From a new paper in Psychiatric Services comes a survey from the U.S. General Social Surveys that will probably send chills down the spines of many readers and gladden the hearts of pharma execs everywhere:
"RESULTS: Public opinions regarding benefits of psychiatric medications became more favorable between 1998 and 2006. More participants in 2006 than in 1998 thought that medications help people to deal with day-to-day stresses (83.4% versus 77.8%), make things easier in relation with family and friends (75.9% versus 68.4%), and help people feel better about themselves (68.0% versus 60.1%). The public expressed a greater willingness to take medications in 2006 compared with 1998 for trouble in personal life (29.1% versus 23.3%), to cope with stresses of life (46.6% versus 35.5%), for depression (49.1% versus 41.2%), and for panic attacks (63.7% versus 55.6%). Opinions regarding the risks of medications did not change between 1998 and 2006."CONCLUSIONS: Americans' opinions toward psychiatric medications became more favorable over the past decade, and people became more willing to take these medications. These changes have likely contributed to the increased use of psychiatric medications in recent years and will continue to do so in the coming years."
Those are the words of a true drug pusher. And then this from the paper's conclusion:
"Traditionally, negative attitudes have been among the greatest challenges in treatment of common mental health conditions in the community. Therefore, a more favorable public attitude toward mental health treatments in general, and psychiatric medications in particular, is a welcome development. However, with the increasing public acceptance of treatments, psychiatry faces the new and growing challenge of educating the public and providers to correctly identify conditions that merit the use of psychiatric medications and to distinguish these conditions from self- limited stresses of daily life that do not require medication treatment."
I suspect that the way psychiatry is going these days there will soon be very few "conditions" that are considered due to natural stresses of life and that don't require medication. It disgusts me that Americans seem just fine with this trend.
The Bazelon Mental Health Center, based in Washington, D.C., and Disability Rights New Jersey yesterday announced a landmark settlement with the State of New Jersey under which approximately 300 psychiatric patients in state psychiatric facilities will be released from those facilities and be provided with housing and services in the community. These people are already medically cleared to leave state hospitals--to be uncommitted in essence--but since the state couldn't find housing for them in their communities (or didn't want to find them housing), they were being held for a year and longer at state psych facilities in a kind of weird and cruel legal limbo.
Under the US Supreme Court's 1999 Olmstead ruling, patients who are stable and deemed able to leave state psychiatric care, and who want to live in the community, are supposed to be able to leave the facilities with the state obligated to provide them community-based housing and supports. New Jersey was in violation of Olmstead and the above-mentioned groups sued the state.
I congratulate the people at Bazelon and Disability Rights New Jersey for striking an important blow for the freedom and decent treatment of the mentally ill.
The reality is that this kind of situation exists all across America and it is disgusting and inhumane. I wrote about a similar group of patients caught in the same net in Washington State in Seattle Weekly in 2004.
It hit 103 degrees in Seattle yesterday--smashing all previous heat records--and my apartment continues to double as a sauna, so I'll hope to get some new posts up when things are a bit cooler in the morning (since it's about 85 in my apartment as I write this). Today promises to be in the high 90s.
It amuses me that in the seven years I've lived in Seattle I have witnessed the city's hottest day ever, its hottest night ever, the 24 hour period with the most rain, the month with the most rain ever (17 inches or so) and, this past winter, some of the most intense snows this city has seen. Hopefully, all this record setting heat goes away soon and life can get back to normal.
Seattle has been going through quite the heat wave this week and today is expected to top the all-time record (going back to the 1850s) of 100 degrees. While that may not sound like much to some of you (and God knows I've lived in hotter places), only 13 percent of housing in this city has air conditioning and, aside from newish office buildings and grocery stores, many business lack a/c as well. It really takes things down to a raw survival level.
All of which is to say that my apartment is a bloody sauna and will be for the next few days--and there's virtually no way to escape it except for brief trips to the supermarket. Posting will be sporadic the next few days.
There was a flurry of attention yesterday in the business press around the still-awaiting-approval drug Saphris (asenapine), an atypical antipsychotic made by Schering-Plough. In briefing documents, the FDA's psychiatry products chief Thomas Laughren said that the company had demonstrated effectiveness in trials of the drug as a treatment for schizophrenia and that it was about as safe as other atypicals. Which is to say not very safe at all, given the well-known problems with drugs like Zyprexa and Seroquel.
It sounds as if the drug is on its way to FDA approval for schizophrenia.
What's troubling to me is this posting from the blog Shearlings Got Plowed, which tracks problems at Schering-Plough, identifies an internal FDA email showing an FDA reviewer who in 2008 recommended that the drug not be approved, cited safety problems with the drug (hypertension, cardiac effects) and stated that officials at S-P knew about "toxicity and specifically tried to prevent our [FDA's] detecting it."
So this sounds like a perfect drug for FDA approval and a perfect opportunity to repeat the misdeeds of the other atypicals: approval for schizophrenia, drug declared best thing since sliced bread, drug off-label marketed for depression and agitation, a few years later the tales of patients dying and being injured show up, and so on. I cannot wait.
I just wanted to note this column in the Los Angeles Times that picks apart a new PR campaign by the Church of Scientology. I haven't seen the ads myself, as they seem to be running in the LA Metro area only.
"And yet, as splendid as these spots are, I do have a couple of questions: What if you're not good-looking? Nearly everyone in these ads is pretty, handsome or better."And some of these dewy, dreamy creatures are downright distracting, they are so beautiful. Does Scientology offer hope to the plain? What about the homely? Or should they stick with Catholicism?
"I'd also note that almost everyone in these ads is under 30. Now, reasonably, this is an age group that is more susceptible to the message, still searching, still curious, still credulous. However, it is also much less likely to be affluent. If money was important to my client -- and money, it seems, is truly the dark matter that binds Scientology's universe -- I'd pitch to an older and better-heeled crowd.
"These ads might recruit only an anguished army of baristas and part-time shoe clerks."
Methinks Xenu likes coffee and loose shoes.
An Australian woman named Rebekah Beddoe became pregnant, delivered a child, began suffering from post partum depression, went to a doctor who put her on Lustral (Zoloft) and she started experiencing anxiety and panic attacks. It gets more fun from there:
"There followed a meeting with my psychiatrist. He assured me that depression and anxiety very often went hand in hand. My dosage of Lustral was increased and, by now, Valium was being thrown into the mix. What I know now (and didn't realise then) was that many of the side-effects of anti-depressants are the same as the symptoms of depression."I have strange recollections of the period that followed. I blocked out a lot of what happened, and only really found out the full extent of what went on later when I had the chance to refer to my medical records. I was referred to Ashgrove Private Hospital, which deals with those suffering from extreme cases of post-natal depression. My condition worsened, and I was placed on stronger drugs, which included the tranquilising drug Xanax. I considered self-harm, and became a suicide risk. I was transferred to Fernview, a major psychiatric hospital close to my home in Melbourne, and before long I became incapable of making rational decisions. I was even given electro-shock therapy. I ended up on a complicated cocktail of drugs including Prozac, Xanax, Zyprexa (which is used to treat schizophrenia), Dutonin (another anti-depressant) and sleeping pills. I was later put on Lithium, and several tranquilisers."
She eventually had to take matters into her own hands and withdrew herself from her meds and is fine today--a cautionary tale for proponents of anti-depressants for post partum depression.
There's a fascinating article on Der Spiegel's website concerning a Swiss psychiatrist who is experimenting with LSD to see if it reduces fear in patients facing terminal illness. Very interesting.
Back in the 1960s, LSD was used by some psychiatrists as a gateway to intense psychotherapy, but the compound has since been banned in the US. I have no opinion, in case anyone wondered, about LSD's use in therapeutic settings. It's one of those things I simply don't know enough about.
After 12 years of DTC advertising of prescription drugs on TV and elsewhere, several members of Congress are proposing limits on TV ads. One wants to ban erectile dysfunction drug ads during prime time, Rep. Henry Waxman (D-Calif.) wants to ban DTC advertising of new drugs until they've been in the marketplace for some time, while another Congressman wants to stop drug companies from deducting the cost of DTC advertising on their taxes. All very interesting and all likely to go nowhere, given the epic power of pharma in Congress and the interests of the mainstream media, which makes billions a year off the ads.
Nonetheless, it is interesting to see some lawmakers pushing back against pharma.
In an email today, Jim Gottstein, president of the Alaska-based PsychRights group, announced the opening of the new Soteria-Alaska project. The project is modeled on the now-defunct Soteria House in California. Explains Gottstein:
"The original Soteria House proved that outcomes for people diagnosed with schizophrenia could be dramatically improved if a psychosocial approach was used instead with neuroleptics used as a last resort and stopped as soon as possible when they were used."
While there was some controversy about client outcomes at Soteria House, which closed in 1983 due a lack of funding, I've long felt the model looked promising enough for it to be tried again. The US spends many billions of dollars a year in taxpayer funds through Medicaid and Social Security disability and other programs for the care and treatment of people diagnosed with schizophrenia but we are seeing terrible clinical outcomes for some people including greatly reduced life spans due to the effects of medications. That kind of situation argues that some other system of care and rehabilitation should be tired, at least on a pilot basis, to see if other approaches might not work as well or better.
The Alaska project opened with two clients, but plans to accept others as soon as its state license is approved. I congratulate everyone involved in the effort to make the new Soteria a reality. I hope it works.
There are several other Soteria-style projects in Europe. A lengthy report on the original Soteria House authored by its founder Loren Mosher can be found here.
Wyeth yesterday announced its second quarter results and once again failed to detail sales of its new and heavily-advertised anti-depressant Pristiq. The company only noted in its announcement that the drug had "higher sales," but offered no sales data. That's better than earlier this year when the drug hardly garnered a mention in earlier financial reports.
What this means is that the metabolite of Effexor--which rang up over 700 million in sales in the second quarter--isn't generating enough sales figures to even be worth mentioning to investors. So much for the creepy wind-up doll ads.
Second quarter financial results are out today for Bristol-Myers Squibb and the results for its atypical antipsychotic Abilify are astounding: worldwide sales of the drug reached $643 million in the quarter, an increase of 22 percent over the previous year. US sales were $518 million, a startling 29 percent increase over the second quarter of 2008. All of which is proof that the company's Abilify as an anti-depesant advertising has paid off handsomely for BMS.
As for patients, well that's another story.
Last evening, President Barack Obama delivered a press conference in an attempt to salvage health care reform. It didn't work. His answers to questions were rambling at times and far too professorial at other times (and still lacked some much-needed details) and I walked away from the whole affair fairly confused about where reform efforts are headed. It seems to me that the President and many in his own party are at-odds with one another and that doesn't often spell success.
I fear that health care reform is headed either for failure--which would really disappoint folks like me who have no insurance--or it's headed toward a watered down plan that will cover some but not all without insurance and that President Obama and the Democrats will call it victory.
It's a measure of just how frustrated people have become that even MSNBC was criticizing the President last night--and that's the first time I've seen that on the Obama-loving network. That tells you something.
The Wall Street Journal is reporting today that Eli Lilly is in "advanced discussions" with attorneys general from several states--presumably ones like Utah and Connecticut--who've sued the drug maker, alleging that the company illegally marketed its antipsychotic Zyprexa. There's not much news beyond that.
Lilly has already settled about $2.7 billion in claims relating to Zyprexa and pled guilty to a criminal charge in federal court in January.
I've been following with much interest patient reports concerning the new anti-depressant Pristiq, actually little more than a metabolite of Effexor. Yesterday, a reader commented:
"I took Pristiq for 3 months and it has been the worst 3 months of my life! Side effects started during 3rd week and included severe nausea, dizziness, fatigue, headaches, night sweating, irritability, weight gain (+15 pounds), vivid dreams, head noises (ch ch sound), and confusion/concentration issues. Have intermittent episodes of these symptoms and have missed lots of work. Withdrawal is even worse (on day 4) and completely bed-ridden. If anybody else is experiencing this, please fill out MedWatch form to complain to FDA at https://www.accessdata.fda.gov/scripts/medwatch/medwatch-online.htm This drug should never have been approved!"
I think I'll just let all of that speak for itself.
A new study in the Journal of Clinical Psychiatry identifies that many thousands of veterans in the VA system are being given antipsychotics for the treatment of depression, a finding that is startling and unsettling. CL Psych had some thoughts on all of this the other day.
From the study:
"RESULTS: Altogether, 20.6% of veterans with MDD received antipsychotic medications, and 43% of those who did received them at the higher doses recommended for schizophrenia. GEE models showed that younger age, male gender, psychiatric comorbidities, duration of diagnosed MDD, and more intensive mental health service use were all associated with greater likelihood of receiving antipsychotics and with less likelihood of receiving them at conventional antipsychotic doses."CONCLUSION: Antipsychotic medications were commonly used in the treatment of MDD prior to FDA approval, especially in the presence of comorbid mental illness and longer term MDD. Further research is needed to evaluate the long-term safety and efficacy of these medications in combination with antidepressants."
Keep in mind this study covered people in the VA system in 2007 and the most widely used antipsychotic for depression within the VA system was Seroquel. But Seroquel isn't approved for treating depression (it is approved for bipolar depression), so this is a very high level of off-label use by the VA and sure makes me curious if there's been any off-label marketing going on by AstraZeneca, which was dinged by the FDA last December for off-label marketing of Seroquel for depression, or what circumstances led the VA to adopt Seroquel and other antipsychotics for use in depression when the available evidence suggests that these drugs are neither particularly safe or efficacious in treating depression.
In other words, I smell a rat.
I cannot thank enough the many readers of this site who left such kind comments in response to my post on my second anniversary off-meds. I got several emails as well and I appreciate them too, especially since I was spending the day working as a poorly paid reporter and wondering where all that will end up soon. I'll know soon.
I'm sure a few of you are well aware of the reduced volume of posts here. That's happening only partly because I've been working close to full time the last two weeks or so. The other reason is because there simply hasn't been much news on the mental health front, something I suspect is driven by Summer itself. I doubt that the lack of news lasts long, because it almost never does.
Anyway, I hope to have another item or two up later today.
As I did last year, I wanted to publicly note my anniversary--this year is the second--of being off-meds. Yes, that's right: I've made it two years, despite the naysayers who told me I'd wind up dead or in the hospital, medicated to the gills. Looks like they were wrong. I'm in pretty good shape and haven't had a lick of anything that would register on any clinical scale in a long time.
So two years after my psychiatrist talked me into going off the last of 18 years of psych meds, my case establishes one of four things: that I was a bad diagnosis back in 1989 and was never bipolar at all; that bipolar disorder burns out over time; that I'm a medical miracle of some kind; or, that I am a sick, delusional man, soon to be hospitalized. I lean towards the bad diagnosis and burns-out-over-time options myself.
Either way, I don't consider myself bipolar any longer and I doubt that a single psychiatrist or psychologist would diagnose me with anything these days. Somehow that smells like victory.
Truly, I wish I had some wisdom about all of this, but since I don't know of too many other cases like mine, I'm kind of on my own when it comes to extrapolating any meaning from all of this. Sure, I can say that I had years of medications that I didn't need, but that's easy to conclude. The bigger question is what do cases like mine mean for psychiatry itself. What do they mean for other patients? I wish I knew these answers but, for now, I just know that the questions are there.
Most of you are familiar with the excellent blog Beyond Meds and the rough go its author, Gianna Kali, has had withdrawing from decades of psych meds. Kali has announced that she's gone on a hiatus from blogging:
"I’ve stopped updating the blog to finish my detox and healing without the scrutiny of the public which has simply became too much. The end of withdrawal is generally recognized to be the most difficult and it’s been almost 6 years of withdrawal for me."
For whatever reason, her site began attracting a bunch of stalkers and haters--mostly from the anti-psychiatry world, oddly enough--and it's all become a bit much for her to deal with. I wish her well and look forward to her return someday.
I think her site is an important resource for people having issues with meds and withdrawal (I've learned a lot from her) and I think she deserves everyone's respect.
An article in today's New York Times reports on a study out of the San Francisco VA/UCSF that the prevalence of mental disorders among Iraq and Afghanistan War veterans is discouragingly high.
"The researchers found that 37 percent of those people received mental health diagnoses. Of those, the diagnosis for 22 percent was post-traumatic stress disorder, or PTSD, for 17 percent it was depression and for 7 percent it was alcohol abuse. One-third of the people with mental health diagnoses had three or more problems, the study found."
War is surely Hell.
Via the Indianapolis Star's Take After Meals blog comes word of a study by researchers at UC-Riverside, published in Social Psychiatry and Psychiatric Epidemiology, which lays to rest the longstanding claim that most suicides occur on Mondays. As it turns out, Wednesday is the most common day for suicide at 24.6 percent of all suicides in America from 2000 to 2004. Monday came in third at 14.3 percent.
Summer is the most common season for suicide--a fact long known to researchers--at 26 percent of all US suicides. It's followed closely by Spring at 25.8 percent.
What all of this might mean to clinicians and patients isn't obvious to me, but it does add an interesting bit of information to the realms of suicidology.
The above blog's author saw the findings in a local light:
"[U]nderstanding the triggers of suicide could help companies like Indianapolis drugmaker Eli Lilly and Co. treat it more effectively."
Yes, I can see the TV ads from Lilly now. "It's Wednesday and you are in mortal danger of killing yourself today. Please take your Cymbalta right now."
Starting with Sunday, the suicide percentage of each day of the week played out thus: 11.8, 14.3, 12.7, 24.6, 11.1, 11.2, 14.4.
Autumn suicides were 23.8 percent of all suicides and Winter's were 24.4 percent.
The FDA today issued a new set of warnings for the non-stimulant ADHD drug Strattera, made by Eli Lilly. I'll just quote the FDA's new language:
"Severe Liver Injury"Reported cases of liver injury occurred within 120 days of initiation of atomoxetine [Strattera] in the majority of cases and some patients presented with markedly elevated liver enzymes [>20 X upper limit of normal (ULN)], and jaundice with significantly elevated bilirubin levels (>2 X ULN), followed by recovery upon atomoxetine discontinuation.
"Effects on Blood Pressure and Heart Rate
"Orthostatic hypotension and syncope have been reported in patients taking Strattera. Strattera should be used with caution in any condition that may predispose patients to hypotension, or conditions associated with abrupt heart rate or blood pressure changes."
The FDA also approved updated language for the drug's adverse reactions labeling, including warnings that the drug can cause lethargy, hypoaesthesia (loss of skin sensitivity), paraesthesia (tingling), sensory disturbances, urinary hesitation and urinary retention.
None of which can be good news for Lilly and its drug.
Most of you recall the completely unconscionable mistreatment and June 2008 death of Esmin Green, a patient at the Kings County Hospital Center’s psychiatric emergency room in New York City. She was diagnosed with schizophrenia, involuntarily committed, then was basically left unattended and unexamined for 24 hours and surveillance video, which I won't link to here, showed her tragic death, reportedly from a blood clot. A New York grand jury is now looking into the case and may potentially return criminal charges against nurses and doctors who failed to offer her even the most minimal of care.
While they likely cannot be charged with murder, since the death was not a homicide, they could be charged with criminal negligence and other offenses. In my opinion, they should all lose their medical and nursing licenses as well.
Read the above-linked New York Times article for details of an investigation into the incident and you'll see just how outrageous these doctors and nurses behaved.
A study out recently in Bipolar Disorders shows that Seroquel failed to beat, and was in fact beaten by, placebo in treating depression in 32 adolescents aged 12 to 18 and diagnosed with bipolar disorder type 1 who were given Seroquel for eight weeks or were given placebo:
"Results: There was no statistically significant treatment group difference in change in CDRS-R scores from baseline to endpoint (p = 0.89, effect size =−0.05, 95% confidence interval: −0.77–0.68), nor in the average rate of change over the eight weeks of the study (p = 0.95). Additionally, there were no statistically significant differences in response (placebo =67% versus quetiapine = 71%) or remission (placebo = 40% versus quetiapine = 35%) rates, or change in HAM-A, YMRS, or CGI-BP-S scores (all p > 0.7) between treatment groups. Dizziness was more commonly reported in the quetiapine (41%) than in the placebo (7%) group (Fisher's exact test, p = 0.04)."
Sixty-seven percent is a high placebo response rate, and the study group is a small one, but then again we keep running across studies of treating teen depression where placebo responses are very high. It's something researchers have tried to explain away with little success.
I wonder how many teens in this country are being given Seroquel off-label (it's currently only approved for adult use) for depression and bipolar depression and having a huge placebo response while taking a fat-producing, diabetes-inducing drug.
Oh, yes. The study authors included the University of Cincinnati's Melissa DelBello (subject of an investigation by Sen. Charles Grassley for undisclosed pharma ties) and Stanford's Kiki Chang. I don't think I've ever seen either of the pair produce a study that was negative for the study drug, so this is news.
Prompted by a recent article in Time that examined the question of whether all expectant mothers should be screened for depression, Emory University psychiatrist Doug Bremner offers his thoughts:
"The problem with this is the attitude that being a mother is a risk factor for a psychiatric disorder. First of all, there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum depression. So to screen all moms as if giving birth is a risk factor for depression is ridiculous. And whenever you start screening the general population, you get into problems with over-identification of people and an increase in the number of people that go on antidepressants. I am opposed to mandatory screenings of the population, like Teenscreen, which are bonanzas for the pharmaceutical industry, but a major intrusion into the privacy and autonomy of American citizens. In the case of Melanie Blocker-Stokes, she had already been treated with multiple courses of psychotropic drugs and electro-convulsive therapy, so there is no reason to think that her life would have been saved by “screening”. This legislation is typical of much that comes out of an individual tragedy, that results in an intrusion into the personal lives of individuals and the further relinqueshment of individual freedoms to the government."The article quotes psychiatrist Katherine Wisner MD as stating 'how can you be opposed to something that will help mothers?' But an examination of the fine print from one of her articles here [linked on Bremner's site] shows that she is on speakers bureaus for Pfizer and Lilly, makers of Zoloft and Prozac, respectively."
Well isn't it classic that the magazine quotes someone as an authority without noting their alliances with pharma companies?
As for the Mother's Act itself, I really don't feel like getting kicked around all over again, so I'll let Bremner's opinions speak for themselves.
Last month, I wrote of yet another case of Seroquel's growing popularity as a street drug in connection with the shooting death of a man in Massachusetts and, given how many of these Seroquel as street drug stories were popping up back there, I wondered aloud why no one in the media was taking a look-see at the phenomenon. "Um, hello Boston Globe" is how I put it at the time.
I have no idea whether anyone at the paper reads this site, but today the Globe has an interesting article on the Seroquel as street drug phenomenon in Massachusetts. The take-aways are: it's mostly being used as a sedative in pill form back there; many of those using it that way are recovering addicts or people who were first given the drug in an institutional setting as a sedative; the DEA isn't even tracking the drug's use on the street, which strikes me as naive on the agency's part; the phenomenon is indicative of the wild off-label use of psych meds; and AstraZeneca issued, as you might expect, a stirring defense of its antipsychotic:
"'Unfortunately, drug abuse extends not just to illicit substances, but also to medicines that are safe, effective, and necessary when used according to doctors’ prescriptions and advice,' said Kirsten Evraire, a spokeswoman for the company."
It's "safe, effective, and necessary when used according to doctors’ prescriptions and advice?" Sure, that's why AZ is being sued like crazy for lying about problems with the drug, which turned in revenues of $4.4 billion in 2008.
It's interesting to me that the article didn't get into the matter of people crushing and snorting Seroquel, but perhaps that's more popular elsewhere in the US. The article does contain an error of fact when the reporter writes "Seroquel debuted 12 years ago as a novel drug for adult patients with schizophrenia and bipolar disorder." When Seroquel hit the world in 1997 it was only approved by the FDA for use in schizophrenia. Its acute mania indication did not come until much later.
For the next three weeks I will be working as a reporter once again in Seattle for the Seattle Post Globe, a news website that sprang up following the closure of the Seattle Post-Intelligencer in March. The pay isn't good, but I'm willing to roll the dice on the future and work damn hard to see that the Post Globe succeeds.
This does not mean that this site is going away. What it does mean is that I will be struggling to find a balance between doing two jobs at the same time. Hopefully, I can find said balance and not end up in a puddle at the end of July.
A study is just out in The Lancet and it is making an interesting and somewhat bizarre claim: that the atypical antipsychotic Clozaril, long out of favor especially in the US due to safety problems, is in fact safer for people diagnosed with schizophrenia than are perphenazine, Seroquel, Risperdal and Zyprexa. All of these drugs have huge problems and sorting out which is safer is about like asking which brand of handgun kills fewer people. I'm also a bit surprised at how Reuters and Bloomberg have cast their stories on the study, but I'll get to that in a minute.
Here's Reuters:
"Clozapine was the first of a new generation of schizophrenia drugs, known as atypical antipsychotics. But its use has been restricted by health authorities because of safety concerns and patients taking it require regular blood tests."Despite this, an analysis of 10 years' records for 67,000 patients in Finland found that, compared to treatment with the first-generation drug perphenazine, the risk of early death for patients on clozapine was reduced by 26 percent.
"By contrast, mortality risk was 41 percent higher for those on Seroquel, known chemically as quetiapine; 34 percent higher with Johnson & Johnson's Risperdal, or resperidone; and 13 percent higher with Eli Lilly's Zyprexa, or olanzapine.
"'We know that clozapine has the highest efficacy of all the antipsychotics and it is now clear, after all, that it is not that risky or dangerous a treatment,' study leader Jari Tiihonen of the University of Kuopio said in a telephone interview.
"We should consider whether clozapine should be used as a first-line treatment option.'"
Let's be clear about one thing: these drugs are not safe for many patients who take them or are forced to take them, so arguing about which one causes less early death is a bit specious, since they all cause early death in some patients.
In the Reuters article, the researcher claims that due to restrictions on Clozaril's use in the UK and Europe (there are no official restrictions on it in the US, although its use is very limited here) many thousands of people diagnosed with schizophrenia died who would otherwise be alive if they had taken Clozaril. That's a pretty fishy argument. While I don't question what the Finnish data showed the Finnish researchers, that data doesn't line up with experiences in America.
The FDA adverse events database shows 3,257 reports of death from Clozapine (most of the database information for that drug is under its generic name) and that database only goes back to the fourth quarter of 1997. There other deaths connected with Clozaril that occurred before late-2007, but I don't know how many there were even though from about 1990 through 1995 was when Clozaril was being used the most in this country. It's probably a safe bet that 1,000 or more people died before late-1997. So figure 4,200 or so deaths.
Here are totals from the FDA's adverse events database for deaths tied to other antipsychotics:
Seroquel: 2,139.
Zyprexa: 3,442.
Risperdal: 2,827.
While I don't know the ages of all the deaths, the fact that we're seeing more deaths with Clozaril than with the other main antipsychotics in America makes me wonder about the efficacy of the Finnish data. It also makes me wonder about how many brain cells some of my colleagues in the media have because, as did Reuters, Bloomberg also cast this study as making the case that non-Clozaril use led to deaths and that this somehow all reopen discussions about using the drug.
Please.
This is just disgusting: a South Saint Paul, MN woman allegedly used overdoses of the antipsychotic Seroquel to poison her son and a daughter in addition to herself. Mom and the daughter survived, the son died. Now, mom stands accused of murder and attempted murder.
It's not clear why the mother had Seroquel in the first place, but it is clear that the widespread use of this drug is bearing some stranger fruit.
As I mentioned the other day, I've been working on an article on a tragedy that occurred in my neighborhood last month. The article is online now and involves a nice, older man who I barely knew named Stuart Thayer. As it turns out, he was a World War II hero, Purple Heart recipient, a historian of the American circus and all kinds of things. He was killed by a motorist who ran him over when he was crossing the street I live on on June 15.
Via If You're Going Through Hell Keep Going comes news that the State of New Jersey has decreed that patients--and presumably employees--will no longer be allowed to smoke on the grounds of its state psychiatric hospitals. It's a move that strikes me as unfair on a number of grounds and, if Washington State's experience with a similar ban at its state hospitals is any guide, it's a move that will eventually be reversed.
While I get the state's point that smoking isn't healthy for patients, for it to make the argument (and it is) about health improvement in a patient population it's already slamming with antipsychotics is assbackwards. Besides, most state hospitals I know of in the US are fairly restrictive on how long patients are allowed outside of their buildings (often patients are restricted to 30 minutes a day of outdoors time), so it's not like too, too many patients were outside blazing through a pack of Camels all day. I bet most patients were smoking perhaps a few cigarettes a day, particularly because state hospital patients are typically medicated to the gills and sleep a lot (at least in my experience). Add that to the fact that this represents one more freedom taken away from a group of people who've lost their freedom of movement, their freedom of association (their freedom to socialize with other patients in a manner of their choosing) and many of their rights to control what goes into their own bodies and I just get pissed off on their behalf.
The Nanny Statists behind this move are chasing a non-problem. Unless they've suddenly made Zyprexa safer.
IYGTHKG has plenty of similar thoughts on her post on the matter.
I wrote about Washington State's ban on smoking at state hospitals in 2007:
"[I]n 2004, Western State Hospital here in Washington State took away psych patients' rights to smoke cigarettes outdoors on their 30-minute a day breaks from the wards. The hospital's CEO told me it was for the patients' "own good." I told him that he was taking away one of the patients' few pleasures and that I considered it mean, given the fact that the patients are mostly schizophrenics who are so doped up that whatever visceral joy they get from smoking ought to be granted to them in the name of their psychological health."
The smoking ban was lifted in 2005.
Posting will be late today as I am working on an outside piece about a tragedy that occurred in my neighborhood a few weeks ago and it will have me tied up for a while.
An interesting article in today's New York Times reports on Washington State's Group Health Cooperative and how its system of providing health care to its members is viewed in some quarters as a model for reforming health care. Known to many in the Seattle area as "Group Death," the co-op has its detractors and fans, but it certainly enjoys a better reputation that does Kaiser Permanente.
GHC's alleged advantages come from keeping costs low, using electronic medical records to save doctors time and the fact that docs are paid a salary and outside of the usual fee-for-procedure reimbursement system. How effective a system of co-ops around the country like GHC would be at getting coverage for all uninsured Americans at an affordable price while keeping costs low isn't clear. And, remaining unanswered, is how bringing 40 million or so new people into the health care system would affect access to services. It's not like you could open GHCs around the country and suddenly staff them with doctors and nurses without pulling those people from somewhere else in the system.
What the article and promotion of a co-op solution by some in Congress suggest to me is that the so-called public option for health care reform is pretty much dead. I don't know if that's a good thing or a bad thing.
I'm sure many of you read a Los Angeles Times article last week on a 6-year-old girl who was diagnosed with schizophrenia and her parents' struggles to cope with her. The girl's name is January and she's called Jani. Schizophrenia is extremely rare in young children and while I know many readers are dubious of the diagnosis, it's difficult to tease out of the story itself what's going on. Whatever she may or may not have, it's clear that Jani's case is very complicated and extreme in just about every way possible. It's also clear that her parents have been pushed to their own personal edges.
Now adding to this complexity is that Jani's father is writing a blog about his daughter and admits on it that both he and his wife have at times hit Jani and starved her. Here's what he writes:
"Jani would fly into rages that would last 5-15 minutes. During this time, when we tried to discipline her, she would hit us, scratch us, bite us, and kick us. People thought we were raising a brat. Even our own families thought this. We were so worried about trying to explain ourselves that we didn't notice at first that Jani's eyes changed when she went into this rages. We didn't put it together that a five year does not swing from 'I love you, Daddy' to 'I want you to die!' in seconds. Teenagers do that, not five year olds. Five year olds are still desperate for parental approval."Yes, kids have temper tantrums. But Jani would dig her nails into my skin and pull...leaving a bloody track down my arm or face. She would grin while she did this, a demonic grin that would have scared me had I had time to really think about it. But I didn't.
"We tried everything. Positive reinforcement. Negative reinforcement. Hitting her back (I won't tell you how many people told us that all she needed was a good beating). We took all her toys away. We gave her toys away. We tried starving her. We did EVERYTHING we could to try and break her. Nothing worked.
"Even then, it did not occur to us that our daughter was mentally ill. Now I wonder who was really delusional. Susan and I held fast to our belief that Jani was just a misunderstood genius.
"Then Bodhi was born.
"The violence became so bad that at times Susan and I both lost it and hit Jani as hard as we could. We hit in impotent rage."
That admission is striking for several reasons, aside from its brutal honesty: I don't think I've read anything like it on a blog before; it makes me wonder if some of the parents' behavior might not be contributing to Jani's problems; and, there's utterly no mention of it in the LAT story.
While I don't know when the father wrote the above lines, the blog goes back to early February 2009 and I assume the reporter--who globally wrote a good piece about something few reporters would touch, likely doing the reporting in May and June--had been through the blog and had run across the admissions of hitting and starving. I'm at a complete loss to explain why that information wouldn't make its way into the story. Perhaps there is a good reason for the omission, but since the father had admitted it publicly I cannot think of what it might be.
While I don't read the hitting/starvation admissions as implying routine beatings or regular starvation, there is no question that schizophrenia and psychosis can certainly be spurred on and deepened as a result of physical abuse and that often people with schizophrenia are the victims of abuse. I know there were a lot of passionate comments on the LAT article when I posted on it last week and that a lot of people blamed the parents for Jani's condition, but in truth I still don't know what to make of it all. My antennae are certainly up, however, as I'd like to see this child do well and escape a lifetime of antipsychotics and the like. I'd like to see the parents do well too.
Is Something Not Quite Right With Stan found the admission first and has plenty to say. Stephany at Soulful Sepulcher picked up on the admission ahead of me and offers her thoughts here. The Different Thoughts blog sees in the initial story the usual line of NAMI parent pathos. I don't know if that's true or not, but I thought I'd pass it along.
So what do you all think?
This from the CBC:
"Medical research out of the University of British Columbia suggests the number of children taking medications known as atypical antipsychotics has increased tenfold over the past decade, CBC News has learned."The drugs — a class of medicines used to treat psychosis and other mental and emotional conditions — can have potentially serious side-effects, and are linked to increases in stroke and sudden death in adults.
"Health Canada has not approved atypical antipsychotics for children."
It's all so discouraging that I literally don't know what to say, except to note that it isn't good.
I don't know whether to be discouraged by the following news (passed along by an eagle-eyed reader) or to consider it a trend that's to the good yet filled with all kinds of tricky implications, but a study out this week in Psychiatric Services asserts that there are more people in nursing homes due to mental illness--depression in particular--than there are for dementia. What's more, the number of people in nursing homes with mental illnesses grew quite a bit.
"The number of individuals admitted with mental illness increased from 168,721 in 1999 to 187,478 in 2005. The 2005 number is more than 50% higher than the number admitted with dementia only (118,290 in 2005). The increase was driven by growth in admissions of persons with depression—from 128,566 to 154,262 in 2005. Persons admitted with depression had higher rates of comorbid conditions than those admitted with dementia or with neither dementia nor mental illness. They also had high rates of antidepressant treatment and high rates of receipt of training in skills required to return to the community."
An accompanying analysis gives some detail on the age groups involved.
"The NNHS produced the most valid national-level estimates of residents with a mental illness—nearly 102,000 with a primary diagnosis in 2004 (6.8% of residents), of which about 23,000 were under age 65 and 79,000 were aged 65 and older."
For the last few years I've heard from nurses who work at nursing homes in the Pacific Northwest that there are loads of elderly people with depression, bipolar disorder and schizophrenia in nursing homes, pretty much as a replacement for the old state hospital model. What it's like elsewhere in the US isn't clear. I'm not saying that this new study establishes that we are warehousing seniors with mental illness in this country, but it sure does make me wonder what's going on here and what the implications are. (Maybe some Seroquel and Zyprexa.)
Thoughts?
A grand jury in Massachusetts has not returned a criminal indictment against Kayoko Kifuji, a Tufts Medical Center psychiatrist, in connection with the doctor's role in the death of Rebecca Riley, a 4-year-old girl who was diagnosed with bipolar disorder and ADHD at 2-years-old. The case has gotten a ton of national attention due to the fact that the girl was actually killed in December 2006 by some of the aggressive medication she was on. Meds prescribed to her included Seroquel, Depakote and clonidine.
Her parents have been charged with first-degree murder and are in jail awaiting trial.
A medical malpractice case brought by the girl's estate against Kifuji continues.
I would've been surprised by any criminal charges against the psychiatrist, but the civil case ought to be a tougher go for her.
The back story on the Riley can be found here.
This should come as no surprise to anyone, but today the FDA announced that it would require a new black box warning on certain smoking-cessation drugs, namely Chantix and Zyban, and would extend the warning to Wellbutrin (Zyban's name as an anti-depressant) and generic versions of Wellbutrin known as buproprion. The warning will notify patients and doctors of the risk of serious changes in behavior, depressed mood, hostility, and suicidal thoughts when taking these drugs.
"[FDA safety chief] Woodcock said health care professionals who prescribe Chantix and Zyban should monitor their patients for any unusual changes in mood or behavior after starting these drugs. She added that patients should immediately contact their health care professional if they experience such changes."The FDA’s request for the additional warnings is based on a review of reports submitted to the agency’s Adverse Event Reporting System since the time the products were marketed and on an analysis of information from clinical trials and scientific literature.
"The analyses revealed that some who have taken Chantix and Zyban have reported experiencing unusual changes in behavior, become depressed, or had their depression worsen, and had thoughts of suicide or dying. In many cases, the problems began shortly after starting the medication and ended when the medication was stopped. However, some people continued to have symptoms after stopping the medication. Also, in a few cases, the problems began after the medication was stopped."
Chantix has been in the news for much of the last two years for causing severe behavior changes and even suicides in some people taking the drug (my Chantix back catalog is here), all of which served to dramatically reduce sales of the drug despite a huge advertising campaign by its maker, Pfizer. Since it's an anti-depressant and already carries a black box warning on suicidality like all anti-depressant must, Wellbutrin's warning is likely a small change to extant warnings.
An FDA advisory panel yesterday voted to recommend a ban on the widely-prescribed painkillers Percocet and Vicodin. Percocet (and its kissing cousin Endocet) is actually a combination of Oxycodone, an almost century-old opioid analgesic medication synthesized from opium-derived thebaine, and acetaminophen. Vicodin is a narcotic analgesic product containing hydrocodone, derived from codeine and thebaine, and acetaminophen. The FDA panel was convened to advise the FDA on how to address tens of thousands of cases of liver damage each year connected to patients taking high doses of acetaminophen either in OTC products like Tylenol or in prescription painkillers like Percocet as well as in cold remedies containing acetaminophen.
Reportedly, FDA data showed that the vast majority of acetaminophen poisoning occurred in connection with opioid-acetaminophen and hydrocodone-acetaminophen combination products, likely due to patients treating pain conditions by taking more and more of the pills to fight off pain, but finding their effects reduced over time and then taking even mroe of the pills and winding up undone because of the acetaminophen.
Earlier yesterday, the panel voted to recommend cutting the maximum dose of acetaminophen in Tylenol and Excedrin, but to not limit the number of pills in a bottle, no doubt a big relief to people who go to Costco and buy their acetaminophen in 1,000 pill bottles--all of which may reduce the effect of cutting dosages.
News of a possible ban on Percocet and Vicodin (and similar opioid-acetaminophen combos) would certainly reduce doctor and patient options for treating pain and it makes me wonder why the panel didn't simply recommend dramatically cutting allowable acetaminophen doses. That said, a ban on the two drugs would be a boon to the makers of OxyContin (Oxycodone plus inert binders) and the makers of opioids combined with either aspirin (Percodan) or ibuprofen.
The New York Times cast matters thus:
"[T]he recommendation is likely to come as a shock to many patients, who may be unaware of the dangers of high doses of acetaminophen--even if they know the drugs contain the ingredient."Some doctors already avoid prescribing pills that combine acetaminophen with narcotics like oxycodone (found in Percocet) and hydrocodone (in Vicodin).
"'It ties the doctor’s hands when you put the two drugs together,' said Dr. Scott M. Fishman, a professor of anesthesiology at the University of California, Davis, and a former president of the American Academy of Pain Medicine. 'There’s no reason you can’t get the same effect by using them separately.'
"Dr. Fisher said the combinations were prescribed so often for the sake of convenience, but added, 'When you’re using controlled substances, you want to err on the side of safety rather than convenience.'"
"Still, some doctors predicted that the recommendation would put extra burdens on physicians and patients.
"'More people will be suffering from pain,' said Dr. Sean Mackey, chief of pain management at Stanford University Medical School. 'More people will be seeing their doctors more frequently and running up health care costs.'"
The FDA isn't bound by advisory panel recommendations but often goes along with them.
While it's easy to brush this news off as a matter of patients not knowing the dangers of using too much acetaminophen, my own experience with pain pills is that not once in the several times that I've been prescribed Percocet and Vicodin (for bruised ribs and for occasional use for chronic back pain) has a doctor ever warned me about not taking too many pills due to concerns with acetaminophen. Patients aren't the only ones who need a refresher course on acetaminophen.
It's frustrating to me that two pretty decent painkillers might be banned because of ignorant patients and doctors. It will be interesting to see how the FDA handles the panel's recommendations.
Keep in mind that while some Percocet and Vicodin does get diverted into the illicit drug trade, it's really the purer OxyContin that's causing problems there as it can easily be crushed and snorted, creating an effect similar to heroin (or so I'm told). As far as I know, very few people would crush and snort a Percocet as there'd be no way to remove the acetaminophen (as far as I know).
It's ironic to me that an FDA panel is paying this much attention to side effects from pain pills while similar FDA panels routinely ignore serious side effects connected with anti-depressants, antipsychotics, benzodiazapines and other psychotropic drugs. Go figure.