"The former head of psychiatry at Duke University told The Miami Herald Thursday that Nemeroff was 'economical with the truth' and his work can't be trusted, while the leader of the Columbia University psychiatry program said Nemeroff was a top-flight scientist and he had never seen any bias in his work...."

"But Bernard Carroll, former head of psychiatry at Duke University and once Nemeroff's boss, said parts of Nemeroff's work involved Paxil, a GSK antidepressant. 'Basically, he was doing basic science pimping for Paxil to produce talking points,' Carroll told The Herald in an e-mail Thursday. 'All he ever produced was speculation but that was enough to satisfy Glaxo marketing. . . . I have been exposing his shenanigans for some years.'

"Jeffrey Lieberman, head of psychiatry at Columbia University, praised Nemeroff as a leading expert in 'basic neuroscience,' studying underlying pathologies and proteins in the brain that cause mental illness. He said he had never detected 'any undue influence or bias' in Nemeroff's research."

I think Lieberman needs to re-review some of Nemeroff's work and his CME pimping.

Often, when a person in the mental health system loses it (for whatever reason) and commits violence, Torrey and the fine folks at TAC are quick to post (anonymously, of course) on their blog the details of the crime and to use it as a springboard to argue for forced outpatient commitment and forced medication for people diagnosed with serious mental illnesses and play their vomit-inducing game of arguing that bad behavior by one person diagnosed with schizophrenia, say, proves that pretty much anyone with a "serious mental illness" needs to be medicated into the ground.

Now, that a psychiatrist has blown away a bunch of outstanding Americans what does TAC have to offer on its blog? Silence, the telling kind. The kind that says they are hypocrites because Hasan clearly had psych issues (whatever his political and religious issues with America may or may not have been) and yet he did what he alleged to have done. TAC should at least say something. Silence.

What does the American Psychiatric Association have to say? Nothing. It's silent, too.

It'll be interesting to read what psychiatrists have to write about this bizarre and unacceptable tragedy. For those of you who read this site who are psychiatrists, feel free to email me your thoughts or leave them in comments.

Maybe it's not fair to read Maj. Hasan's act in the context of his being a psychiatrist. After all, who's ever heard of a doctor much less a psychiatrist committing mass murder? Almost never, excepting cases of genocidal killers like Nazis Josef Mengele and Aribert Ferdinand Heim and Radovan Karadzic (a psychiatrist. Thanks for the reminder, Qwerty). So inevitably this story will be treated as the multi-layered, conflicted beast that it is and there won't be much moment made of his being a psych doc, except to the extent where one might ask, "Why couldn't someone who did psych evaluations realize he had lost it and seek help?"

But, then, Torrey and TAC are never so fair to the people they write about. They never have complete lives and souls, their motivations are never complex. They are just schizophrenics and bipolars, bad boys and girls who didn't take their medicine.

Psychiatric News is a "chronicle of human rights violations and crimes by the psychiatric industry." And people call me anti-psychiatry!?

Technorati's rankings are based on how many blogs and websites link to a particular blog, so if you want to see me get up there with Postpartum Progress, then link to this site. Or should I go out and get a glamor shot for my site like PPP's author has up? (What is it with some bloggers and photos of themselves?)

The AP is now reporting that Army Maj. Nidal Malik Hasan, an Army psychiatrist, was the suspected shooter at Ft. Hood, Texas earlier today. The tragedy left 12 soldiers dead and 31 wounded and there were reports of other shooters. Two soldiers were taken into custody but later released. Maj. Hasan was said to be upset about his pending deployment to Iraq.

The New York Times reports that Maj. Hasan was a "Fellow, Disaster and Preventive Psychiatry, Department of Psychiatry, F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences." In other words, it sounds like Maj. Hasan had a specialty in PTSD.

Said Lt. Gen. Robert Cone at a press conference this evening: "The shooter is not dead but in custody." Gen. Cone declined to answer other questions about Maj. Hasan.

I really don't have anything reflective to offer on this at the moment, but I'd ask commenters to not play "trash psychiatry." Maj. Hasan must've had something really ugly going on inside to pull this off. It's one of the first instances I can remember of an officer--a senior officer, no less--opening fire on soldiers.

For those of you who are troubled by DTC pharma ads, especially on TV, I'm with you. But we're stuck with them. They bring in so many billions of dollars in ad revenue for various media companies each year that they will go unchallenged (with a few exceptions) for decades to come. Yes, the mainstream media has become pharma 'hos.

Back in 1997, one of the first radio interviews I did was of Tom Brokaw who was visiting UC-Berkeley for some kind of smarty pants sit-down with the dean of the J-School. I took Brokaw into a hallway at school and pointedly asked him about the NBC "Nightly News," of which he was the managing editor, and its sudden embrace of health care coverage, which it hadn't focused on much in the past. But this was 1997, DTC ads had just become legal, General Electric owned NBC and sure as heck wanted those pharma ads. Any connection there, Tom?

Brokaw, who had a huge pimple on his chin that day, insisted that there was nothing to it, that it was all legitimate news and so on. Some of it was, no doubt. Twelve years later, I watch health care news stories on NBC and other networks with much interest and much consternation. Almost across the board, the major TV and cable news networks all have doctors on their airwaves plus a few stray health care reporters and so many of them are terrible and spew out distorted, deeply-biased reports on various aspects of health care that it just makes me laugh, especially when you consider that roughly 50 percent of the advertising on a program like "Nightly News" is from a pharma company.

One of my favorite examples of dubious health care reporting came from "Nightly News" earlier this year when a huge study came out and linked depression and cardiac deaths in women. The same study also linked anti-depressant use to cardiac deaths in women.

"Meanwhile, NBC's 'Nightly News' gave the depression and cardiac death link huge play on its program last evening, but Brian Williams, the show's anchor, completely failed to mention the anti-depressant link. I'm not sure who is writing Williams' copy, but either they or he are utterly blind to not mention that point. Or is the TV media too scared of being dinged for allegedly scaring people off their meds?"

Or scaring Big Pharma from buying ads?

The Miami Herald reports:

"On Thursday, Pascal Goldschmidt, dean of UM medical school, called Nemeroff 'an extraordinary psychiatrist and scientist. . . . He got into serious trouble on disclosure on conflict of interest.'

"Goldschmidt said he had read investigative reports from Emory about Nemeroff's activities and found nothing to indicate that payments the psychiatrist received had in any way influenced his research results.

"In a telephone interview at mid-day Thursday, Nemeroff, 60, told The Miami Herald he was excited to be coming to Miami. 'I think it's going to be a top-10 school.'"

Extraordinary psychiatrist and scientist? Last month, Bernard Carroll, a California psychiatrist and co-author of Health Care Renewal, delivered an epic smackdown of Nemeroff over his involvement in pimping Seroquel for major depression:

"As for Dr. Nemeroff, he is yesterday’s news. The adverse findings by ACCME about his program serve as a reminder to corporate sponsors and CME companies that Dr. Nemeroff is so compromised by now that he has lost effectiveness as a front man for Pharma. Indeed, he is so toxic that he now glows in the dark."

So it looks as though it'll now be sunny 24/7 in Miami.

My Nemeroff back catalog is here.

First, a Norwegian study appearing in the British journal BJOG looked at 38,602 kids born between 2000 and 2005 and found:

"Children of mothers who used antidepressants during pregnancy showed increased healthcare use during the first year of life, independent of the mother's healthcare use. The relative risk of more than two visits to general practitioners was 1.5 (95% confidence interval, CI: 1.3–1.8) in the continuous antidepressant users group and 1.3 (95% CI: 1.2–1.5) in the group of children whose mothers stopped taking medication. In both study groups there was a trend towards more drug use for infections and inflammation compared with the control group. Children continuously exposed to antidepressants had an increased risk of cardiac interventions such as cardiovascular surgery or heart catheterisation, relative risk of 5.6 (95% CI: 1.8–17.4). The risk of physiotherapy was twice as high in the antidepressant group compared with the control group (relative risk 2.0; 95% CI: 1.5–2.6).

"Conclusion: Antidepressant use during pregnancy is associated with increased child healthcare utilisation and increased risk of major cardiac interventions in early childhood."

Almost six times the risk of needing invasive cardiac procedures is an official "Wow." The researchers told Reuters, however, that the mothers' depression might play a role in all of this:

"It's possible that mothers' depression itself was a factor here, according to Ververs' team. Past studies have found that depressed mothers tend to take their children to the doctor more often than other mothers do.

"Compared with other mothers, Ververs and her colleagues note, depressed moms may find it more difficult to cope with problems like respiratory ills and digestive symptoms."

Depression might explain the office visits, but it sure wouldn't explain the need for cardiac procedures. They did tell the wire service that the evidence supports fetal heart screening for mothers who use anti-depressants throughout a pregnancy.

Separately, a study in the journal Women's Health Issues in September (and brought to my attention by a reader) examined possible links between maternal depression, psych med use during pregnancy and preterm deliveries. Researchers found:

"The odds of overall PTD [preterm delivery] was increased among women who used psychiatric medication during pregnancy and had either elevated levels of depressive symptoms at mid-pregnancy (adjusted odds ratio [AOR], 2.0; 95% confidence interval [CI], 1.1–3.6) or a history of depression before pregnancy (AOR, 1.6; 95% CI, 1.1–2.5). The combination of psychiatric medication use in pregnancy and depression, before pregnancy, or within pregnancy was most strongly linked to a medically indicated delivery before 35 weeks' gestation (AOR, 2.9 and 3.6, respectively). Conclusions

"There are at least two plausible explanations for these findings. First, psychiatric medication use in pregnancy may pose an excess risk of PTD. Second, medication use may be an indicator of depressive symptom severity, which is a direct or indirect (i.e., alters behavior) contributing factor to PTD."

The study examined 3,019 women in Michigan.

Plain and simple, the evidence continues to mount that anti-depressant and psych med use during pregnancy poses significant risks to a child. Clearly, depression--past or present--is no friend to fetuses either, so the tricky question about how to treat all of this remains unclear.

"Since when have we become a nation of super-conformists, fitting all children into slots and molds, killing initiative, uniqueness and creativity? The Beatles wrote a song about taking a "little white pill" to get through the day, but that song was about a suburban housewife, not a child.

"We scream about kids smoking an 'L' or taking Ecstasy or methamphetamine, but yet parents and medical adults are pushing drugs on them from a very tender age. Untried drugs, and by that I mean not tested for use on children. The long-range effects of these pharmaceuticals on children are as yet unknown....

"Frankly, I think the relief of prescription drugging belongs mainly to the teachers, the school system and the parents/caretakers. It would be most interesting to have a symposium of adults and children, a sort of moderated pro and con debate. We frequently talk about quality of life but in a nation that frowns on the use of medical marijuana, it seems strange to allow children to take habit-forming and potentially dangerous prescription drugs. Any drugs given to children 18 and under should be heavily monitored including six-month blood work and weekly therapy sessions, either group or family. Children are more apt to speak their feelings in a situation including like peers and/or complete (including siblings) family members."

There is something about America as a culture that is so inherently messed up when it's OK to give kids antipsychotics for non-psychotic disorders but we utterly freak out at the idea of them putting other unhealthy items into their bodies. How do we get this out of our culture?

"We studied the course of major mood disorders in the offspring of parents with well-characterised bipolar disorder prospectively for up to 15 years. All consenting offspring were assessed annually or anytime symptomatic. The participants began to develop major mood episodes in adolescence and not before. The index major mood episode was almost always depressive, as were the first few recurrences. Onsets and recurrences continued throughout the observation period into adulthood. We did not find evidence of pre-pubertal mania. In summary, adolescence marks the beginning of the high-risk period for major mood episodes related to bipolar disorder."

Someone alert Joe "Agitation is Mania!" Biederman and CABF! Seriously, that's a pretty stunning finding and certainly confirms what other researchers elsewhere in the world have written. Of course, this study was done by Canadians, not proper psych researchers at Harvard.

But the rest of the world simply hasn't glommed onto the bipolar child paradigm. As I told Psychology Today earlier this year:

"As for bipolar disorder in kids (meaning pre-teens and younger), it's simply not an issue in the rest of the world. The bipolar child is a purely American phenomenon, as big a metaphor of our times as credit swaps, subprime loans, and government bailouts."

I appreciate peer-reviewed research that backs up what I've been writing.

"In response to queries from a reporter, Dr. Waikar wrote in an e-mail message that he received fees for speaking to other health care professionals about disorders like schizophrenia and depression, which can be treated with the Lilly drugs Zyprexa and Cymbalta respectively....

"In an e-mail message to a reporter, Dr. Waikar wrote that although drug company presentations were standardized to comply with drug marketing regulations, he and other speakers did provide suggestions on the content. And he said that there was room for spontaneity at such events, because he was allowed to answer questions from doctors in the audience, drawing from his own practice experience or opinions, as long as he explained the basis of his answers.

"In an another e-mail message, Dr. Waikar wrote that talks like his could be helpful to primary care providers having to treat complex psychiatric problems. He added that doctors had contacted him after the talks to consult about difficult cases."

Since Waikar is affiliated with an academic institution and teaches medical residents, there are questions about the ethics of these kinds of things. While the article doesn't break any new ground, I'm glad it's somethign the paper chose to spend some time on.

Coming on the heels of last month's study showing depression-protecting effects of the Mediterranean diet, this study is further evidence of the well-known link between food and mood. Of course, it's not going to be real easy for people in the UK to follow a Mediterranean diet nor in most of the US, so this study is quite real world in that sense. It's also a big argument in favor of moderation: there's a great middle group in this study who had little depression yet did eat some of the whole foods and some of the processed foods. That said, I'm sure some would love to make an ideological argument about corporations and processed foods and a conspiracy of depression-for-profit, when really what you eat boils down to individuals eating what they already know is good for them. If they don't buy Cheez Whiz and the like (or buy much less of it), then companies won't bother making it.

The study also confirms what I've long said on this site: if you don't eat reasonably well and reasonably often, then you aren't even giving yourself a fighting chance with depression. I feel the same way about exercise and socialization. Neither are cures per se, but without them, you can go down a rat hole of mood.

One weakness of the study (I haven't seen the full version) and the reportage on it is that I cannot tell how depressed people were at baseline and at the study's conclusion. My hunch is that the findings are probably most applicable to mild-to-moderate depression and that diet would have less of an effect, especially short-term, in severe, chronic depression.

At least that's the opinion of this light-on-processed-foods, heavier-on-fruits-than-veggies eater.

"Human brains are not the only ones with the 5HT1A receptor. Rats also have it.

"Here's the really interesting part: the rat version is 99 percent identical to the human one. This suggests that in the evolution from the shared ancestor of rats and people (hold those creationism letters!), natural selection did not mess with the receptor much. That leave-well-enough-alone history tends to happen when the function of some trait is so important that tinkering with it evolutionarily would produce more harm than good. What kind of harm? Rodents that have a mutation causing them to lose this receptor exhibit fewer symptoms of depression when they suffer some stress, a 1998 paper reported. In other words, losing the receptor that promotes depression in response to stress is something evolution thought would be a very bad move. Ergo: depression is not something to be thrown out lightly.

"Why not? Because, argue Andrews and Thomson, depression alters thinking and behavior in beneficial ways."

Depression's supposed advantages are deep rumination and focused thinking. As with today's other post on diet and depression, I suspect this is most applicable to mild-to-moderate depression.

Anyway, it's interesting stuff, although perhaps not much comfort to someone in the throes of depression itself and I think Begley's argument is a bit too bio-reductionist for me to be comfortable with (depression is vastly more complex than brain receptors). What's interesting to me as well is that this appeared in Newsweek in the first place as the mag has a long history of subscribing to all psych disorders being fit for medication and objects of fear.

That said, Begley does make the excellent, likely controversial point that we monkey with depression perhaps to our own detriment as a culture.

"Never before has this country seen so many women paralyzed by the psychological scars of combat. As of June 2008, 19,084 female veterans of Iraq or Afghanistan had received diagnoses of mental disorders from the Department of Veterans Affairs, including 8,454 women with a diagnosis of post-traumatic stress — and this number does not include troops still enlisted, or those who have never used the V.A. system."

I appreciate their service and wish them well. While I'm wishing, I wish someone would come up with a safe, effective treatment for post-combat PTSD because what we are using now certainly isn't working well.