health push on something like depression, then you'd like to know if you are getting any results. My loose guess is that things are about the same as they were at the dawn of the Prozac age. But that's a loose guess.

Mad Pride Article Gets More Responses

A couple other voices on the 'Net have weighed in on Sunday's New York Times on folks with allegedly serious mental illnesses writing about such matters online. I wrote about the piece the other day.

John Grohol at PsychCentral.com smartly critiques the article, especially its underlying set of assumptions about mental health care:

"The article only refers to psychiatrists as being responsible for treating people with mental illness, which is an unfortunate oversight. Psychiatrists make up the smallest profession responsible for the treatment of mental illness — it would have been more balanced to refer to 'mental health professionals.'

"The writer’s bias goes beyond only referring to psychiatrists in the article. She also apparently believes that mental disorders can only be treated by drugs (which is mentioned a few times in the article; psychotherapy is mentioned zero times):

"'Mr. Oaks, who was found to be schizophrenic and manic-depressive while an undergraduate at Harvard, says he maintains his mental health with exercise, diet, peer counseling and wilderness trips — strategies that are well outside the mainstream thinking of psychiatrists and many patients.'

"Really now? Having regular exercise, a good diet, and engaging in self-help support groups is “outside the mainstream thinking of psychiatrists” when it comes to maintaining good mental health and wellness? How does she know that? Did she survey them?

"Of course not — this is the writer’s opinion creeping into the writing, and getting it 100% wrong."

It's one of journalism's tragedies when a reporter doesn't place a call to someone who would be a good source for a story like this--Grohol in this case, who'd I'd wager knows a lot more about mental health writing on the 'Net than does Fuller Torrey.

Meanwhile, the wonderful "flawedplan" at Writhe Safely absolutely lets rip:

"Oh I can imagine an earlier me who would come away from that complete piece of shit grateful for the exposure and yay for recognition! But that column pissed off a lot of people in a number of ways I can relate to, beginning with its placement. I ask you, does this social stigma make my butt look too big? Because Gabrielle Glaser’s "Mad Pride Fights a Stigma" is in the Fashion & Style Section, it must be tres chic, don’tchaknow, the fight against prejudice and discrimination, just one more set of kooks aboard the pop cult bandwagon with their self-important, trendy and disposable cause. Sigh."

And the buttkicking goes from there.

GOP Swipes Effexor Marketing Slogan

Yes, it's true. House Republicans, who apparently need a cheery pep-boosting slogan these days, have rolled out some kind of identity campaign and dubbed it, "The Change You Deserve." (Via Bluestem Prairie.)

Well, that just happens to be one of Wyeth's marketing phrases for Effexor. So, this means that the GOP is telling us it's got a closet case of depression, or it's telling us it really wants to enjoy a nice, nasty withdrawal from a very tricky anti-depressant, or it just means they are really dumb and didn't do the least amount of research. I'm voting for all three.

It's interesting, too, that the often-smart Andrew Sullivan had this to offer:

"An unfortunate marketing slogan for the GOP - but a good drug, I'm told. Hey, if I were a Republican, I'd need some anti-anxiety meds as well."

I wonder who told him it was a "good drug." Couldn't possibly be a reader of this site.

Drug Czar Plays Politics With Mental Illness, Suicide And Marijuana

I suspect a few of you are aware that last Friday John Walters, America's Drug Czar, held a press conference and issued a report claiming that marijuana was leading to depression among teens. His office also once again floated its weak claim that pot causes schizophrenia. I suppose it's a sign of just how desperate Walters is to justify the federal laws on marijuana that he has to resort to the old Reefer Madness card. I think trying to use teen depression as a wedge issue shows just how hypocritical Walters has become because a press release from his office cannot cite much more than a stray survey and some SAMSHA surveys indicating that pot causes teens to be depressed. Surveys ain't science. In other words, he's not made his case very convincingly and is engaging in little more than fear mongering, SOP for his office.

"Millions of American teens report experiencing weeks of hopelessness and loss of interest in normal daily activities and many of these depressed teens are using marijuana and other drugs, making their situation worse, according to a new White House report released today. The report, from the White House Office of National Drug Control Policy (ONDCP), reveals that marijuana use can worsen depression and lead to more serious mental disorders, such as schizophrenia, anxiety, and even suicide."

Yes, pot makes people kill themselves. That's such a bizarre assertion that it's embarrassing--and, indeed, claiming pot causes anxiety and suicide while perfectly legal drugs such as Paxil, Zoloft, Effexor and so on have been linked to suicidality and suicides and to cases of very extreme agitation is the very height of hypocrisy. A 2001 study published in the Journal of Clinical Psychiatry found that 8.1 percent of admissions to one hospital's psych unit in a 14-month period were due to "antidepressant-associated mania or psychosis." Whether you like or hate pot, you ought to be against the feds making such hypocritical claims or you ought to be in favor of Walters warning parents of teens about the dangers of anti-depressant-caused psychosis. I simply don't know of any studies proving that pot causes suicide. I'm not saying it's impossible, but it's highly unlikely that such a link is very strong.

Why do I say that? So many more Americans smoke marijuana now than in, say, 1965, yet the rate of suicide in this country is pretty much the same as it was then (it's actually a small bit lower, depending on what year you look at).

More from the Czar:

"Research shows that some teens are using drugs to alleviate feelings of depression ("self-medicating"), when in fact, using marijuana can compound the problem. The report, released to coincide with May's Mental Health Awareness Month, shows a staggering two million teens felt depressed at some point during the past year, and depressed teens are more than twice as likely as non-depressed teens to have used marijuana during that same period. Depressed teens are also almost twice as likely to have used illicit drugs as non-depressed teens. They are also more than twice as likely as their peers to abuse or become dependent on marijuana. Marijuana use is associated with depression, suicidal thoughts, and suicide attempts.

"'Marijuana is not the answer. Too many young people are making a bad situation worse by using marijuana in a misguided effort to relieve their symptoms of depression,' said John P. Walters, Director, National Drug Control Policy. 'Parents must not dismiss teen moodiness as a passing phase. Look closely at your teen's behavior because it could be a sign of something more serious.'"

According to the Los Angeles Times, Walters may not even believe his own hype:

"Some addiction experts said the report stretches evidence by implying a causal link between smoking pot and developing mental illness that does not exist, even if there is consensus that depression is a risk factor for drug use.

"A British government advisory group concluded in a report last month that there was not convincing evidence to show 'a causal relationship between the use of cannabis and the development of any affective disorder.'

"Questioned about the drug control policy report's claim that 'using marijuana can cause depression and other mental illnesses,' Walters demurred and acknowledged there is no proof one leads to another."

Sounds like Walters may have been smoking something when he put this campaign together. Doctors tossed cold water on Walters's claims as well in the LAT piece:

"Among experts inside and outside the government, opinions are mixed on the relationship between teen depression and marijuana use.

"'Both conditions could be related to something else,' Dr. Victor Reus, a psychiatrist at UC San Francisco, said in an interview. 'Depressed teens are more likely to exercise less, stay indoors and watch TV. Take your pick as to which one is causal.'"

One further bit of hypocrisy: if Walters is so concerned about pot causing depression and suicides (and every other human psychological malady) in teens, then why isn't he concerned about the same phenomenon in adults, who smoke pot in numbers that must far outnumber teens? Or is he trying to say that pot doesn't cause depression and suicides in adults?

Adderall Dubbed "College Crack"

That's quite a term for the Adderall taking and snorting that's apparently sweeping across college campuses and which is detailed in Northern Illinois University's Northern Star. I'm not sure if it's an apt term, but it sure is catchy.

"Mild forms of amphetamine, such as Adderall and Ritalin, are supposed to help calm people who have ADD or ADHD, making it easier for them to concentrate. But, these drugs can have a paradoxical effect if taken by people who do not have these disorders. They can make some users more alert and hyper, while reducing appetite and increasing feelings of euphoria, paranoia and aggressiveness. Some call the drug 'college crack' because of its potency and frequent use and abuse by college students.

"'I couldn’t sleep and I wasn’t hungry,' said Andrew, an NIU student who once used the drug. 'All I wanted to do was clean and study.'

"Paul, an NIU transfer student, said that before coming to NIU, he was given Adderall from a friend who had a prescription for the drug.

"'It makes you very interested in whatever you’re doing, more alert,' Paul said. When writing a paper, he said he did extra research into the subject because the Adderall made him more interested.

"'The next day, I was very hyper and had a fast heartbeat,' Paul said."

Now, I'm all in favor of studying hard and clean dorm rooms and an alert populace, but not at the expense of heartbeats gone wild. The, there's this weird bit.

"Another problem arose as friends of Holly’s who are against smoking marijuana seem to accept peers’ abuse of Adderall. 'They see it as something to just help them out in school, when it’s really "speed,"' she said."

Interesting justification. The paper doesn't really get into the whole issue of Adderall snorting--or Seroquel snorting for that matter--but it sure is striking to see this Adderall abuse/performance enhancing drugs (take your pick) situation going on. And, it sure is interesting watching how psych meds have crept into every corner of American life.

Mental Health Month Meet Bipolar Overdiagnosis Awareness Week

I heard from a couple of psychiatrists yesterday and many readers that they liked my post yesterday examining the recent news that bipolar disorder is overdiagnosed in relation to my own existence on Spaceship Earth. I appreciate the compliments, especially for something I pretty much wrote on the fly and which still feels very tentative to me somehow.

Anyway, it was CL Psych's idea to call this Bipolar Disorder Overdiagnosis Awareness Week in honor of Mental Health Month, which is what May is. And he posed some great questions in his post:

"Do you know that your symptoms are probably not indicative of bipolar disorder? "Ask your doctor if you've been misdiagnosed with bipolar. "Find out if you are unnecessarily taking Zyprexa today."

Gianna Kali at Bipolar Blast is now asking some of the same questions I am about whether her bipolar dx ever made sense. She's probably been asking the same questions I am for even longer, and like me appears to have had no history of bipolar disorder in her family tree. This is all getting very interesting and very suspicious.

I have a weird hunch we are going to hear a lot more about this.

Separately, the nice folks at Mental Health America would like me to remind you all that it is Mental Health Month.

Major Researchers Support Bipolar Overdiagnosis Study

Well, this is charming: an article in the Providence Journal today on the recent bipolar overdiagnosis study published in the Journal of Clinical Psychiatry, authored by Brown University's Mark Zimmerman, shows that even two of the leading lights in bipolar disorder research agree that the disorder is being overdiagnosed. The two are Michael Thase of Pitt and Gary Sachs of Harvard. That's kind of significant. (For those of you who want to read it, Zimmerman's study is here.) I wrote about my own grappling with the implications of Zimmerman's study earlier today.

"Asked about Zimmerman’s study, Dr. Michael E. Thase, professor of psychiatry at the University of Pittsburgh Medical Center and the Western Psychiatric Institute and Clinic, said that he, too, has seen people diagnosed with bipolar disorder who don’t meet the criteria. 'I’m not surprised or shocked by these findings,' Thase said of Zimmerman’s study. After many years of hearing that bipolar is under-diagnosed, he said, 'the pendulum has swung the other way.'

"Dr. Gary S. Sachs, founder and director of the Bipolar Clinic and Research Program at Massachusetts General Hospital, in Boston, says that Zimmerman’s study goes to the heart of 'a serious issue for our field': inaccurate diagnoses, arrived at through casual impressions rather than the careful application of formal criteria.

"'This is the sacred duty of a caretaker — to make sure they have the diagnosis right,' he said.

"Sachs urged patients who receive a psychiatric diagnosis to ask their doctor how many criteria for the illness the patient fulfills. “If the doctor can rattle that off, they have done a formal assessment,” Sachs said. The assessment should also include medical records and conversations with family members, because people often don’t accurately perceive their own moods and behaviors."

I suppose if I were in a more cynical mood, I'd say, "What took you guys so long to say so?" but nah, I'm glad they are speaking out. I've been saying for close to three years on this site that bipolar disorder was being overdiagnosed and, well, it's good to be right. And it's nice that Thase and Sachs essentially think I've had a point all along. If it weren't so early in the day, I'd go have a beer.

Meanwhile, Zimmerman himself offers this assessment of the problems associated with overdiagnosis:

"Believing that one has bipolar disorder when one doesn’t can have serious consequences, Zimmerman said. The drugs given to treat it can have harmful side effects, including damage to the kidneys, liver and immune or endocrine systems.

"Additionally, he said, some patients 'are very much invested in their diagnosis and disorder and live a lifestyle that is consistent with that. They stigmatize themselves. They view themselves as not being able to do certain things.' Some patients are 'looking for a magic pill that will cure all ills' when they really need to do the hard work of psychotherapy."

Again, something else I've been saying for a time and, again, nice to see a researcher get my back, as it were.

Of course, none of this news is going to please the various advocacy groups in the land because they are wedded to the notion that all mental health diagnoses are underdiagnosed.

"Donna Howard, who heads the local chapter of the Depression and Bipolar Support Alliance, was unconvinced by Zimmerman’s study. 'I know it’s just the opposite,' she said, asserting that for 10 years, psychiatry has been biased against bipolar disorder.

"Zimmerman’s methods, she said, 'ignore the nature of bipolar,' which she said can vary in form and intensity over time. 'One could be diagnosed and then six months or a year later present to a different clinician … a different set of symptoms and not meet the very narrow criteria he’s using,' she said."

I sincerely hope that when DBSA's national office and NAMI National and MHA decide to respond to this study that they are a bit more reflective about what's been going on in our culture. It'd be good if they read the paper first as well.

Making Sense Of Bipolar Disorder Overdiagnosis

Most of you are likely aware of a study that was released last week showing that bipolar disorder was being overdiagnosed at about a 50 percent rate. I've now had a chance to review the entire paper from the Journal of Clinical Psychiatry and, before I try to make sense of its findings in a real world way, let me add a note of caution. This study involves only one large clinic in Rhode Island, so it's not necessarily representative of America as a whole (except I fear it well could be) and Mark Zimmerman, the lead author, calls for others to attempt to replicate his findings. I hope other researchers look into this matter because--and this is Zimmerman's view--we may have a crisis of overdiagnosis (or false positives) as a result of doctors who either aren't using the appropriate clinical instruments to assess someone's "bipolarity" or are just diagnosing by the seat of their pants. As a result, hundreds of thousands of people are winding up on meds they don't need, meds which injure some people (not everyone. Yes, I know some people do derive some benefit from them) and a diagnosis that follows them for life and can lead to discrimination in employment, health and life insurance and personal relationships. That's serious stuff.

Zimmerman's paper can be accessed in full here. It is an important study, in my opinion, and one I encourage all of you to read. CL Psych has already offered his thoughts here. My earlier assessment is here. It's deeply ironic, of course, that Zimmerman's paper appears during Mental Health Awareness Month.

I want to point out that this is not an attack on anyone or any school of thought in particular. It's not an argument that someone should or shouldn't be on meds or off meds. I am simply not looking for that kind of a fight. So please read the following in that light. Because I think my own case may be illustrative of the phenomenon Zimmerman describes. I want to stress the "may" part of that again. I have not reached any final conclusions. I simply have lots of questions.

For example, Zimmerman uses familial history of bipolar disorder in his paper to rule out bipolar disorder in people in the study who did not meet formal clinical criteria for bipolar disorder according to the Structured Clinical Interview for the DSM-IV (SCID). In other words, if the people didn't test out as having bipolar disorder and there was no family history of bipolar disorder, then Zimmerman determined that these people had been bad diagnoses if they had previously been given a bipolar disorder diagnosis.

In my own family going back as far as the 1850s I know of no cases of bipolar disorder or any other formal psychiatric diagnosis with one exception. Period.

There is no one to be suspicious of in my family tree on both sides of the family (there are a few drunks in the family tree, but we are Irish-French-British, so spot me a few a drunks in the family tree). The only known suicide was of a cousin by marriage who killed himself in the early-1960s, but he wasn't a blood relative.

Taken together, this, of course, makes me very suspicious of my own bipolar diagnosis, particularly in light of Zimmerman's paper. My familial background doesn't support a bipolar dx for me.

Second, I know for fact certain that when I was diagnosed by a psychiatrist in 1989, the psychiatrist did the diagnosis in about 10 minutes and was not using a formal diagnostic tool (unless it was in his head). I did not show up at this doctor's office in crisis or in the midst of mania or depression. Indeed, I had been seeing a psychologist for about a month and I had been working on my first novel for a few months and was energized in a good way. Nonetheless, life was troubled, things didn't fit together and I had had a very nasty patch of depression a couple of months earlier (I'll plead guilty to having bouts of depression since my teens, although they were well spaced out episodes). The psychologist didn't diagnose me but suggested to me that I might have manic depression and asked if I would like to be referred to a psychiatrist. We discussed some of the symptomology of manic depression (this was before it was changed to bipolar disorder in 1994).

I could see where the depression symptoms fit. The mania symptoms I was less sure of. I certainly had never been delusional, had never experienced hallucinations, and had never lost contact with reality. I was sleeping well--likely because, in addition to doing tons of writing, I ran about 20 miles a week and lifted weights three times a week (even when I was depressed). There were no weird spending sprees (I didn't have the money for that anyway), and while I'd been in a couple of fights (risky behavior per the DSM) the previous year, they'd both been self-defense. I was chasing women very hard (and succeeding!), but I was 26, so that's hardly abnormal. (I've long considered the emphasis on sex in the mania side of the DSM's bipolar diagnosis to be hogwash, likely determined by some very unsexed psychiatrists with deep Freudian issues. I'm not really joking either.) What's more, I had never been hospitalized for anything in my life, except for a broken nose I had operated on when I was 14.

In other words, I had none of what Sascha Scatter of The Icarus Project called "superpowers" in the New York Times yesterday.

But I was agitated at times and had a classic bad Irish temper (both since childhood) and I had certainly been feeling jolts of energy and racing thoughts. In retrospect, I have to wonder if getting wrapped up in the joy of stringing words together and having them make sense at longer than short story length for the first time in my life didn't lead to the racing thoughts and energy. That's certainly something for me to chew on late at night these days.

Anyhow, I went to see the psychiatrist like a good patient and walked out a half hour later with a diagnosis of manic-depression and a scrip for Lithium (Lithobid as I recall).

For the last few years, there's been all sorts of news around the increased diagnosis of bipolar disorder in American culture. Most of the attention has been paid to the alleged child bipolar disorder. But among adults, bipolar disorder has exploded as well, doubling between 1993 and 2003. Most of the increase among adults was among women and, to go by Zimmerman's paper, it's pretty clear to me that most of these diagnoses are similar to mine--depression plus agitation and a certain rage. What's called bipolar disorder type 2 these days. I suppose the psychiatrist who diagnosed me figured I was experiencing some hypomania and that he was doing me a favor diagnosing me with manic-depression and putting me on Lithium.

When I told my parents about all of this a few days later, they were blown away. Like me, they didn't really know what manic depression was, but they sure weren't expecting that diagnosis.

In the almost 19 years that I've been diagnosed with bipolar disorder, I never questioned my diagnosis until last fall when I'd been off meds (at my psychiatrist's urging) for several months and was clearly non-symptomatic for depression, mania and hypomania. And, that's when my psychiatrist told me the ugliest words I have ever heard in my life: "Once diagnosed, never undiagnosed." I've written about that bit of business before.

But, now, I've got all kinds of questions. I wonder if any other folks do as well. And, I've got to think that given how some leading researchers are insisting on a bipolar disorder prevalence of 4 percent to 5 percent (as opposed to NIMH's 2.2 percent) among American adults and given how many leading researchers are arguing for even broader diagnostic criteria for bipolar disorder (yep, they want a bipolar disorder type 3) that there are millions of people being diagnosed with bipolar disorder who don't have bipolar disorder, at least not in anything approaching the classic sense of the term.

Someday, I'll get into why I didn't question my diagnosis for so long. I am not in the mood for that now. I find it depressing.

I want to again stress that I am not attacking anyone's views on bipolar disorder here. I am just putting some things in the public realm that I think have to be in the public realm--some much needed healthy skepticism. And, let me stress again that I have not reached any conclusions about my own diagnosis. I just have lots of questions, very painful ones, especially given that I've lost jobs and lovers over my diagnosis and have taken 18 years of meds that I may well not have needed and that have caused me numerous problems and may have compromised my long-term health.

British Lawyer, Crazed On Anti-Depressants And Booze, Killed By Cops

This a very sad story and should serve as a warning to anyone taking anti-depressants, particularly someone new to them or going through a dose change. A London lawyer was shot dead by police last week after he came home drunk from a pub, began acting erratically and, then, began firing his shotgun from his home. His name was Mark Saunders, aged 32, and he'd reportedly been taking an anti-depressant for a few months.

After a standoff, the cops shot him five times.

This is a tragic outcome and points to a very simple rule that people who take anti-depressants should adhere to: be damn careful about mixing alcohol and anti-depressants, particularly until you know how you react to the mixture, adn I simply do not care where you stand on the great meds divide. There have been too many stories over the last 20 years of people who met tragic outcomes from mixing booze and anti-depressants (and booze and Chantix) and tragedies such as Saunders' should serve as a reminder to all.

The New York Times On "Mad Pride"

There's an interesting piece in today's New York Times discussing how some writers with serious mental illnesses--bipolar disorder and schizophrenia, according to the paper--have taken their writing online. That's of course nothing new to readers of this site which has been tackling the issues around mental illness for three years (and I was tackling them before that in a certain newspaper as well).

The article includes photos of Liz Spikol and mentions Elyn Saks (USC law professor who's diagnosed with schizophrenia), MindFreedom's David Oaks, The Icarus Project's Sascha Scatter, and The Freedom Center. It includes quotes from Charles Barber, author of Comfortably Numb. It also includes Fuller Torrey's assessment of the phenomenon of people with alleged serious mental illnesses writing on the 'Net.

"While psychiatrists generally support the mad pride movement’s desire to speak openly, some have cautioned that a 'pro choice' attitude toward medicine can have dire consequences.

"'Would you be pro-choice with someone who has another brain disease, Alzheimer’s, who wants to walk outside in the snow without their shoes and socks?' said Dr. E. Fuller Torrey, executive director of the Stanley Medical Research Institute in Chevy Chase, Md.

"Dr. Torrey, a research psychiatrist who specializes in schizophrenia and manic depression, said he understood the roots of the movement. 'I suspect that not an insignificant number of people involved have had very lousy care and are still reacting to having been involuntarily treated,' he said."

Always interesting to hear the views of the dark prince of forced medication. Why the author, Gabrielle Glaser, chose to sound out Torrey on this phenomenon is beyond me. The guy is as relevant to a discussion of how patients lead their lives as are testicles to a heifer. And, from what I know, very few of the people mentioned in the article write about their experiences in response to having been involuntarily treated. Lousy care, though, is a great motivator and unites many of us who write about these issues.

Anyway, it's a decent article and it's nice to see some good people get some well-deserved attention.

Too bad the reporter in question decided to overlook this wee website. It's kind of hard to understand why, given (insert apology for self promotion here) that this site has about three times the number of unique readers each month as does Icarus (the "reporter" pegs Icarus's monthly uniques at 5,000. This site's uniques currently run between 13,000 and 15,500 a month, depending on the time of month, time of year, etc.) and given that this site has been kind of aggressive in taking on the issues around mental illness that float around our culture. What's more, it was this site that got the Times's back during the whole Zyprexa documents saga last year, and it's been this site that has been--um, what's the word?--"helpful" to a few journalists who write about mental health issues. In this regard, the oversight feels like a slap in the face, or is proof that a certain reporter at the Times is rather incomplete in her reporting.

Slate Responds To "The Infinite Mind"'s Criticism

Jeanne Lenzer and Shannon Brownlee--co-authors of the recent Slate piece criticizing "The Infinite Mind" radio show for, among other things, not revealing its ties to the pharma industry and for not revealing the pharma ties of its host and guests on a recent program defending anti-depressants--has now posted a response to Bill Lichtenstein, the show's producer, in response to Lichtenstein's response to the initial article. That's a whole lot of responding and there's a whole new set of accusations floating around.

A snippet of Lenzer's response:

"Bill Lichtenstein fails to contradict the key points we made in our article; namely that The Infinite Mind series was funded in part by drug company money; that each of the four experts on the show, “Prozac Nation: Revisited” has received drug company funding; that despite enormous controversy about the safety and efficacy of antidepressants, the experts all expressed a singular viewpoint; and finally, listeners were not told about the experts’ financial conflicts of interest."

The rest, which is fairly detailed, can be read here. The original Slate article is here. My thoughts on the article are right here and my take on the show, which aired in March, is here.

Lenzer does offer a completely different account of what Lichtenstein cast as the Slate authors' payback motivation--if that's the right term--for the article. Short story: Lichtenstein claims that Lenzer tried to pitch him a second show on anti-depressants and their problems and that somehow his not going ahead with the program and the subsequent Slate article are connected. That is of course a huge jab at the Slate authors' credibility and journalistic ethics.

Lenzer and Brownlee state:

"Mr Lichtenstein claims that one of us (Lenzer) pitched him a radio show. Quite the opposite. When Lenzer called Mr. Lichtenstein for an interview, after he realized our interest was in the funding of his guests and the absence of those with contrary views from the show, it was he who suggested that we do a show, telling Lenzer that sometimes differing viewpoints are better heard with separate shows (which he used as a defense for why only those experts with pro-antidepressant viewpoints were present on Prozac Nation: Revisited)."

I do think that "The Infinite Mind" should do a second program on anti-depressants and their problems. The sad thing is that this whole dust-up could've been avoided if the show had revealed its various conflicts upfront. The show gets some funding from Eli Lilly and ran a program actively and questionably defending Prozac and other anti-depressants yet didn't reveal that it took money from Lilly nor that the show's host, Fred Goodwin, has also taken money from Lilly.

For what my peon-on-the-Left-Coast's opinion is worth, it seems to me that since Goodwin and his guests, two of them well-published academics, regularly reveal their conflicts of interest in their academic writing for the smallish audience of doctors who read their journal articles, then they should've done the same for the 500,000 or so listeners to the program. The public deserves just as much full disclosure as doctors do. In fact, we deserve more.

We also deserve a public radio show that is willing to take on these matters is a more thorough fashion than the one-sided manner in which "The Infinite Mind" defended anti-depressants.

"The Infinite Mind" Producer Responds To Slate.com Article

It's just been brought to my attention that Bill Lichtenstein has posted a response to the Slate.com piece earlier this week taking "The Infinite Mind" to task for not disclosing its Big Pharma funding as well as the ties to pharmaceutical companies of its host, Fred Goodwin, and three guests on a recent program, "Prozac Nation: Revisted." The original Slate piece is here. My earlier critique of the program (well ahead of the Slate article) is here and my thoughts on the Slate piece are here. Lichtenstein is the senior executive producer of the program.

I'll let Lichtenstein's response speak for itself. Feel free to chime in in comments or go leave comments on Slate, if you are registered there.

"From Bill Lichtenstein "Senior Executive Producer, The Infinite Mind

"In their May 6 Slate article, Jeanne Lenzer and Shannon Brownlee use The Infinite Mind's recent program "Prozac Nation: Revisited" to frame an argument that pharmaceutical companies are planting "stealth marketers" inside seemingly objective media outlets to manipulate public opinion. The article suggests that as public radio producers we have allowed our guests on our national weekly program to hide financial links with pharmaceutical companies for the purpose of promoting the use of dangerous prescription drugs.

"Ironically, "Prozac Nation: Revisited" was intended to examine the way the media has handled links between violent behavior, suicide and antidepressants. Our interest in the story began with press reports about Steven Kazmierczak, whose shooting rampage at Northern Illinois University left six dead and 16 wounded. We wanted to know: Why did the major news media uniformly target Steven's withdrawal from an antidepressant as explanation for his violent act? Why did the media ignore any number of other factors, such as his gun collection, his work as a prison guard, or his troubled childhood? We were interested in exploring the reflexive public reaction that ends up making the medication the culprit, and so simplifies a disturbing violent act while stigmatizing the already vulnerable people who take or consider taking prescription medication for depression.

"And at the core of the program, we asked the question we always ask, the question that has guided the past 10 years of The Infinite Mind: Where is the best science on this particular issue? In this case, does the science find links between antidepressant medications and out-of-control behavior?

"To help us, we turned to recognized experts in the field. Framing the discussion, we began with Dr. Andrew Leuchter, director of UCLA's Laboratory of Behavior and Pharmacology, who himself has conducted much of the important research in this area.

"Next, we spoke with Dr. Nada Stotland, current president of the American Psychiatric Association and an expert in medical ethics. Dr. Stotland, another distinguished research scientist and clinician, spoke about the gap between public perception and the research about violence, suicide and psycho pharmaceutical medications.

"Finally, we talked to Peter Pitts, a former associate commissioner for the Food and Drug Administration who was involved in the FDA's 2004 "black box" labeling of antidepressants as carrying a risk of suicidal thoughts and behavior, and who was at the time the "go-to" guy for the FDA on that issue.

"What we didn't know, because he didn't disclose it to us, was that Pitts is currently working for a public relations firm whose clients include major pharmaceutical companies. If we had known, and (full mea culpa here) we should have, we would have disclosed that connection. Pitts apparently didn't disclose it elsewhere, either - he's appeared on NPR's Talk of the Nation as well as PBS' News Hour with Jim Lehrer, without either of those programs mentioning the PR company ties.

"In any case, to suggest that distinguished researchers such as Drs. Stotland and Leuchter are shills for the drug industry is bad journalism. Pharmaceutical companies fund the lion's share of research being conducted today. There are strict ethical codes and laws governing the use of such funds. Journalists covering this industry know that, and routinely disclose only those ties that are likely to raise serious questions about a researcher's neutrality. It would be patently ridiculous, for example, to presume that Dr. Stotland, speaking for all American psychiatrists as president of the APA, would somehow distort the truth because of some past connection to an industry speakers' bureau.

"It is important to state that we stand by the program and its editorial content. There is, as our guests observed, no credible evidence that the use of antidepressants contributes to the sort of violence that erupted at NIU. There is, on the other hand, a study by the Centers for Disease Control and Prevention suggesting that more young people may be dying in part because of the chilling effect of the FDA "black box" warning. While some will take issue with these studies, we believe they are important, that they deepen the public dialog, and that they've gotten lost in superficial media coverage of a complex issue.

"So finally, let's tackle the other question raised in the Slate article: Is it acceptable for a public radio program about the human mind to take grants from the pharmaceutical industry?

"Back in 1994, I came face to face with that question. Preparing to produce a program about people living with schizophrenia, I met with Delano Lewis, who was at the time president of National Public Radio. I told Lewis that I had offers of unrestricted educational grants from several pharmaceutical companies who were interested in helping lift some of the stigma about this misunderstood and feared disease, but that I wasn't sure whether it would be proper to accept the grants.

"The conversation that we had helped set the ground rules that have governed our underwriting ever since. Lewis began by observing that in many cases, especially on difficult and unpopular subjects, it would be hard to find support from organizations without some kind of substantial interest in the subject matter. The important thing, he said, was to assure listeners and stations that there was an absolute firewall between funding sources and editorial decision-making.

"With this in mind, 14 years ago, we created a system with the following rules: We would take no more than 15 percent of our total budget from any one industry sector. We would not take substantial amounts from any one company. Corporate support would have to come in the form of unrestricted "no strings attached" educational grants. Corporate funding would be mixed with support from other sources (in the case of The Infinite Mind, that's been sources like the MacArthur Foundation, the National Institutes of Health and the National Science Foundation.) We would list underwriters on the air. Under no circumstance would producers ever have editorial discussions with any funder; and it's probably important to note that in the case of the pharmaceutical industry, such conversations would be a violation of federal law as well as a violation of our own ethics as journalists. And, we would require employees to sign a code of conduct that requires disclosure of any potential conflict of interest and makes failure to disclose a fireable offense.

"By the way, our 1994 program on schizophrenia, with substantial and disclosed support from the pharmaceutical industry, won a Peabody Award and was credited with changing the way Americans look at people with serious mental illness. Over the past 18 years, following these rules, our programming on the human mind has been honored with more than 60 awards for journalistic excellence and offering insight into issues that society would often prefer to ignore.

"In the interest of full disclosure, I also should note for the record that Lenzer, who co-authored the Slate article, called me a few days after the "Prozac Nation: Revisited" program aired to pitch a program that she wanted us to do for The Infinite Mind, called "Journalists on Prozac," which would feature her and her writing partner Shannon Brownlee. Checking into Lenzer's credentials, I found a troubling article in The New York Times taking her to task for a British Medical Journal article that suggested that Eli Lilly and Company, which makes Prozac, had concealed documents about the link between anti-depressants, suicide and violence. The BMJ subsequently retracted the article, with full apologies, and the whole matter was widely covered in the news media.

"After we told Jeanne Lenzer that we would not be proceeding with a program featuring her, she and Brownlee wrote the article for Slate."

Article Exposes Injuries, Deaths At Texas Psych Hospital

Among other things, staff at this hospital did not properly recognize or treat a 6-year-old with a broken arm, one of the most obvious and easy diagnoses to make in all of medicine.

And, then, there's this:

"What is specifically known from other reports is that on June 14, 2007, patient Mario Vidaurre died at West Oaks when the one-on-one tech assigned to him beat him to death [see "Death in a Box," by Margaret Downing, October 25, 2007]. An investigation by the state found West Oaks was at fault. On March 22, 2007, Alan Chambers, a man who was supposed to be under suicide watch, hung himself behind the closed door of his room on Unit 1. On May 12, 2006, a 17-year-old girl who tried to hang herself with one of her shoelaces was allowed to keep the other shoelace of the pair in her West Oaks room.

"Frederick Williams, the tech who fought with Vidaurre and caused his death, has left the psychiatric center and retained an attorney to represent him in a lawsuit against his former employer. He's arguing he had no business being assigned to Vidaurre; he never got trained for that kind of job."

A tech beating a patient to death? That's crazy. Keep in mind this is a private psych facility not a state hospital (not that this should go on anywhere, ever). Why is the Treatment Advocacy Center silent when this kind of stuff is going on? Cat still got your tongue Fuller Torrey?

There's plenty more on West Oaks in this fine article by the Houston Press. Why is this hospital even still open?

Congress Tells Pharma Companies To Rein In Deceptive Ads, Or Else

At a hearing today on recent pharmaceutical television ads, Rep. Bart Stupak (D-Mich.) let rip on what he considers deceptive TV ads by pharma companies.

"'It appears that we need to enforce significant restrictions on DTC (direct-to-consumer) ads to protect American consumers from manipulative commercials designed to mislead and deceive for the profit of pharmaceutical companies,' said Stupak, head of the U.S. House of Representatives Energy and Commerce investigative panel.

"The Michigan Democrat said Congress should consider whether ads promoting medicines should be allowed to continue to target consumers in the United States, the only country that allows such marketing except for New Zealand.

'Pharmaceutical companies should consider it a privilege to be allowed to air DTC ads in this country,' he said. 'We should make sure that pharmaceuticals companies conduct themselves responsibly.'"

One pharma company defended the infamous Robert Jarvik Lipitor ads thus:

"James Sage, a Pfizer senior director, said ads are necessary because companies cannot sell prescription products directly to consumers. Such patient-targeted spots 'motivate them to seek additional information ... consult their physicians ... and follow treatment plans,' he said."

Yes, motivate them to seek additional information from their doctors who the pharma companies also go out of their way to misinform and deceive.

As much as I am against limiting anyone's free speech, the pharma companies have gone way too far in their advertising the last 10 years and I have a hard time understanding the benefit to the public when doctors can simply access the same information, twisted as it might be. Congress was not examining any ads for mental health meds today, but it is certainly the branch of pharma advertising that Congress should look at, especially magazine and online ads for anti-depressants and antipsychotics (I'm thinking of the Pfizer ad for Geodon featuring a serene looking woman practicing yoga).

I've written before that pharma ads for psych meds should be banned or greatly restricted. I stand by that statement.

Quiet Today

Not a lot of news on the mental health front in the last 24 hours after a fairly busy week, so I am going to use this opportunity to take a bit of a breather today and catch up on some personal stuff.

For now, however, take a look at this piece on a child in Kansas--a kindergartner no less--with alleged child bipolar disorder. Despite my own disbelief in the disorder--no mania means no bipolar--it's clear that there is something very dramatic up with this child. And it's sad regardless of the cause.

Have a nice day and weekend.

New Abbott ADHD Drug Is "Drug Dealing," Plus Adderall Snorting Explained

Yesterday, my good friends at Abbott Labs rolled out phase II data on its experimental adult ADHD drug known as ABT-089. One assumes that the phase III trials are well underway and that the drug will have a much sexier name if it ever heads to the FDA for approval. I'm betting that it will because Abbott is clearly aiming this drug at the adult ADHD market and in its press release the company talks about it as a lifestyle drug:

"Phase II study results show that ABT-089 appears to significantly improve the core symptoms of ADHD, improve quality-of-life and work effectiveness, and reduce overall work impairment in adults with ADHD. Data also revealed that ABT-089 appears to be generally well tolerated with no significant negative effects on sleep, appetite or vital signs (heart rate and blood pressure).

"ADHD, an ailment historically associated with childhood, persists into adulthood in more than two-thirds of cases."

How much ADHD persists into adulthood is debatable (recent studies put it at closer to 50 percent), but you know how the ads for this drug will go: "Having trouble getting your reports done on time for the boss and still having spare moments to catch the kid's soccer practice and shag the wife? Abbo-Fix is the answer for you." Something like that at any rate.

Given the company's emphasis on lifestyle improvement, you know Abbott will market the hell out of the drug once it hits the market, possibly in 2010. And why wouldn't they? Abbott hasn't had a homerun mental health drug since it turned Depakote into a "mood stabilizer" for bipolar disorder in the early-1990s (David Healy is deeply critical of Abbott for creating that terminology). But one does have to wonder about just what we are doing when we are introducing a lifestyle drug into the marketplace as opposed to something that addresses a truly debilitating problem. I guess that would make ABT-089 the Viagra of psych meds.

Aaron Rowe over at Wired Science put it thus:

"In my opinion, selling chemicals which affect the brain, but do not treat a major human malady, is a legitimized form of recreational drug dealing. But from a capitalistic point of view, it is a brilliant idea: A drug which strikes α4β2 nicotinic acetylcholine receptors is sure to have more off-label uses than duct tape, which means it could be a really big seller for the pharmaceutical giant."

That's a bit more harsh than I'd be, but since he opened the door, let me budge on in: So many ADHD scrips wind up being diverted into the underground market and so many teens and college students (and, hell, probably adults) are laying hands on ADHD drugs without a scrip, grinding the pills and snorting them like speed that I think Rowe's terminology is apt. This is especially true of Adderall, which goes for about $5 a pill on da' street and is quite popular among the college crowd as a, ahem, study aid.

I recently had a chat with an admitted Adderall snorter, who told me she didn't have an ADHD diagnosis, but that she and her friends in college often use the drug to help them stay up for days on end and cram for mid-terms and finals and term papers and such. She liked how easily available it was and how focused she was while on the drug. It also gets her high as a kite. I asked about side effects, fluttery heart beat and the like. She said she'd had no problems and that the only downside of using the drug in this fashion was when she had finals later than her fellow whiffers. They'd come off the drug first and be all zonked out and she'd have no one to stay up late and study with.

Oh, yes: there is apparently a very big crash coming off Adderall and the once-snorter becomes the many-hours-sleeper. This has become much larger phenomenon than I'd thought a few years ago (witness all the busts of teens for dealing Adderall) and whenever I speak at a college, I get asked about it.

I once took speed ("greenies") to keep me up all night for a Econ final when I was a freshman in college, in the days before ADHD meds were commonplace. So did a few pals of mine. The speed made me shiver internally and I felt chilled. It was such an icky feeling that I promised myself after the final that I'd never touch speed again (I haven't) and that I'd make sure to organize my life better so that I never had to pull an all-nighter ever again. And I never have.

What's interesting and spooky is that ABT-089 is not a stimulant, it's a neuronal nicotinic receptor agonist, making it somewhat akin to Chantix (Champix outside the US), the very messy stop-smoking drug that keeps acting like an SSRI and causes erratic behavior, suicidality, suicide and, in some reported cases, depression. It'll be very, very interesting to see how ABT-089 performs in the real world.

BTW, Rowe implies that ADHD is not a major human malady. I have no idea whether it is a major one or not since I don't have it myself and the adults I know with the disorder don't seem particularly disabled to me. What do you think? ADHD: major or minor malady? Is Abbott trotting out a mere lifestyle drug or are they addressing a major health issue?

Full disclosure: In the late-1980s, I was a sales rep (and a very good one) for Abbott Labs for its then-tiny Abbott Critical Care Systems which sold critical care monitoring devices commonly used in operating rooms and ICUs. I never repped drugs for Abbott.

Antipsychotic Set For Approval For Depression, Anxiety Has Big Problems

Most of you are well aware that AstraZeneca has been trotting out data--not especially impressive data BTW--touting its antipsychotic Seroquel as a treatment for depression and generalized anxiety disorder. The drug is already approved for treating schizophrenia, mania in bipolar disorder and bipolar depression. It is widely used off label for treating sleep problems, agitation, anxiety, depression, public speaking anxiety (bring back Toastmasters!), ADHD and so on. It rings up about $4 billion a year in sales and AZ is determined to wring every nickel possible out of this molecule, especially since it's not a particularly good performer in treating schizophrenia as the 2005 CATIE study showed.

What strikes me as strange is how the media has largely given the drug's many well-known problems a free pass and has instead largely parroted AZ's press spin in announcing the depression and anxiety data the company presented at the APA on Monday. Here's an example from WebMD.com wherein the "reporter" (or would that be copywriter?) details the new data on the drug and ignores its propensity to induce rapid weight gain in patients and cause diabetes and all sorts of fun extra pyramidal symptoms as well as daytime somnolence. Instead, she sticks to the AZ script.

Why does that piss me off? First, a lot of people read WebMD.com. It is the number 34 website in the world, according to quantcast.com, as it's read by an estimated 19 million unique readers a month. Regardless of what one thinks of websites like WebMD (I think it largely blows), it's clear that the public is paying attention to the site's prose. The public certainly deserves more complete information about any drug the site writes about. Second, the Seroquel article on WebMD was allegedly reviewed by a doctor. One has to wonder precisely what kind of doctor would let pass an article that doesn't even offer the most basic set of information about the drug, especially since Seroquel's problems are well documented. Third, you also have to wonder what kind of media ethics and editorial oversight are in use at the company if that's the kind of prose they feel compelled to offer the public.

In short, WebMD is not being fair to the experiences of the many millions of people who have taken this drug and run into problems on it. And, fairness much less objectivity is supposed to be the hallmark of the mainstream media and WebMD clearly flunks that test. You can read my own writing about this drug here. While I don't always acknowledge that some people do derive benefits from the drug, no one really expects me to since blogs are supposed to be the metaphorical equivalent of an old school newspaper column and they are not required to be as fair-seeming.

What blows my little mind is that WebMD makes no mention of the fact that AZ faces a large class action lawsuit in federal court in Florida over its handling of the drug and that the drug is sometimes converted into a drug of abuse by crushing it and snorting it or by melting it down with cocaine and shooting it (a Q-ball). The drug already has some catchy street names such as Susie Q and Quell and is a favorite of prisoners. For WebMD to pretend that such information wouldn't be important to the casual reader looking for information on the drug is galling. This is basic stuff that most any responsible journalist would find a way to slide into an article on the drug, pro or con.

And it's websites like WebMD that have helped drive thousands of journalists out of their jobs. Keep that in mind every time you read its prose. These are the clowns driving hardworking people out of their jobs and they are doing a bad job of replacing them. Personally, I trust WebMD about as much as I'd trust adders fanged, to steal from Shakespeare. The article doesn't even mention that the "studies" it cites are in fact unpublished (meaning the data has technically not passed peer review yet) and that the data it pimped at the APA is little more than averages of each arm of the placebo controlled studies, not a report of what percentage of patients in which arm saw how much benefit from the drug. That's just lame.

The sad fact is that I get dozens of hits to this site each week from readers searching for information on "shooting seroquel," "snorting seroquel," "Susie Q" and the like. Teens have been arrested around the country for dealing the drug.

And that's just really strange for a drug that is on the verge of being approved to treat depression and anxiety. And it's strange that the mainstream media--online and offline--hasn't noticed. Weirder still: I've recently begun to get stray hits from people searching for information about "snorting Abilify." I kid you not.

Or am I wrong to be bothered by any of this?

Cymbalta Hand Soap, Zyprexa Cosmetic Bag, And More!

Soulful Sepulcher has a wonderful set of pictures of various pharma swag she's run into over recent years of following her daughter through the mental health system. There was Cymbalta soap at mental health court, her daughter was given a Zyprexa cosmetic bag at a psych hospital (now that's just offensive. Couldn't Lilly at lest spring for a glucose meter?) and there are lovely DTC ADHD kits as well.

For those of you who don't know, her daughter is technically diagnosed as psychosis NOS and is one of the most profound cases of mental illness I've ever run across. Her mother, who has fought heroically for her daughter's rights in the system, is beginning to lean towards autism as the most sensible diagnosis. The docs haven't gone there yet, but then she's usually ahead of the docs.

Lexapro For Teens!!!

The fine folks at Forest Labs today rolled out results from a clinical trial of teens diagnosed with major depression, while carefully noting that the drug is not approved for use in treating depression in teens. Let the off label marketing begin!

"A double-blind, parallel-group, placebo-controlled phase III study to evaluate the safety and efficacy of Lexapro in the treatment of depressed adolescents, aged 12-17, was conducted in multiple centers across the U.S. A total of 316 patients entered the eight week study, receiving either Lexapro 10-20 mg (n=158) or placebo (n=158). The primary endpoint was change from baseline to Week 8 on the Children's Depression Rating Scale - Revised (CDRS-R) using last observation carried forward (LOCF) approach. The CDRS-R is a commonly used clinician-rated instrument that covers 17 symptom areas of depression relevant to adolescents, including impaired schoolwork, difficulty having fun, social withdrawal, physical complaints, and low self-esteem. The study showed statistically significant improvement in patients treated with Lexapro relative to placebo based on the change from baseline in the CDRS-R score (-22.1 for Lexapro vs. -18.8 for placebo treatment; p=0.022)."

The improvement in the CDRS-R scores is an average of all the patients in a particular arm of the study, so it's not clear what percentage of patients in the Lexapro arm of the study received whatever benefit might be ascribed to Lexapro. I'll have to wait for the published results to be able to dig up those bones.

Until then, I'd say teens and their parents ought to be damn careful when using any anti-depressant--that black box warning isn't on Lexapro and the other anti-depressants for nothing, regardless of what Fred Goodwin thinks. To be fair, Lexapro is a long way from Paxil and Effexor on the ugly meter, but it's still an SSRI and the Brits banned all SSRIs (except for Prozac) for use in under-18s.

Thanks To Whomever "Stumbled" Me

I think that's the right verb and, um, anyhow many thanks to whomever slapped yesterday's post on the nightmare conditions in Texas state hospitals up on stumbleupon.com. Many people are reading.

Whomever you are who posted that, drop me a line and I'll buy you the metaphorical equivalent of a beer.

New Sleeping Pills As Bad As Old Ones

Now that we've been getting flooded for a few years with ads for Ambien, Rozerem and Lunesta--the new age, totally safe sleeping pills!--it's becoming clear that these drugs create as many problems as the old prescription sleeping pills which were addiction-producing benzos such as Halcion (which was so bad it was pulled from the market). That's what popped up in a recent Wall Street Journal piece (sadly, behind the subscription firewall).

"The WHO Collaborating Center for International Drug Monitoring received 867 reports from 24 countries of people encountering amnesia, often coupled with confusion, agitation and other behavior disturbances, while taking the new sleeping pills, like Lunesta and Ambien, through March, 2007. That compares with 1,032 adverse reports with the older class of benzodiazepines, even though they have been on the market for decades longer.

"People under the influence of these drugs have gone on eating binges, driven their cars and engaged in other activities that they later cannot remember. The Wall Street Journal relates one story of a woman who painted her front door in her sleep, and in some cases, people have had serious car accidents and even set fire to their homes while in the seemingly-hypnotic state sometimes caused by the drugs."

Yep, that's a nice new class of sleeping pills the pharma companies have bestowed upon us.

Bipolar Disorder Overdiagnosis Seen In Private Practice

In response to yesterday's news that bipolar disorder may be overdiagnosed by 50 percent, a psychologist in private practice left a comment here that I wanted to pass along:

"In my private practice as a psychologist, I frequently find people misdiagnosed with Bipolar disorder. If someone has an anger problem, they often end up diagnosed as Bipolar. This happens frequently by family doctors and also psychiatrists. In my opinion, it's really often a matter of justifying the meds they want to prescribe (most often an antipsychotic). I'd say, anecdotally, that the level of overdiagnosis I see is pretty consistent with the studies results (50-60%). I do evaluations for people seeking disability based on mental illness diagnoses, so I frequently see people labeled as Bipolar. More often than not, the diagnosis is more consistent with a cluster B personality disorder (erratic, unstable, and hyperemotional personality traits). But once you diagnose someone as being Bipolar, you can pretty well throw any class of psychotropic medication at them that you want to."

Yes, the mental health industry throws whatever they feel like at bipolars and schizophrenics. It's amazing that so many people are winding up diagnosed with bipolar in such a fashion.

I wonder when the backlash will begin because this kind of nonsense won't go unanswered for long.

Another Satisfied Seroquel User

A reader commented yesterday:

"I took 200 mgs. of Seroquel daily for two years after a questionable diagnosis for Bipolar II (manic symptoms appeared only after treatment with antidepressants or with high doses of IV steroids). Now, a year after withdrawing from Seroquel, I still wake up every two hours, and I still have episodes of akithisia. I believe this drug has permanently damaged my nervous system. I struggled with deep depression the entire time I was taking Seroquel; since withdrawing (a painful process) my mood has improved."

This drug is being given to millions of Americans for everything from psychosis to sleep problems to "public speaking anxiety." I wonder how many other stories there are like this. I wonder how many more we'll encounter once this drug is approved for depression and anxiety.

NPR Radio Show Tied To Pharma Influence

Excellent piece on Slate.com today detailing Big Pharma influence on "health and science" programs in the media. It paid particular attention to "The Infinite Mind," a program hosted by Fred Goodwin, who as most of you know is one of the godfathers of bipolar disorder treatment and an extremely influential voice in psychiatry, having authored the standard medical textbook on the issue. "The Infinite Mind" is carried on all manner of public radio stations stations around the US and Canada. It is independently produced.

Slate focuses in particular on three guests Goodwin had on his program in late March, a show entitled "Prozac Nation: Revisited," which laid out the view that the press had wildly overreacted to concerns around anti-depressants and violence as well as suicides and suicidality connected to the drugs. As it turns out, the guests and host all have financial ties to pharmaceutical companies.

"Which brings us back to The Infinite Mind and "Prozac Nation: Revisited," a show that may stand in a class by itself for concealing bias. In addition to the show's unrestricted grants from Lilly, the host, Goodwin, is on the board of directors of Center for Medicine in the Public Interest, an industry-funded front, or "Astroturf" group, which receives a majority of its funding from drug companies. CMPI President Peter Pitts was one of Goodwin's three guests for "Prozac Nation." We don't know which companies fund his group because when we asked him, Pitts said, "I don't want to go into that." But CMPI took in more than $1.4 million in 2006 and, according to its tax forms, spent $210,000 to influence the media through a large conference, a blog the group maintains, op-eds published in major newspapers, and multimedia programs and podcasts. Pitts has another title that might have been relevant to The Infinite Mind; he is the senior vice president for global health affairs at the PR firm Manning Selvage & Lee, which represents Eli Lilly Inc., GlaxoSmithKline, Pfizer, and more than a dozen other pharmaceutical companies. Yet on the show, Pitts was identified only by his title as "a former FDA official."

"The second guest on "Prozac Nation," Andrew F. Leuchter, is a professor of psychiatry at UCLA who has received research money from drug companies including Eli Lilly Inc., Pfizer, and Novartis. The third guest, Nada Stotland, president-elect of the American Psychiatric Association, has served on the speakers' bureaus of GlaxoSmithKline and Pfizer. None of Leuchter and Stotland's ties to industry was revealed to listeners—instead, each was introduced as a prominent academic.

"The Infinite Mind's Web site states, "Our independence is perhaps our greatest asset." Perhaps, indeed. Neither Goodwin nor the show's producers responded to our repeated requests for interviews and queries about their funding. Pitts, who to his credit did give us an interview, said he didn't know why his ties to industry weren't revealed on the show. Curious, we tried to learn more about the funding for The Infinite Mind—and could discover only that the show's award-winning production company, Lichtenstein Creative Media, was dissolved by the state of Massachusetts on March 28 for failing to file a single annual report since its establishment in 2004."

I congratulate the reporters on this piece--Shannon Brownlee and Jeanne Lenzer--for kicking butt all over the place. They didn't get into Goodwin's industry ties--probably because they speak for themselves--but here's a statement he made on behalf of Eli Lilly when Zyprexa was approved as a maintenance med for bipolar disorder in 2004 (and, you can bet such a statement isn't made for free):

"'It is good news that the FDA has now approved Zyprexa as a new tool for physicians to use to delay relapse and prolong periods of stability and wellness.'"

Here's Goodwin's financial disclosure from a 2004 paper in the Journal of Clinical Psychiatry (.pdf here) touting Lamictal:

Dr. Goodwin has received research support from Abbott, GlaxoSmithKline, Solvay, Janssen, Pfizer, Eli Lilly, Forest, Sanofi and Bristol-Myers Squibb; has received honoraria and participated in speakers/advisory boards for Solvay, GlaxoSmithKline, Pfizer, Janssen, Eli Lilly, AstraZeneca, and Bristol-Myers Squibb; and has been a consultant for GlaxoSmithKline, Eli Lilly, Pfizer, Bristol-Myers Squibb, Solvay and Novartis."

If Goodwin is willing to release his financial conflicts to his own academic peers in a juried article, then why isn't he willing to tell the public the same thing when he holds forth on criticizing the media over its coverage of anti-depressants? It is discouraging to me to see someone of Goodwin's stature--I know from a patient of his that he is well-regarded by his clients--is such a shill for Big Pharma on the side and doesn't disclose that on his program. It's even weirder to me that the program didn't disclose Peter Pitts' deep ties to Big Pharma.

I have previously criticized the "Prozac Nation" program for misstating available evidence on the issues and for not making available to the public competing viewpoints. In other words, the show was wildly biased in a way scientists and allegedly "independent" media should avoid and, frankly, had damn near religious overtones in its praise of SSRIs. If that's how Goodwin and his producers want to do things, it's a free country, but they ought to disclose whatever financial conflicts they have. It also galls me that the program, as I noted last month, is so one-sided yet is carried on taxpayer-funded and listener-funded public radio. It's heard by 500,000 people each week and one would expect a certain level of media ethics from such a program, if not some level of oversight by NPR itself. In fact, I think the NPR stations that carry the program ought to reexamine their relationship with the program, especially given that the program's producers won't disclose their funding to even the IRS.

Maybe some readers would be interested in writing the station in their area that carries the program. Let me know.

Here, I'll disclose my financial conflicts for this site: reader-supported and Pharma-free. I thank my readers for my ability to say this each and every day. In addition to reader contributions, I subsidize my work here through outside freelance writing.

New DSM Authors In Bed With Big Pharma

The Center for Science in the Public Interest reports that over half of the 28 new members of the DSM-V writing group have ties to the pharmaceutical industry (.pdf here). Well over half of the older authors already have been outed in 2006 for their ties to Big Pharma.

As I noted then:

"But the hell with the non-disclosures for a moment. Don't the 30 million to 60 million psych patients in this country deserve a health care system in which the bases of diagnoses are made independent of any conflicts with pharmaceutical companies? You bet they do. These researchers should be ashamed of themselves and so should the American Psychiatric Association, which publishes the DSM, for allowing this situation to persist. The APA promises that for the DSM's next revision in 2011 conflicts will be revealed. I have another suggestion: No one who receives a plug nickel from pharma companies should be allowed to particpate in any way in designing the DSM."

Somethings simply never change. (Via the NYT's Well blog.)

Chokeholds, Headlocks, Beatings In Texas State Hospitals

Thanks to a reader for passing along this account of reports indicating that 70 employees of Texas's state hospitals have been fired in recent years for openly beating patients. It's a complete outrage that such events were allowed to take place. While I know that state hospitals are very difficult places for employees to work (akin to prisons), there is little justification for such widespread abuse, especially considering that the patients are not dangerous criminals.

What's astonishing is that state employees were using chokeholds on patients. Almost every police department in the US banned the use of chokeholds in the 1980s after a series of deaths from the use of the procedure.

"The psychiatric hospitals, which have about 2,500 patients daily, had 137 confirmed abuse cases in 2007. The state schools for people with disabilities, which have twice as many residents, have an average of 300 confirmed abuse cases per year.

"But some advocates fear the mentally ill patients may face greater risks. Patients of the psychiatric hospitals are largely indigent, transient and not connected to their families, so they have few allies as they bounce through the mental health system.

"'It's a population that's easy to abuse because they're not on the radar in any way,' said Richard Hansen, a Texas mental health advocate who was chemically restrained, shackled and beaten to the point of broken ribs years ago while suffering from bipolar disorder in a New York mental hospital."

The whole thing is disgusting. How come the Treatment Advocacy Center isn't talking about this on its website? Cat got your tongue Fuller Torrey?

Study: Bipolar Disorder Overdiagnosed

Over the last few years, I've read assertion upon assertion by psych researchers that bipolar disorder is underdiagnosed in adults and that it's vastly more prevalent among American adults than standard estimates suggest. That's usually followed by the assertion that people simply must be diagnosed or their time on Earth will be filled with unnecessary strife and torment. Pharma companies such as AstraZeneca even developed websites asserting that many cases of depression could actually be bipolar disorder and even had a website called isitreallydepression.com, which is now no longer active.

Now comes a small contrarian study in the psych world by Mark Zimmerman, a psych prof at Brown University, to be presented tomorrow at the American Psychiatric Association's convention. In a survey of 700 people, 145 indicated they'd been diagnosed with bipolar disorder yet Zimmerman found that only 43.4 percent of those diagnosed with bipolar disorder had been diagnosed by a doctor using the Structured Clinical Interview for DSM-IV. Although the doc doesn't come right out and say it in a press release, it's clear that he thinks some docs are diagnosing people far too casually (it's not clear from the press release if the other 46.6 percent of "bipolars" later checked out as bipolar on the SCID). Check out what he ascribes the cause to:

"'Clinicians are inclined to diagnose disorders that they feel more comfortable treating. We hypothesize that the increased availability of medications that have been approved for the treatment of bipolar disorder might be influencing clinicians who are unsure whether or not a patient has bipolar disorder or borderline personality disorder to err on the side of diagnosing the disorder that is medication responsive.' He continues, 'This bias is reinforced by the marketing message of pharmaceutical companies to physicians, which has emphasized the literature on the delayed and underrecognition of bipolar disorder, and may be sensitizing clinicians to avoid missing the diagnosis of bipolar disorder.'

"Zimmerman concludes, 'The results of this study suggest that bipolar disorder is being overdiagnosed and we recommend that clinicians use a standardized, validated method in diagnosing bipolar disorder.'"

Classically, bipolar disorder was estimated to affect about 1 percent of the adult US population but that estimate was bumped up to 2.2 percent by NIMH a couple of years ago, mostly to account for the prevalence of bipolar disorder type 2. But there have been numerous other researchers who've pressed for a prevalence of 4 percent, 5 percent and even as high as 11 percent.

Either way, Zimmerman is flat out accusing his colleagues of using their gut hunches with patients and of diagnosing based upon a person's reaction to medication, a very dangerous bit of backwards logic often employed in children (the Harvard bipolar child mafia have argued that since the kids they diagnose with bipolar disorder respond to antipsychotics and other meds then that proves they have child bipolar disorder). And, let's be clear that he's saying that doctors--you know, those rational, god-like creatures who do things based on Science--are being softened up by all those pharma ads saying bipolar is wildly underdiagnosed.

It will be interesting to see what kind of response this study gets.

Thoughts?

AstraZeneca Releases Limited Seroquel Data For Depression

About two months ago, AstraZeneca filed three separate new drug applications with the FDA to have Seroquel XR--the extended release version of bad old Seroquel--approved as a treatment for depression as monotherapy, adjunct therapy, and maintenance therapy. I noted at the time that using antipsychotics for depression would represent an huge tectonic shift in treating depression and that it was odd that AZ hadn't released any efficacy data for Seroquel XR's performance versus placebo in treating depression (or Major Depressive Disorder, as AZ has it). AZ yesterday released limited performance data for the drug during a poster session at the American Psychiatric Association's convention. This data has not been published yet in a peer-reviewed journal, so I have no information to share on drop outs as well as whatever statistical methodology may have been used. So it's still Missouri time as far as I am concerned.

Here's the lowdown on the poster session:

1. "In a six-week, multicenter, double-blind study, 723 patients were randomized to receive SEROQUEL XR 50 mg/day, SEROQUEL XR 150 mg/day, SEROQUEL XR 300 mg/day, or placebo. At Week 6, all SEROQUEL XR groups had significantly reduced mean MADRS score versus placebo (-11.07): -13.56 (p<0.05) for 50 mg/day; -14.50 (p<0.001) for 150 mg/day; and -14.18 (p<0.01) for 300 mg/day. By Day 4, all SEROQUEL XR groups significantly reduced mean MADRS score versus placebo (-3.27): -4.91 (p<0.01) for 50 mg/day; -5.43 (p<0.001) for 150 mg/day; and -5.35 (p<0.001) for 300 mg/day. The most common adverse events (AEs) (>5% and double the rate of placebo in any SEROQUEL XR dose group) were dry mouth, sedation, somnolence, dizziness, constipation, back pain, irritability, and myalgia."

2. "In a six-week, multicenter, double-blind study, 446 patients were randomized to receive antidepressant (AD) plus SEROQUEL XR 150 mg/day, SEROQUEL XR 300 mg/day, or placebo. SEROQUEL XR 300/mg day plus an antidepressant showed statistically significant advantage versus placebo plus an AD for 1) change in MADRS total score at Week 6 (-14.70 versus -11.7; p<0.01); 2) improvement in MADRS from Week 1 onwards; 3) response (58.9% versus 46.2%; p<0.05); and 4) remission (42.5% versus 24.5%; p<0.01). For SEROQUEL XR 150 mg/day plus AD, improvements in these variables were not significantly different versus placebo, except for MADRS improvement at Weeks 1 and 2. The most common adverse events (AEs) (>5% and double the rate of placebo in any SEROQUEL XR dose group) were dry mouth, somnolence, sedation, dizziness, constipation, fatigue, and weight increased."

3. "In a time-to-event, double-blind, randomized-withdrawal, parallel-group, maintenance study, 787 patients were randomized to SEROQUEL XR or placebo and dose-adjusted as clinically indicated. The mean daily dose of study drug at randomization (last open-label dose) was similar for the SEROQUEL XR group (176.6 [95.5] mg/day) and the placebo group (177.9 [90.8] mg/day). In total, 89.0% (n=348) of SEROQUEL XR patients were receiving the same doses at study end as at open-label baseline, 5.1% (n=20) were receiving a higher dose, and 5.9% (n=23) a lower dose. The risk of a depressed event was significantly reduced for SEROQUEL XR compared with placebo suggesting increased time to event (HR = 0.34 [0.25, 0.46]; p<0.001). In total, 55 (14.2%) SEROQUEL XR-treated patients and 132 (34.4%) placebo-treated patients experienced a depressed event."

The basic story here is that Seroquel improved MADRS scores by about two or three points over placebo (if I am reading things correctly), and got about a 30 percent effect size over placebo (although I'll need the published study for a final number). Two or three points improvement on the MADRS scale doesn't really impress me much (it may impress others), especially given the many, many problems associated with the use of this drug.

But the Seroquel XR story at the APA doesn't end there. Researchers also rolled out data for the use of Seroquel XR in treating generalized anxiety disorder. AZ announced that it would file a new drug application with the FDA before the end of June seeking approval of the drug for treating GAD.

Here's my prediction: the FDA will soon approve Seroquel XR for use in treating depression (it's already approved for "bipolar depression"), AZ will market the hell out of the drug as a new wave anti-depressant for tough to treat cases, doctors will prescribe the drug (which is already well saturated in the marketplace), and soon enough the stories of even more patients packing on the pounds and unable to be wakeful throughout the day will come rolling in. Along with the stories of even more teens using Seroquel as a drug of abuse.

I hope I'm wrong but I doubt that I will be.

Terror War Vets' Suicides May Exceed Combat Deaths

That's a claim made today by Tom Insel, head of the National Institute of Mental Health, as reported by Bloomberg. Insel appears to be forecasting into a very grim future and using recent estimates that upwards of 20 percent of Iraq and Afghanistan vets are returning home with PTSD and are not getting proper care (and PTSD is tough to treat even with proper care).

"Based on those figures and established suicide rates for similar patients who commonly develop substance abuse and other complications of post-traumatic stress disorder, 'it's quite possible that the suicides and psychiatric mortality of this war could trump the combat deaths,' Insel said."

Insel made his remarks at the American Psychiatric Association annual convention, which opened today. To date, there have been 4,560 soldiers, sailors, airmen and marines killed in the two wars.

I have no way of sorting out if Insel's assessment of the situation is appropriate or simply fearmongering, but it is a wake up call. In case anyone has forgotten, this country has been dealing with (and paying for) the fallout of Vietnam War PTSD among vets since the 1970s. We need to do a better job of things this time out.

Author Wants Paxil Withdrawal Victims' Stories

In response to a post I did the other day on a bunch of British patients taking on the MHRA (Brit FDA) over how it handled the many problems with Paxil (Seroxat over there), I heard from a legit author who wrote:

"I'm writing a book about Paxil Withdrawal stories. I believe we can all see from this audio that there is not going to be any progress made by trying to 'reason' with MHRA so the only hope we have is to educate the GP's, psychiatrists, etc and get them to stop prescribing this drug needlessly. If you have a story regarding Paxil Withdrawal or suicide regarding Paxil withdrawal, please send it to my e-mail hart.shelly@yahoo.com.

"I'm a registered nurse married to a doctor of medical research/ public health director for the state of Arizona. We can make a difference by educating the public and the health care professionals. The organizations are completely unreasonable and unbendable. It is time for the general public to speak out and save the lives of others in the future. You might say it is time to 'pay it forward.'"

The author, Shelly Hart, and I have corresponded some today and I am beginning to understand why I am getting so many readers from Arizona: they even have three-year-olds on Paxil in Tucson. Wow, what doctor put a three-year-old on Paxil for what alleged disorder?

Anyway, those of you who are interested in helping out Hart should drop her an email at the above address.

To Hell And Back: College Student's Misadventures In The Mental Health System

I'm not even going to attempt to summarize "To Hell And Back," a very brave piece of writing by a University of Kansas senior, Thor Nystrom. In it, he lays out how he got sucked into the mental health system big time (he was already on anti-depressants and ADHD meds) after a fight (induced by a combo of Paxil and booze) and how he's now basically walked away from it. It's a long piece and its got "Wow" written all over it. Many diagnoses ensue (including borderline), as do many, many meds. One group home he was in sounds like absolutely everything that's wrong with the mental health system (another place doesn't sound quite so bad), and the poor guy ends up out of college, ballooning to 330 pounds, ditching meds (cold turkey even. Like I said, "Wow"), working off the weight, getting himself back into KU and graduating.

"I will graduate on May 18. The diploma’s text will read: 'Thor Reabe Nystrom, The University of Kansas, Major Emphasis in Journalism.' But that’s not everything it will say. That piece of paper will say: Determination. Resolve. Fight. Conviction. Purpose. Willpower. Persistence. Success. Failure. Happiness. Sadness. Life. Death. Blood. Sweat. Tears.

"A broken man will accept it. He will look at it, and he will whisper to himself that he doesn’t deserve it; to never, ever think that he does. But there will be another voice in his head telling him that he has never deserved anything more in his entire life."

I know exactly what he means.

A Puppy On Prozac

I ran across a fascinating account of a woman who put her dog, Scout, on Prozac at the urging of her veterinarian. Or maybe it was the new Reconcile, Eli Lilly's Prozac for pups. Anyhow:

"When I took Scout to the vet last week, he observed her extreme anxiety and OCD behavior. He thought that a sedative, like xanax or prozac, might help calm her and help her avoid relapse. So we started her a few days ago, and so far she's spazzier than ever. But the vet said it takes 3 weeks for the blood levels to adjust to the drug . . . So, my poor pup's on prozac! My prayer is that it relieves her separation anxiety and helps calm her during fireworks season. And that it doesn't douse her vibrant personality."

Ah, the vets are beginning to sound just like psychiatrists and PHPs, although I've yet to hear the serotonin hypothesis of canine anxiety yet. Let's hope Prozac doesn't kill Scout's spirit either. No word from leaders in the cat anxiety advocacy community on how they feel about dogs doped on Prozac. I have a hunch some cats would be all in favor of the forced medication of dogs and order that the public ignore dogs' complaints about side effects.

Joking aside, I continue to be fascinated with how psych meds are crawling into every corner of our culture. They are in your kid, they are in your grandma and they are coming for you and your dog too. It's also fascinating to hear a dog owner use terms like "relapse" to describe their dog. And, I say this as someone who grew up with a dog--that'd be Rascal, the greatest dog ever!--who went utterly nuts each Fourth of July. I cannot recall either of my parents describing the event as a relapse. We eventually had to start putting her in the basement for a few hours each year. Poor puppy!

Defining Terms And Thanks

First, I wanted to thank you all for the many kind comments in response to my depression post the other day. Let me just try to address them globally by saying a) my energy seems to be back; b) I attribute that to two long walks over the weekend, a sunny warm Sunday, being hypervigilant about getting six to eight hours of "quality" sleep a night and taking 5-HTP for a couple of days late last week (I'm not endorsing this for anyone else of course; it's the first time I've taken the supplement); c) the 5-HTP tip came to me from a very intelligent reader; d) someone asked about Lamictal: I've been there and think it's an OK drug, as these things go, but the withdrawal was a nasty affair; e) I actually told a ranking FDA official about the Lamictal withdrawal problem that many others have experienced when I interviewed him in February; dude wasn't real interested; f) thanks for the kind words about my work here.

Second, I appreciate the volume of comments (105 as I write this, yep it's a record) on my anti-psychiatry post of last week. It's actually been a decent discussion.

Third, in the last couple of weeks readers have left some interesting thoughts about the coercive and voluntary mental health system/s, and I made a comment back that makes me think I ought to poke at this some more. But I need help defining terminology. What is the coercive model of the mental health system? Is it just court-ordered treatment? Just involuntary commitment or jail? What is the voluntary model? And, what about what I called the subtle coercion of the mental health system, blending a voluntary patient response to doctors and families pressing people into compliance and treatment?

I'm interested in your thoughts on those terms.

Eli Lilly Funds Medscape, American Psychiatric Association, Harvard, NAMI National

Eli Lilly's report detailing the company's contributions to various health care organization and advocacy groups for the first three months of 2008 is out now--and it's a doozy. Among the top recipients is the American Psychiatric Association, Harvard University's Massachusetts General Hospital psychiatry department, Medscape and the National Alliance on Mental Illness (NAMI). You can read the report here. Keep in mind that these dollar amounts are for the first quarter of 2008.

The APA, which is the physicians group for psychiatry, got $623,190 from Lilly for three separate programs including something called "Using A Chronic Disease Model When Managing Patients With Severe Mental Illness." Mass General got $500,000 for its 2008 "Psychiatry Academy," whatever that might be. Oh, wait, it's a big old CME operation run by the psych department at Mass General, home of the bipolar child mafia and the medicate people into the ground alliance.

NAMI National got $500,000 for two programs, one entitled "In Our Own Voice" and another called the "Multicultural Action Center." Various NAMI local and state affiliates also got smaller contributions, as did local affiliates of Mental Health America and DBSA.

Medscape LLC got $175,000 for something called "ADHD--Optimizing Diagnosis and Treatment Through an Online Educational Continuum" and $205,000 for something known as "New Data in the Recognition and Management of Bipolar Disorder." Medscape is, of course, the huge and hugely influential medical information and news website. They need money from Lilly to talk about ADHD and bipolar disorder for what reason? Shouldn't they just cover ADHD and bipolar disorder and let the ad dollars flow to those pages? Why would they need seed money from Lilly? Perhaps these are articles they stick online as CMEs for docs, but I'm confused as to why, if docs are so interested in educating themselves about bipolar disorder, for example, they wouldn't just develop the materials themselves. Something smells very fishy to me here. Or maybe I am just old fashioned and would like to see medical information made available to doctors and the public that is untainted by corporate largess.

Continuing Medical Education LLC--that's the big CME company--got $604,375 for programs on ADHD, depression, bipolar disorder and fibromyalgia.

And, finally, one odd little item: An organization called the Mental Health Services Coalition got $6,000 for a program called "Mental Health Day At The Capitol." I cannot find this group listed on the Net, but I imagine this is a consumer "grassroots" group of some kind that got funding from Lilly to go lobby a state legislature on mental health issues. One can only wonder what these were.

As odd as this might sound to some readers, I congratulate Lilly for being transparent about who it gives money to, as required by a recent legal settlement. It would be interesting to see the contributions of companies Like Glaxo, AstraZeneca and Pfizer, as well.

Recording: British Paxil Users Meet With Brit FDA

Just hitting the Net right now is a recording of a group of British Paxil users, known as the Seroxat User Group (Seroxat is Paxil's name in the UK), holding a meeting with the head of the MHRA and some other government officials in the UK. The MHRA is their FDA. The levels on the recording aren't the best, but someone in the UK is cleaning up the audio and I'll post that later. I've only been able to listen to some of the beginning of the recording, but from what I gather the government officials get questioned on why they chose not to prosecute GlaxoSmithKline (which hid all sorts of bad data on the drug from regulators and the public) and about the connection between the drug and suicidality. Listen for yourself.

I'll try and post something later today if possible.

No matter what, I congratulate the Seroxat users for challenging the decision makers on drug regulation in this fashion.

Here's the audio:

Let me know what you think.

What I Did When I Got Depressed

I've been waiting a while to write this: in late March and early April, I was depressed and it wasn't one of those little two-day dips that I've grown accustomed to the last several years. This was the real thing: major depression. Two weeks of being stuck to the couch, sleeping 12 hours a day, barely able to eat at times (yet putting on weight!) and hardly able to write. It's a miracle that I managed to write posts here and I am sure they weren't very good. On the professional front, I had to contact one of the editors I write for and tell her that I simply couldn't pump out an assignment they wanted. It was dark and cloudy out, alternately raining and snowing, an endless Seattle winter. I had no one to hang out with mostly and was up against a host of midlife crisis crap: 45, unmarried, unattached (women in Seattle simply don't care for men like me), no prospect of ever having a family and my news reporting career basically over (that's true, it basically is), and I was staring at a future where I cannot pay off my debts, I have no health insurance and all that fun stuff. Somewhere in there, I interviewed for a job outside of journalism, was told I was a fine fit for what they wanted and was then told the next week that I was not a good fit. By email. At nine p.m. Nice touch.

I never get depressed in March, but all of those things working together sure sealed the deal. They are the kind of things that make grown men (and women) put guns in their mouths and pull the trigger or jump off a bridge or what have you. I'm not being dramatic here. Men and women in their 40s off themselves at a remarkably high rate, the men especially. I understand why they get there. Fortunately, I don't get suicidal anymore (haven't in years) and the thought never crossed my mind, but it was a very rough go otherwise. In fact, it was the single worst bout of depression I've had since 2003 at least. Despite the fact that I manage to handle the little squalls of depression I sometimes get very well (I've largely been free of them since 2005), the black dog was coming around to let me know who's boss. And it is. I couldn't even listen to music and when that happens I know that shit is fucked up.

Ironically, I had just finished reporting and writing a piece on Erick Turner's paper on the inefficacy of anti-depressants and there I was depressed off my ass, or onto my ass, waiting for the darn thing to run. Somewhere in there I was scheduled to see my psychiatrist, who I only see ever three months now. I called his office and canceled the appointment.

I knew what would happen if I went in and was honest about what was up. We'd have a nice chat about whether I wanted to be on meds, what meds I would be on and for how long. And I would probably end up telling him that since I've been off meds nine months, I wouldn't be going back onto them. I didn't want to have that talk. Besides, let's say I went in and saw him and he talked me into to taking pill X. Let's say pill X worked like magic right out of the chute. I'd be undepressed but still not able to get full-time work. Nothing about my life would be resolved. Just how I felt about it. That's an empty game.

Back in the day when I got depressed and life started dragging like a wagon missing a wheel, I would hightail it to my psychiatrist (whomever that was at the time) and there would be a med switch. Or a dose increase. Or something. And, then, six months later, I'd be back, depressed, and we'd do it all over again. By the standards of manic depression (and that's still my official diagnosis), I was the king of unipolar depression. That's how I got on so many meds over the years and so many combinations of meds and I've paid a very high price for all of that. I'm pretty sure I am still withdrawing from all those years of meds, or my brain and body are readjusting and I simply cannot go down that road again. With the experiences I've had, anti-depressants scare me. I could maybe pop a small dose of Seroquel for a day or two and see if that flipped the switch back the right way, but I wasn't down for that either. The Seroquel fog is not a party.

One day, I sat on my couch and that all hit me. When it comes to meds, I was out of options. They either don't work for me particularly well or mess me up over time. As much as I'd love to trot off to a therapist and see if there is any voodoo for me in CBT, well that was not going to happen either. No money will do that to a guy. Rent and food and such do come first.

I've been in the clear more or less for three weeks now. I'm not 100 percent. My energy is low and some days I simply have to force myself to write. I've never had to force myself to write since I was 19. I don't know if this is some kind of lingering trait of depression or if the low energy is due to withdrawal from long-term use of psych meds or what is up. I just don't know and neither do the docs. Oh, they'll call it depression--or minor depression now--and suggest that I get all doped up on something. But why at this point would I go back on their drugs when I know how rough it is to get off them later? Or, why would I stay on them for a lifetime when I know they don't stop depression for me? For me, the miracle anti-depressant doesn't exist.

So, yeah, I rode things out as best I could.

A week ago, I was talking with a friend of mine about this on the phone. "Aren't you proud that you didn't go to the doctor and get medicated?" she asked.

"No," I said. "I'm relieved, but not in a happy way."

And that's kind of where things stand. I'm OK, but dragging. Maybe it's the lack of sun. It's been ugly and cloudy here in Seattle (still!!!) and I just cannot get my motor going no matter how hard I try, no matter how attentive I am to eating and vitamins and so on. Maybe my sleep isn't the best, but I've had several nights in a row of solid, eight-hour snoozes. Maybe I'm still in mourning for a career I will never get back (and I won't. News reporting has gone out of fashion in our culture. People only want mouthy opionistas and feature articles that make them feel good and I ain't neither of those kind of writers. OK, I have mouthy opinions about mental health issues, but that is clearly something the mainstream media--you know, the people who pay people salaries to write and report--is definitely not interested in. Unless you are pimping for the mainstream). Who knows?

And that's just it--no one ever knows.

Iraq War Vet Another Chantix Success Story

OK, the hed is sarcastic because yet another person trying to stop smoking by using Chantix (Champix elsewhere) wound up depressed from using the drug, had erratic social behavior (meaning the drug made him angry) and so on. In this case, the man is an Iraq War vet and was told by his VA doctor that Chantix worked 80 percent of the time. While I doubt it works that often, it does work for a decent number of people (including friends of mine). But in a large percentage of people Chantix is clearly causing problems, including reported suicides and cases of suicidality and depression. What a weird drug this has turned out to be. I've said it before, but here it comes again: Chantix is like Paxil's kid brother.

People have got to be careful with this drug. That's for sure.

Which raises a dilemma for me. Let's say I want to stop smoking cigarettes. Would I dare take Chantix knowing what I know about the drug's possible effects and knowing my own history of icky responses to SSRIs and how Chantix seems to have weird effects particularly for people who've had bad responses to anti-depressants in the past? What would I say to a doctor who was pushing it on me? Thanks, but no thanks.

Vermont State Leaders Call For Investigation Of Antipsychotic Use In Kids

Yesterday, Vermont's Lt. Governor and Senate President said the state needs to begin investigating why antipsychotics are being used so much in that state's children.

"Shumlin [Senate President] said the state needs to get active in stopping the sole reliance on antipsychotic medications for treatment of children and teenagers, just as law enforcement has cracked down on the use of these drugs for recreational use.

"'It should shock us all that we as a state have allowed and accepted that we are using powerful psychotic drugs on our children at an alarming rate,' said Shumlin, a Democrat from Windham County."

In a six-month period last year, the state's insurance program spent over $10 million on antipsychotics for people aged under 18, and about 6,200 kids and teens under 18 are being prescribed at least one psych med. That's a lot of dope in a lot of kids in a state that doesn't have a lot of people to begin with. I'm glad political leaders in the state are asking what the hell is going on here--as they are also starting to do in New Jersey--and I look forward to the answers they get.

How much do you want to bet that a lot of these kids on antipsychotics are going to turn out to be boys diagnosed with ADHD?

Thanks For The Hits

This site came achingly close to breaking its monthly hits record in April, but that's encouraging. The record was set in February and that was a very busy news month--NIU shooting, therapists stabbed to death in NYC, big studies criticizing anti-depressants, etc.--while April was a more normal month. Thanks to all of you for reading.

I'll not post much today because I am working on an outside project today and was simply too exhausted to write last night.

Have a nice May Day.