JANE'S MHSP ARCHIVES: 2006

New Schizophrenia Drug Approved in the U.S.

U.S. Food and Drug Administration (FDA) has approved Invega (paliperidone) for treating schizophrenia. Invega is a first-in-class (new molecule drug), which this is the first drug of its kind in the therapeutic category. Invega is an active metabolite of a drug already available for treating schizophrenia, risperidone. Common side effects included the following: Restlessness, Extra-pyramidal symptoms (movement disorders), Rapid heart beat, and Sleepiness.

You may have first read about this drug in clinical trials here on the Mental Health Source Page. According to the FDA, it approved Invega based on 3 placebo-controlled clinical trials conducted for 6 weeks in North America, Europe and Asia and involving 1665 adult patients / human subjects. Based on clinical trial results, recommended dose range of Invega is 3mg to 12 mg a day.

Invega is also an atypical antipsychotics that have an increased rate of death compared with placebo in elderly patients with dementia-related psychosis, as its official website and drug label is required to disclose:

IMPORTANT SAFETY INFORMATION FOR INVEGA™

Elderly Patients with dementia-related psychosis treated with atypical antipsychotic drugs are at an increased risk of death compared to placebo. INVEGA (paliperidone) is not approved for the treatment of patients with Dementia-Related Psychosis.

Since the drug’s clinical trials spanned 6 weeks, Invega has not been studied in controlled clinical studies longer than 6 weeks, which means patients taking this drug for more than 6 weeks (more than 1.5 months) should be periodically checked by a doctor.

You may learn more about Invega at its official website or visit the FDA website for the original approval press release.

SSRI Suicide Risk Differs in Age of Patient

Wall Street Journal published on December 6, 2006 the article, “FDA: Antidepressants Lessen Risk of Suicidal Thoughts for Seniors”, stating that the FDA’s review of 372 clinical study data involving 11 antidepressants had shown that antidepressants may increase suicidal risk in adolescents, but this risk decreases in but that in older adults the risk declines.

Currently antidepressants carry a black box warning (reserved for life threatening risk) on the increased risk of suicidal thinking in children and teens who have taken antidepressants. This FDA review included at least 100,000 patients who have taken antidepressants across different age groups. In fact, the FDA suggested that in adults 65 years and older, antidepressants actually had a protective effect against suicide risk. This has to be welcome news to drug companies that manufacture antidepressants, although a new labeling change may not happen anytime soon.

2 Comments
Jeffrey Dach MD wrote:
According to Dr. Irving Kirsch in Prevention & Treatment , “there is now unanimous agreement that the mean difference between response to SSRI antidepressant drugs and response to inert placebo is very small. It is so small that, despite sample sizes involving hundreds of participants, 57% of the SSRI trials funded by the pharmaceutical industry failed to show a significant difference between drug and placebo. Most of these negative data were not published and were accessible only by gaining access to US Food and Drug Administration (FDA) documents. Various methods were used to manipulate the results of SSRI drug studies to insure a favorable outcome:

1) Responders to the placebo are eliminated at the beginning of the study. (Placebo washout)
2) Benzodiazepine sedatives were given to mask the SSRI induced agitation.
3) Unfavorable drug studies are buried in the file cabinet and not disclosed to the public.
4) Miscoding suicidal events as “emotional lability”, and homicidal events as “aggression” to hide suicidal events from regulators.
5) False attribution of suicide to the placebo arm.
6) Hiring ghost writers to make the medical articles more favorable.
7) Cash settlements for SSRI drug litigants which seals records and withholds unfavorable drug studies from the public.

For more information and links see my Paxil, Prozac, and SSRI Induced Suicide Newsletter

Sunday, June 17, 2007 at 4:34 am

Jane Chin, Ph.D. wrote:

Dr. Dach,

I agree with many of the points you have raised re: SSRI studies and the lack of transparency around safety issues. Given the scrutiny and investigations, I believe that there is greater transparency of safety concerns and I hope that most doctors will discuss these with their patients when prescribing SSRIs. I visited your website and saw that you have no financial disclosure with pharmaceutical companies. Given your advocacy for herbal or nutraceutical approaches, do you have any financial affiliations or interests in nutraceutical companies or manufacturers of herbal supplements?

Also, if you don’t mind me asking, are there robustly designed, randomized-controlled clinical studies that proactively looks at the effectiveness and safety of nutraceuticals, herbal supplements, or medical foods in the treatment of depression when compared with the “traditional chemical” standards and/or compared with placebo?

My understanding is that the few clinical studies in depression looking at St. John’s Wort/Hypericum had a select patient population – those patients who suffered from mild to moderate depression, but not severe depression, and that patients who were severely depressed did not respond as well to Hypericum.

Finally, I enjoyed looking through your online art gallery.

Saturday, June 23, 2007 at 6:03 pm

Past Edition for November 28, 2006

I hope you had a good weekend; those of you who celebrate Thanksgiving, as I did, I hope you had a good Thanksgiving holiday weekend. I appreciate those of you who sent in your entries and help us better understand the mental health journey from your perspectives. Thank You!

isabella mori presents speed, mania and depression posted at change therapy. Jane’s Note: I’m wondering if the clinical study results that isabella was referring to had a lot to do with interrupting certain thought patterns in depressed patients, rather than just the pace of the mental activity. Unfortunately I don’t have access to the clinical study, but the conclusion is intriguing and raises additional questions. For example, what happens when rapidity in thought crosses a boundary to a pathological (clinical mania) state? Also, in a mixed bipolar disorder episode, is the rate of thinking rapid even when the patient is feeling extremely depressed?

Talia Mana presents Centre for Emotional Well-Being: All depressive illnesses are not created equal posted at Centre for Emotional Well-Being.

Jane’s Note: I think it’s very important to differentiate different types of depression, because we often hold the idea that depression is slow… dark… deep… and not realize that agitation and anxiety are both comorbid conditions with depression. In fact, my original misdiagnosis, which I bought into for some time, came from a psychiatrist not recognizing that I had depression with anxiety symptoms. I see a similar type of depression with my mom.

Jon Schnaars addresses an important new study in which the CDC found that 1 in 3 suicides involved alcohol. Alcohol is a dangerous drug for anyone, and can be even more so for those already dealing with a mental illness. Visit Jon at Anxiety, Addiction and Depression Treatments.

Jane’s Note: I usually get the carnival published by Monday morning, but for some reason I waited. I just received Jon’s entry (above) – and now I know why I was waiting! Thanks, Jon, for alerting us to this important correlation between alcohol involvement and suicide.

Mother Jones RN presents From the Mailbag posted at Nurse Ratched’s Place.

Jane’s Note: Thanks, Nurse Ratched, for bringing up this emotionally charged issue. We are starting to see increasing “lifestyle use” of potent drugs, including some antidepressants. I’m also “all about feeling good” (believe me, I’ve suffered from severe depression and I want nothing more than to feel good), but too often we are not made aware of the true risks and benefits of taking medications. Most prescription drugs are not as “benign” as drinking a cup of coffee to get us going in the morning. Unfortunately we only learn about the risks over time, when enough people have taken a drug and enough data collected, to have a profile of risks with a drug. Those who suffer from clinical depression and bipolar disorder take medications that come with side effects that vary on the nastiness scale depending on the person – I am sensitive to medication and have experienced some extreme side effects even when others may not experience the same. Still, the issue has to do with lifestyle options that may be safer in the long run and also enhances mood – exercise, relaxation / meditation techniques, volunteering are some simple examples. My personal bias is that we as a society have come to view drugs too benevolently, thereby giving many drugs “lifestyle” status instead of a clinical or medical status.

I.B. presents PTSD and Fibromyalgia Pain in Men posted at Fibromyalgia Research Blog, saying, “New research suggests the possibility of trauma, and the resulting PTSD, as a triggering event for the onset of fibromyalgia.”

Aleksandr Kavokin, MD, PhD presents Psychology of Law and Order. Interview with Dr. Deborah Serani posted at RDoctor Medical Portal, saying, “exclusive interview with famous psychologist.”

Jane’s Note: I enjoy Law & Order and this interview with Dr. Serani, who is a very cool psychologist as well as the contributor to the below post. Thanks Alex for sharing this interview with us, and to Dr. Serani for giving us a glimpse into her blogging and professional history.

Deb Serani presents Gene Linked With Mental Illness Shapes Brain Region posted at Dr. Deborah Serani.

Randy Yniguez presents How To Relax Your Muscles posted at Randy Yniguez, saying, “Thanks for including us! Readers can record the script into a tape recorder and play it back to help them unwind from a stressful day.”

Jane’s Note: This is an interesting technique to relax and can be very helpful in general, not just for people who suffer from depression or bipolar disorder.

That concludes this edition. Our next blog carnival – and my ever present comments – will be posted on Tuesday December 12, 2006. Click here to share your stories and entries on the upcoming carnival.

Past Edition for December 12, 2006

I want to thank everyone for your overwhelming response to this edition of our carnival. I personally visit each and every entry submission, and where warranted, comment on the entry. Thus unlike other carnivals where your entries simply get listed, you know your submissions are being read (at the very least, by me!). However, this also means my carnival posts tend to run long. We’ve received almost 20 entries in this edition! Unfortunately I had to eliminate entries that are not directly related to mental health, which is unrelated to the quality of the post.

This edition will be particularly lengthy. If you need to find a particular topic, you can hit the [Ctrl] + [F] keys to “find” the word you are looking for without scrolling down paragraphs of text.

Dr. Neill Neill wrote Mental Illness after a mother of a mentally ill daughter came to him depressed, grieving and at her wit’s end as to how to help her daughter. Dr. Neill has been around these woods, both professionally and personally. He wrote the article for her and the rest of us. Jane’s Note: I want to add to Dr. Neill’s #6, which states “The mentally ill are first and foremost people, albeit people who may be severely traumatized.” The mentally ill not only may be traumatized, but they can also traumatize others, which can further exacerbate mental conditions in another person and further perpetuates the victimization cycle in mental illness. For example, my mother’s mental condition caused her to traumatize me as a child, which then triggered my disposition to depression as I was growing up. One of the main reasons why I sought help is to end the victimization cycle.

Charles Donovan presents VNS Therapy™: No Pain, no gain. Not True posted at MyDepressionSpace.com, saying, “Vagus nerve stimulation(VNS) is the only FDA approved long term treatment option for depression.” Jane’s Note: Charles was kind enough to send me a gift: his published book on VNS. I will be reading this over the holidays and sharing more about VNS with readers here in the next few weeks.

Beau presents My Seasonal Affective Disorder posted at Seasons Under The Sun. Jane’s Note: I like this post because Beau talks about different modalities in therapy for SAD, where antidepressants are but one of many options.

John Briffa presents Bulimia shown to be more common in cities, and two highly effective remedies for this condition for those not planning on moving to the country posted at drbriffa.com – a good look at good health. Jane’s Note: I’m grouping John’s post with Beau’s because John also talks about sunlight. Even though John included citations to his article, I want to caution that 2 of the references dealing with supplementation in treatment of bulimia and quite dated. This post therefore is considered anecdotal and not a scientific conclusion (although John is a medical doctor).

Miguel Trujillo presents Happiness and Culture posted at Miguel Trujillo. Jane’s Note: This post suggests that modern culture encourages unhappiness. I’m curious whether there are any epidemiological studies looking at cultural influences on depression.

lorenzo presents The Source of All Illnesses posted at RealitySeeds. Jane’s Note: Many may consider this post more along the “alternative therapy” approach and some who are more critical may consider it “quackery”. However, Lorenzo at no point advocates not taking medication or stop taking medication, and states, “Even if the root cause of illness is in the mind and in the thoughts you have, it doesn’t mean that you should stop taking medicines or go to see a doctor when you are sick.” Lorenzo has written a long and thoughtful article on how some of our internal conflicts bear fruit as illness symptoms. I think this article is worthwhile to look at some of our beliefs and how these may affect our thoughts and actions, and subsequently cause physical symptoms.

Alvaro Fernandez presents Dr. Elkhonon Goldberg on Brain Fitness Programs and Cognitive Training posted at SharpBrains: Your Window into the Brain Fitness Revolution, saying, “An interview with a leading expert in the field of cognitive training.” Jane’s Note: I suspect that the “bolded” phrases are Alvaro’s own highlights of notable points. I do like the new (and more effective) perspective of “use it and get more of it” over the old “use it or lose it.”

Randy Yniguez presents Breathe Away Anxiety and Stress posted at Randy Yniguez, saying, “This goes hand in hand with progressive muscle relaxation. A great combo for on the spot reduction in anxiety.” Jane’s Note: Important point about stress and breathing; some of us don’t realize that we actually hold our breaths when we’re anxious and cut off oxygen to our system. Also I want to comment on Randy’s statement about personal growth: “Personal growth involves not only branching outward, but taking care of your inner needs.” I believe that personal growth happens from the inside out.

Linda Freedman presents Holiday Post 3: Remembering and Xmas posted at Everyone needs therapy? Lessons from a family therapist, saying, “The holiday season is a busy time of year for therapy docs. This post demonstrates how to turn memories into living memories, making holiday loss a managable, even bittersweet observance.” Jane’s Note: Thanks, Linda, I enjoyed the story. This is practical advice on how to keep on living and building new traditions for yourself.

I’m grouping this one with Linda’s given the topical relevance: Suni presents Depression and the Holiday Season posted at Bulletproof Soul, with resource links relating to depression and the holidays.

Mercurial Scribe presents Aftermath posted at Mercurial Scribe. Jane’s Note: I’m with you, Scribe. Keep on keeping on, and you’ll be doing the right thing.

GrrlScientist sent me 3 posts, which I’ll group here: To Answer Some Questions saying, “this story goes to show you that truth is stranger than fiction”, Court Date saying, “involuntary commitment? we shall see” and Some More Answers saying, “more about my bipolar breakdown.” Jane’s Note: GrrlScientist, thank you for sharing your experience with us. This is a rare, inside look at a personal experience with bipolar disorder, suicide, and the aftermath of a suicide attempt (institutionalization)… on top of being enrolled in a Ph.D. program. During my Ph.D. program, I was deep in the throes of clinical depression. I admit, suicide ideation was not foreign to me, although it remained mainly ideation in my case at the time. I read past the 3 entries Grrlscientist wrote and you can do the same by clicking on the ‘What Happened Next?’ link at the bottom of each entry. Grrlscientist: My thoughts are with you.

Miguel Trujillo presents Elements of Happiness: #1: Thought control posted at Miguel Trujillo, saying, “The link between happiness and personal thought control.” Jane’s Note: Interesting point, but needs an important premise that the choice to exercise thought control to become happy may come easier to some (example: non clinically depressed persons) than others (example: clinically depressed persons). While I can see how increasing one’s awareness to painful thoughts is a first step toward managing those thoughts and the influences over one’s actions and thus life, this awareness can be a long way off from actual behaviorial change that requires more internal work (for some this may include various forms of therapy).

This concludes our edition! Sorry I posted this one day late… I was in a thought-intensive seminar all day yesterday, and my brain was happily exhausted by the end of the day.

Since the holidays are coming up, I’ll posting the next edition of carnival of depression, bipolar disorder, and mental health journeys on January 10, 2007. Happy Holidays and Take Care of Yourself!

2 Comments

Alvaro wrote:

Jane, this is one of the best presented carnivals I have seen. I enjoy very much your one-sentence take-aways. And you guessed right (“I suspect that bolded phrases are Alvaro’s own highlights of notable points”). The alternative would be quite funny…I could give interviewees some castanets for them to play while they say something that they’d like me to highlight

Wednesday, December 13, 2006 at 10:09 pm

Jane Chin, Ph.D. wrote:

Thank you, Alvaro! I can see how castanets can come in handy when blogging becomes multimedia! I’m not quite into blogcasting (blog podcasting?) or YouTube’ing yet.

Thursday, December 14, 2006 at 11:00 am

This Week in Mental Health Research

Newer Not Necessarily Better. An October 2006 issue of Archives of General Psychiatry has published a report that suggests second-generation (“newer”) antipsychotic medications offered little advantage over older drugs for schizophrenic patients, which runs counter to a wide belief that newer antipsychotic agents are safer and more effective. Based on this study’s findings, justification for using more expensive newer agents could be problematic if the newer agents indeed offer similar side effect profile or effectiveness than cheaper generics. The study was based on a study of 227 individuals age 18-65 with schizophrenia, randomly assigned to receive first-generation medications or second-generation medications. Authors concluded that further study looking at newer drugs are needed to determine their usefulness in managing schizophrenia and that older drugs remain useful in managing schizophrenia. (Source: Arch Gen Psychiatry. 2006;63:1079-1087.)

Speaking of newer antipsychotic agents, US Food and Drug Administration (FDA) has sent an “Approvable Letter” to Johnson & Johnson for extended release paliperidone for the treatment of schizophrenia. Paliperidone is a chemical derivative of risperidone, which is already used in the treatment of schizophrenia. The extended release form uses a delivery technology that allows the medication to be consistently delivered in the bloodstream over 24 hours. The brand name of the medication is yet to be determined. (Source: Janssen website)

Women who suffer from both emotional and physical symptoms of Premenstrual Dysphoric Disorder (PMDD) has an option with a birth control pill that has received approval from the FDA to also treat the the emotional and physical symptoms of premenstrual dysphoric disorder (PMDD) in women who takes an oral contraceptive. The pill’s snappy brand name, “YAZ” makes me wonder if its aimed at the youth market. Women who suffer from PMDD experience mood swings, irritability, headaches, feeling anxious, bloating and food cravings, with more severity in symptoms than women who suffer from premenstrual syndrome (PMS). (Source: YAZ website)

Past Edition for October 17, 2006

Check out what you have submitted so far to the October 17, 2006 edition of carnival of depression, bipolar disorder, and mental health journeys. As you send new entries I will update this carnival. Thanks for everyone who have contributed!

depression

Mona Johnson presents Stress, Depression and Alzheimer’s, Part 1 posted at Stress, Depression and Alzheimer’s, Part 1, saying, “A history of depression may increase your risk of developing dementia later in life.”

On the other hand, Yahoo News proclaimed antipsychotics showing no sign to help Alzheimer patients and similiary, New York Times presents Alzheimer’s Drugs Offer No Help, Study Finds (requires free subscription) posted at The New York Times, saying “The drugs most commonly used to soothe agitation and aggression in people with Alzheimer’s disease are no more effective than placebos for most patients, and put them at risk of serious side effects, including confusion, sleepiness and Parkinson’s disease-like symptoms, researchers are reporting today,” and referencing this New England Journal of Medicine article.

Phil B. presents Phil for Humanity: Complaining is Good for You posted at Phil for Humanity.

medications

Hsien-Hsien Lei, PhD presents Serotonin Transporter and Norepinephrine Transporter Genes Determine Effectiveness of Antidepressants posted at Genetics and Health.

mental health

Mental Health Source Page presents Spreading the word one hit at a time posted at Brony: “Brony is using her blog as a way to increase awareness of what it’s like to have mental illness and be a parent. This post includes some myths about mental illness.”

Mother Jones RN presents Dying to be Beautiful posted at Nurse Ratched’s Place.

Aleksandr Kavokin, MD, PhD presents Head Injury posted at RDoctor Medical Portal, saying, “Head injury may lead to behavior changes, depression, suicide”

recovery

purpleshazza presents Six ideas to get you started posted at Another Me, Inside.

This concludes this edition so far. Submit your blog article to this edition of carnival of depression, bipolar disorder, and mental health journeys here. Past posts and future hosts can be found on our blog carnival index page.

Seroquel Approved to Treat Manic and Depressive Episodes in Bipolar Disorder

Seroquel or quetiapine fumarate (manufactured by AstraZeneca) has received US FDA approval to treat both depressive and manic episodes associated with bipolar disorder. The benefit of one medication that can treat both the depressive and manic symptoms is that patients can adhere to (comply with) the medication regimen more easily. On the other hand, patients’ symptoms may still require additional medications if Seroquel could not adequately manage the constellation of symptoms of someone suffering from bipolar disorder. Even depressed patients can sometimes be on multiple medications besides an antidepressant.

The approval was based on a study with over 1000 patients with bipolar disorder type I or II, comparing Seroquel at 300 mg or 600 mg to placebo. Based on the study, 300 mg once a day (or “QD” as your doctor will call it) is recommended by day 4 of treatment.

Side effects of Seroquel included dry mouth, sedation, somnolence, dizziness and constipation. Seroquel should not be used in patients with dementia-related psychosis and should be monitored very careful for risk of suicidal thinking or behavior in children or teens requiring Seroquel (these would be “off-label” or unapproved uses of the drug, which sometimes is used by some psychiatrists based on their clinical judgment). Source: Yahoo Press Release.

Past Edition for October 31, 2006

Welcome to the October 31, 2006 edition of carnival of depression, bipolar disorder, and mental health journeys!

Thanks to everyone for submitting your entries. Therapy Doc Linda Freedman asked an excellent question about bipolar disorder, putting some reality behind a “romanticized” notion of this devastating mental illness. I know people whose families were torn apart because of bipolar disorder. Jon Schnaars also highlights an important risk factor in taking psych meds – drug interactions can be dangerous and patients must be as proactive (if not more than) as doctors in asking about potential drug interactions. I LOVE (LOVE!) the YouTube clip that Deb Serani posted that shows us how distorted our perception of beauty is. Most of the “people” that young adults try to look like exist only after multiple pixelations of Adobe Photoshop. Thanks to Christine Kane on her entry on addictive eating. I eat when I’m stressed, and occasionally would overeat (that time of the month…) to the point where I feel sick. My bad eating behavior has wreaked havoc on my stomach and now I’ve got stomach problems. Be sure to also check out Dr. Kavokin‘s quizzes.

Until our next carnival (of course, ongoing now)!

bipolar disorder

Linda Freedman presents So Many Bi-Polars, So Little Time? posted at Everyone needs therapy? Lessons from a family therapist, saying, “This post is a reminder that not everyone with symptoms of either mania or depression or both has bi-polar disorder. It takes issue with the disorder as primarily psychiatric, meaning “in the head” because so many episodes are triggered by contextual and family stress.”

medications

Jon Schnaars presents Drug Interaction Risk Studied posted at Anxiety, Addiction and Depression Treatments, saying, “In this post I discuss new research regarding the trouble often caused by medication interactions. For those on psych meds, this is a particularly relevant problem, and one that health care consumers need to be aware of.”

mental health

Aleksandr Kavokin, MD, PhD presents Schizophrenia posted at RDoctor Medical Portal

Deb Serani presents Love, Love, Love Dove posted at Dr. Deborah Serani, saying, “This post teaches us how the media uses technology to create unattainable beauty. Seeing these tricks can help you learn to love yourself and your own beauty.”

Aleksandr Kavokin, MD, PhD presents Depression and Heart Disease Quiz posted at RDoctor Medical Portal, saying, “The link between Depression and Heart Disease Quiz”

recovery

Christine Kane presents Healing Bulimia and Addictive Eating (Part 5) posted at Christine Kane.

This concludes this edition so far. Submit your blog article to the next edition of carnival of depression, bipolar disorder, and mental health journeys here. Past posts and future hosts can be found on our blog carnival index page.

Store Brand Acetaminophen Recall Alert

US Food and Drug Administration (FDA) is recalling 500mg strength store-brand acetaminophen caplets because of contamination with small metal fragments found in some caplets. If you have bought a store-brand or private label pain reliever acetominophen, please check on the bottle against this list of lot numbers.

The company that produces the caplets for private label sale in stores found that one of the machines used in making the tablet was prematurely wearing down. FDA is also investigating the incident. So far no illnesses (or worse) have been associated with this contamination.

Source: FDA Website.

Medication: Hypertension Drug for Depression

Mecamylamine is an antihypertensive and has been used to treat high blood pressure or hypertension. Mecamylamine controls nerve impulses to relax blood vessels and therefore lower blood pressure. Now, a company called Targacept is looking at this drug as a potential add-on treatment with the antidepressant citalopram (Celexa) to see if patients who did not respond to citalopram would respond when mecamylamine is added to citalopram.

The combination regimen is currently in Phase II clinical trials. Phase II clinical trials help establish efficacy (effectiveness) of a treatment, and occurs after Phase I clinical trials established safety profile of the treatment.

The company issued a press release stating favorable data from the study, where patients receiving mecamylamine and citalopram improved in their depression scale scores than patients who received citalopram alone. However, where symptom remission is concerned, patients receiving mecamylamine and citalopram did not show statistical significance in symptom remission than those who received only citalopram. Still, the press release emphasized there was clinical significance even if there was not statistical signifiance. Bottom line? More studies will be needed both to confirm the response to the drug combination and to see whether the combination would improve symptom remission over antidepressant alone.

I’d be also interested in understanding the rationale for choosing citalopram, and whether other antidepressants within the SSRI class and outside of the SSRI class of drugs would be explored in this combination.

Read more from Forbes or visit the Targacept website. You can also find out more information about mecamylamine from Medline Plus.

Past Edition for November 14, 2006

Welcome to this edition of our blog carnival of depression, bipolar disorder, and mental health journeys. Here are submissions accepted to this edition.

John Hill presents Overcoming Depression Permanently posted at Universe Of Success. Jane’s Note: This above article requires a disclaimer. The premise of the article is that depression is entirely caused by the individual’s choices, a notion that I subscribe to up to the point. Depression can be caused by organic factors, meaning, there is a biochemical and physiological cause that may be treated with good results by medication. I understand that the focus of the blog is personal development and may be focusing more on non-medical aspects of depression.

The reason why accepting an organic cause of depression is so important is because the last thing I want to advocate is “choose your way out of it” for those people whose depression has a biochemical cause and should seek help from a licensed medical doctor or healthcare practitioner specializing in treating depression. Yes, surround yourself with positive people and positive habits, and work on your cognition of your thought patterns that may be harmful to your state of wellbeing. On the other hand, for some of us, we need to seek help to get there… and I’m speaking from personal experience.

medications

Jon Schnaars presents Patients Should Consider Multiple Antidepressants posted at Anxiety, Addiction and Depression Treatments, saying, “In this post my co-blogger, Patrick Coffee, examines new research that shows that depression sufferers need to be patient and try several medications, but should find relief.”

Jane’s Note: The operative word here being “patient” (the adjective, not the noun)! It’s so important for depression sufferers to see that the fight can be a long one – trying different medications, persisting through the disappointments when you don’t get relief or when you feel worse from the side effects, and always keeping that hope alive. This really is a fight for your life.

mental health

Deb Serani presents Happy Stigma-Free Halloween posted at Dr. Deborah Serani, saying, “This post looks at the need to make Halloween stigma-free.”

Jane’s Note: Thanks to Dr. Serani for reminding us that social stigma can take many forms, and each “seemingly harmless” label can amount to perpetuating discrimination against mental illness and discourage people from seeking help to get better.

steven aitchison presents Attempted suicide – a turning point posted at Change your thoughts, saying, “I’ve never really spoke about my attempted suicide since I tried it all those years ago. I was a different person. At the time life to me was a jacket that did not fit and for years I had felt this way.”

[Jane's update August 2010 - It looks like Steven removed this post from his archives, since it probably does not lend itself well to the personal development theme that he is moving his site into. I think it's a pity that he removed it, but I also understand that he probably did this for business reasons. There is still a stigma connected to the topic of suicide, and people don't feel comfortable talking about it or acknowledging that it exists. I am going to keep this link broken - for archival purposes.]

Jane’s Note: Thanks, Steven, for sharing this very personal story with us. For those of us who have experienced that level of despair. It was a turning point for some of us to make a change. You can also catch Steven’s blogcast on his suicide attempt. The blogcast gave us more details from Steven about the changes he had made – including friends, career, and what he ultimately decided to do following his suicide attempt.

That concludes this edition. Submit your blog article to the next edition of carnival of depression, bipolar disorder using our carnival submission form.

Past Edition for October 3, 2006

Welcome to the October 3, 2006 edition of Carnival of Depression, Bipolar Disorder, and Mental Health Journeys.

depression

Steve Woodruff presents Clearing Clouds posted at Steve Woodruff, saying, “At first, it was like walking out on a frozen pond. You gingerly put a foot forward, and silently ask, “Will it hold me?” Waking up in the morning with feelings of happiness – for no external reason! – I’d wonder if this could be real. Would it last? Where did all that negativity and uptightness go – surely a pill can’t really change the way I think and feel! I no longer ask that question. I am a changed man. Steve version 2.0.”

Peterborough Today UK presents DEPRESSION: ‘They say pull yourself together.’ posted at Peterborough Today UK, saying, “TONIGHT well respected actor, comedian and author Stephen Fry talks candidly about the torment of manic depression. He tells of how he was driven to the brink of suicide in Stephen Fry: The Secret Life Of The Manic Depressive, on BBC2, at 9pm. He was diagnosed with bipolar disorder at the age of 37 shortly after walking out of a starring role in a West End play.”

bipolar disorder

Daily Mail UK presents I seemed the life and soul of the party. in fact, I was mentally ill | the Daily Mail posted at Daily Mail UK, saying, “Alex Fontaine, 39, a successful London businesswoman, suffers from bipolar disorder, also known as manic depression. Although nearly half a million people suffer from the illness, it can take an average nine years to be diagnosed, and one in five manic depressive commits suicide – the actor Stephen Fry, another sufferer, admitted he’s contemplated taking his own life. Here, Alex, who appears in a new book on the illness, speaks frankly to BECKY SHEAVES about the highs and lows of living with manic depression.”

mental health

Aleksandr Kavokin, MD, PhD presents 3 points to know about psych illness in elderly. posted at RDoctor Medical Portal, saying, “quiz about mental health”.

This concludes our first edition of Carnival of Depression, Bipolar Disorder, and Mental Health Journeys. Submit your blog article to the next edition of Carnival of Depression, Bipolar Disorder, and Mental Health Journeys using this carnival submission form!

Ketamine for Clinical Depression

Anesthesiologist Joe had written a rather detailed article on the use of Ketamine for depression. Joe did such a good job translating the science jargon into plain English that I don’t want to regurgitate what he wrote here. I will, however, summarize for you the key points, so you know what to expect when you hop over to read Joe’s “BehindTheMedspeak: Ketamine for depression?”

1. Ketamine is a controlled substance and an anesthetic drug.

2. In a clinical trial referenced by Dr. Joe, patients’ depression improved, some within a matter of hours of receiving Ketamine. This improvement was lasting beyond one week after receiving drug.

3. Unfortunately there were only 18 patients in the study, which in the medical world warrants this conclusion: “more studies are needed.”

Dr. Joe references this Washington Post article on the study.

Irritable Male Syndrome

Disclosure: I am not compensated by or affiliated with Mr. Diamond’s Organization. Jed Diamond takes a holistic approach to a seeping epidemic with “The Irritable Male Syndrome: Managing the Four Key Causes of Male Depression.” Rather than a predictable direction of “this is IMS, here’s how you get rid of it,” Diamond discusses all factors surrounding and contributing to the irritable male syndrome (IMS.) Diamond’s book deals not only with IMS, but with life transitions and how men’s social roles form and evolve. Diamond urges an examination of the biological and social context of men, including the upbringing of boys and their initiation into manhood. Stress, biological changes, and perpetual devaluation of men is feeding a growing infestation of irritable male syndrome and breeding a new generation of irritable males.

Andropause may remain a subject of conceptual debate among healthcare professionals; however, Diamond has experienced IMS and freely shares the intimate details of his struggles. This unabashed vulnerability may be why men are willing to risk exposing their own fears in working with Diamond, and why the use of personal stories throughout the book is effective. Make no mistake – this book is not all stories and no action – “points of understanding” provide a framework from which readers explore the core issues involved (this may speak to a systematic approach to problem solving that many men are comfortable with.)

You will have to read the final chapter for Diamond’s ultimate motivations for this work, but the reader can immediately appreciate Diamond’s philosophy and genuine concern in the root causes of the problem. Diamond even exercises beliefs that will take aback many therapists and patients – that happiness and unhappiness can coexist, and talking about problems don’t necessarily lead you to solutions. As a woman who has neither IMS (although I could identify with many symptoms) nor live with a man with IMS, I still value many kernels of “a-ha!” wisdom readily applicable to my own life.

Irritable Male Syndrome, when untreated, creates very real social problems that we have become familiar with via the evening news. Violence, aggression, and suicide are bred from untreated IMS. The story of 15-year old Josh touched me deeply, for I can remember a time when I went through similar feelings of worthlessness, despair, and anger. Josh’s story was painful to read, for it demonstrates that children today are subject to very harsh lessons that we would not bear to articulate.

Diamond does not shy from the controversial subjects, including media portrayal of man (“oppressor”,) symbolic castration of men in society (sperm donors,) and women’s valuation of men (resource/status provider.) I am ambivalent to such dissection of these social issues and how these relate to IMS. On the one hand, understanding the larger context of IMS is important. On the other hand, readers may become engulfed in the enormity of these issues and even feel distracted or overwhelmed by the “big, messy situation.” Still, I prefer to be overwhelmed by an ambitious undertaking than underwhelmed by reductionism.

Diamond’s book is important not only to readers who have personal experiences with irritable male syndrome, but to anyone who wishes to understand how threads of our biological and social conditioning are tightly woven into the tapestry of mental illness.

Seeking Help for Depression and Postpartum Depression

I’m currently reviewing Dr. Ruta Nonac’s A Deeper Shade of Blue, “a woman’s guide to recognizing and treating depression in her childbearing years.”

Early in the book, within the first chapter, Dr. Nonac’s made these important points about seeking depression treatment and about postpartum depression:

People who suffer from depression often are “discouraged” from seeking help for their depression because they may be told that what they are experiencing is normal, not serious, and / or go away.

Dr. Nonac states that depression is never “normal” and should never be ignored. Dr. Nonac in fact re-emphasizes this in other chapters of her book. Although Dr. Nonac’s book is about depression during a woman’s childbearing process, and thus is focused on the woman audience, this premise about seeking help for depression applies readily to men who suffer from depression.

Postpartum depression resources, and information about depression during pregnancy and during nursing, remain scarce.

It wasn’t long ago when we saw Brooke Shields’ and Tom Cruise’s public spat about postpartum depression and whether psychiatric conditions were made up by evil drug companies (according to Tom, psych conditions were imaginary). Other incidents of postpartum depression had come into our public consciousness as horrendous crimes committed by the mother to her children. This does not bode well for women who suffer from postpartum depression, because they were now afraid of being classified in the same group as those mothers. The positive thing is that this publicity brought postpartum depression to primetime, and Brooke’s public admission about her postpartum depression helped dampen some of the social stigma around postpartum depression.

However, information about what happens to a woman with depression during pregnancy and and during nursing is scarce. Women with a history of depression not only worry about their chances of experiencing postpartum depression, but also face questions like, “should I stop taking my antidepressants while I’m pregnant?” and “Should I wait until I finish nursing to start taking antidepressants again?” These are questions unique to women who are no stranger to depression, and are now facing childbearing decisions.

Bipolar Disorder in the Work Place

Both Forbes and BusinessWeek reported on a newly published study by Dr. Ronald Kessler in the September 2006 issue of the American Journal of Psychiatry (see Abstract).

Dr. Kessler and his colleagues concluded that employers should look at the cost of mood disorders like depression and bipolar disorder, and suggest additional studies to look at work place screening and treatment of depression and bipolar disorder. Dr. Kessler found that an employee with bipolar disorder on an average missed almost 66 work days per year, and an employee with depression on an average missed almost 28 work days per year. An employee with bipolar disorder had more missed work days because of the severity and persistence of the depressive episodes.

In the same issue of the medical journal, there was another study published looking at the effect of depression on work place performance. What was intriguing was a comparison between “absenteeism” (not at work) and “presenteeism” (at work, but performing poorly). Even when employees with depression begin to show some clinical symptom improvement, their work place performance could remain poor (read abstract).

Dr. Howard Goldman and Dr. Robert Drake wrote an editorial putting these two studies in perspective. Screening and treating depression and bipolar disorder should be of great interest to employers, because employee productivity has a direct impact on employers’ bottom line. However, these studies suggest that treatment may not completely reduce productivity loss in the work place. “Additional workplace interventions and specific rehabilitation efforts” are called for. What these interventions and rehabilitation approaches may be, however, remain to be proposed and implemented by employers.

2 Comments

desbest wrote:

If anything, I would say the study would discourage people from hiring people with “mood disorders”, as they would cost them money.

Thursday, April 4, 2013 at 11:04 am

Jane Chin, Ph.D. wrote:

You may be right, but I suspect the % is who may be considered “normal” is in a minority. The workplace is probably mostly “non normal” human beings all pretending to act normally. What is more productive is learning skills in collaborating with different mindsets.

Thursday, April 4, 2013 at 11:11 am

Depression from Cultural and Social Pressures

I’ve been fascinated by the recent clamor over the birth of a baby boy in Japan’s Royal Family.

Not so much the debate over whether Japan would change its policy of allowing women to assume the royal throne, and the birth of a prince will postpone that debate for a while. I was more interested in what happened with Princess Masako, a modern woman whom many looked to as Japan’s “Princess Diana”, someone who would represent a breath of fresh air to the Japan Royal Family.

According to news reports, Princess Masako was a stark contrast to her sister-in-law, Princess Kiko (mother of the much anticipated heir to the throne). Masako was a career oriented and Harvard educated scholar who spoke five languages and worked as a diplomat. Kiko grew up dreaming of marrying a prince and ultimately she did and she loved her role as a royal wife. For all the talk about modernizing the royal family, the media and public had focused intently on the Masako’s childbearing responsibilities. Masako’s 1999 miscarriage was alleged caused by stress from the media, and even after the 2001 birth of daughter Aiko, Princess Masako didn’t get a break (because her royal responsibility was mainly to produce a son and heir).

There’s talk of Masako and the Crown Prince heaving a sigh of relief now that there is a male heir and the media perhaps would get off their backs. I have a feeling the media won’t relent. It’s going to be more “Masako-this versus Kiko-that” for years to come, it’s how the tabloid companies sell magazines.

Who can be surprised at Masako’s 2004 “mental illness” that even the Royals cannot suppress? When you’re in the public eye as these royal women are, those who are seen as a change to tradition are subject to tremendous strain – both from the cultural pressures that a woman may threaten to change – and from the social pressures of a public caricaturizing every moves of a celebrity. It also seems like the more “face time” you get with the media, the more likely you’d suffer from mental strain and stress of living under the microscope.

Intelligence and education stand little chance when it comes to the cultural and social pressures. I am not sure that Masako was vulnerable to depression to begin with, and I suspect the tremendous pressures caused depression to develop. When her husband the Crown Prince reprimanded the media for creating a hostile environment for his wife, his younger brother reprimanded the Crown Prince, saying that the duty of the royal family was to passively accept the responsibilities given to them by the public.

Medication: Corlux Not Meeting Goals for Depression

Corcept Therapeutics’ lead drug, Corlux is being studied for its ability to reduce the psychotic symptoms of major depression in patients. Corlux is a Glucocorticoid receptor type II (GRII) antagonist and may be better “known” as the controversial mifepristone (or RU-486, otherwise known as the “morning after” pill). The company initiated studies on Corlux based on the rationale that abnormally high cortisol release has been observed with many disorders including psychotic major depression (PMD), and has licensed a patent to use the drug for treating psychotic features of PMD to relieve symptoms more quickly, effectively, and without the same side effects seen with current treatments.

For now it appears that the drug is not living up to its promise where effectiveness is concerned, at least in two out of three late-stage (Phase III) clinical studies sponsored by the drug company. There was no meaningful difference in response between patients who received Corlux and patients who received placebo. The company noted that the two failed studies had an unusually high placebo response.

Source: company press release and company website. You can also read a pharmaceutical industry executive journal article about the company and its drug.

Depressed Patients Don’t Get Enough Follow-Up

Recent controversy in antidepressant therapies centered on an increased risk of suicidal thoughts in new patients who started antidepressant medications. However, a new study published in American Journal of Managed Care suggests that this concern about increased risk of suicidal thoughts in patients taking antidepressants did not translate into physicians following up on patients who started antidepressant therapy.

US government guidelines recommend children and adults who are taking antidepressants meet with doctors at least once a week during the first month of antidepressant therapy, Then, patients can meet twice a month, and thereafter, once every 3 months. However, the published study found that 45% of the patients who started to take antidepressants did not see their doctors during the first crucial month of taking antidepressant medications. When you consider almost 85,000 patients (including children) surveyed in this study, you can imagine the staggering number of patients who should have received monitoring but weren’t followed up by their doctors.

We can have a lot of media attention on the risks of increased suicidal thoughts in some patients taking antidepressants – especially pediatric and adolescent patients – and we can have government issued warnings and drug makers revising their medication labels to reflect the risks. However, if doctors aren’t following up on the actions necessary to monitor for these risks, then all the media attention and advisories in the world won’t make a difference in reducing preventable tragedies.

Study source: Am J Manag Care. 2006;12:453-461. Frequency of Follow-up Care for Adult and Pediatric Patients During Initiation of Antidepressant Therapy.

Post Traumatic Stress Disorder and Depression in the Military

As we’re celebrating the long holiday weekend and Independence Day (July 4th) here in the US, our thoughts are also with the troops overseas in Iraq. We’re often exposed to the facts in the news – what’s happening in Iraq and the activities that go on – but we often don’t hear about the soldiers’ mental health during and after the war.

I’m not sure that our nations are prepared to face the reality that many soldiers are experiencing depression and post traumatic stress disorder (PTSD) from this war. The media is starting to pick it up, though, and this will increase awareness of the stark mental and emotional consequences of war.

Recently Dateline NBC’s story, “Rescue on Roberts Ridge” and touched upon the effects of war on the mental health of a soldier, Nate Self. Nate had described feelings of guilt of being alive while his comrades had died, and how his mental state plummeted to the point where he did not take care of himself or wanted to do anything.

MSNBC’s website also had an article about 1 in 8 returning soldiers suffering from PTSD not seeking help because they are afraid of social stigma and their careers being hurt if they speak up. What was notable was that the rate of PTSD was much higher for those engaged in the Iraq war than those in the Afghanistan war, because of those in the Iraq war saw more combats including attacks and firefights.

Mental health crisis is hitting UK troops as well. UK’s The Observer ran an article that echoed what was found in US soldiers: that UK troops engaged in the Iraq war has record levels of PTSD and depression.

Regardless of the political discussions around the war, what is clear is the need for troops to get mental health screening, support, and treatment they need for what they’ve been through in serving their country.

Like Some Antipsychotic Meds, Antidepressants May Increase Diabetes Risk

For most depressed patients, taking antidepressants are a risk-benefit ratio; improving depression comes with a set of side effects that require management in the long term. For a population of depressed patients who may be at risk for developing type 2 diabetes, antidepressants have been a cause for concern because of an association between antidepressants and development of type 2 diabetes.

American Diabetes Association (ADA) announced that antidepressants may increase the risk of type 2 diabetes for depressed patients who already have that risk. This came from ADA’s 2006 scientific meeting held during the summer. The association also published on the role of depression and developing diabetes, which you may access via this PDF from ADA’s website. Those with depression and diabetes definitely need to carefully manage both conditions.

In one of the studies looking at antidepressants and diabetes, people with high diabetes risk who took antidepressants were 2 to 3 times more likely to develop diabetes during the course of the study, compared with people who did not take antidepressants. This study is important because there had been headlines for some time about antipsychotic medications increasing diabetes risk, but this is the first time that antidepressant drugs have been linked to increasing diabetes risk. How this happens (the mechanism) is still unclear at this time.

Debate also centered already a “chicken or egg” question: which came first, the diabetes or depression? Certainly, people with chronic conditions (chronic pain, cardiovascular conditions, diabetes) are understandably prone to triggers causing depression. What is not yet known is whether depression is caused by the diabetic condition, although most endocrinologists realize that depression can occur in diabetic patients.

Search for more: ADA’s Press Release or Google News on Antidepressants and Diabetes

Family History and Stress Triggers Depression in Politician

Recently, a Maryland Governor candidate dropped out of the race because of his depression. Montgomery County Executive Douglas M. Duncan said that family history and stress triggered his depression, which was newly diagnosed during the race even when he had suffered symptoms for longer; his father had bipolar disorder and died in 2001.

Many famous politicians and public figures suffered from depression, including Abraham Lincoln, Richard Nixon, and Winston Churchill. Although we still have a long way to go, politicians who admit their battle with depression know that this would no longer end their political careers.

Political figures have also been known to commit suicide relating to depression. Baltimore Sun noted U.S. Rep. William O. Mills and Former state Sen. George R. Hughes Jr.

Susan Levine, a Washington Post Staff Writer also reported on this incidence in a separate and related story.

Politician’s History of Being Physically Abused Surfaced during Campaign

This link no longer works but a follow up to the story is found in NY Times:

http://www.nytimes.com/2006/07/14/nyregion/14kt.html

In a related post for today’s entry on politicians and mental illness, Kathleen Troia “KT” McFarland’s past history of being physically abused as a child surfaced during her campaign.

The media got a hold of letters that McFarland wrote in 1992 to her parents at the advice of a counselor. This caused McFarland to disclose her history with physical abuse. McFarland’s father was allegedly the abuser.

Interesting Way to “HEAL"

Andrea Grimes writes about attending a “bootcamp” aimed to heal people who are in emotionally abusive relationships. The bootcamp was based on Dr. Steven Stosny’s method. Dr. Stosny is an anger and domestic abuse expert.

Andrea cringes at the $800 price tag for the event, and learns the acronym “HEALS” for Stosny’s compassion-grounded process:

“H” – visualizing the word “HEALS” when you feel angry

“E” – experiencing core hurts

“A” – accessing your core value

“L” – loving yourself

“S” – solving the problem

Although Andrea described examples of the “HEALS” process, I suspect that most situations may end up in the “self love” bucket. That is, whenever you become angry at someone’s actions, it may be because you perceived that action to mean you were unlovable and undeserving in some way. Then you lash out at the perpetrator that has triggered this experience in you, thereby inflicting abuse. The solution is then to swim in imageries and experiences that make you feel good and lovable, which are usually conducive to compassion.

Abusers need to practice these steps 12 times a day for 6 weeks, essentially reprogramming how one reacts to a situation.

(P.S. Perhaps those with road rage may consider Stosny’s “compassionate driving” method for one’s intermittent explosive disorders.)

How Drug Companies Communicate Information with You

I’ve been hearing some talk in the drug industry about how they desire to better communicate with patients and consumers. I’ve also become aware of some companies exploring blogs as a way to reach consumers and market to them.

I’m quite wary of these types of approaches – but I have a personal interest in this because I blog here, and having an emergence of “marketing” blogs or worse – splogs (spam blogs) will only hurt the credibility of blogs in general.

That said, I’m wondering how you’d want drug companies to communicate information with you as a patient. What should they do to make you believe that the information they have presented to you is “fair balanced” and is not a promotional spin?

If you have any thoughts or ideas on this, please comment here or please email me at mhsourcepage@gmail.com .

UK Mental Health Worker Opens Up About Bipolar Disorder

BBC News Online published a story about Robert Westhead, a 33-year old National Institute of Mental Health (NIHME) worker who suffered from bipolar disorder.

Robert began experiencing symptoms at age 19 and became seriously ill with severe mood swings. His moodswings happened in cycles of 8 days where he would be manic for 8 days and depressive for 8 days. Robert described some of the symptoms of mania and depression that are common among bipolar disorder sufferers; feelings of grandeur (“I was on a divine mission seeing God personified in a black dog and the eyes of a cat”), needing very little sleep, racing thoughts – before crashing down and bursting into tears at various moments.

Robert’s story was important in illustrating that sometimes patients can forget what it felt like to feel “normal” that when he was in a mildly depressed state from cutting back medication dosage. Essentially, Robert stabilized at a depressed level and thought it was a normal mood until he began to experience physical pain from the depression. Then, Robert came to a dangerous state of becoming suicidal. He attempted suicide from a lithium overdose.

Robert took another year to stabilize with different drug combination and eventually finding an effective combination for him.

Bipolar in the Elderly: 61-Year Old Man Finds Support and Encouragement After Bipolar Disorder Diagnosis

Mr. Tom Doucette had suffered from bipolar disorder most of his life but didn’t know it. When his hallucinations about his dead mother became severe, Tom went to see his doctor and was diagnosed with bipolar disorder at the age of 56.

Tom considered the day that he received his diagnosis the day he “was born.” He found acceptance, support, and encouragement from his wife and a friend he had met through a community crisis center. Dean Shalhoup described Tom’s story in the Nashua Telegraph, which you may find here.

Tom founded the Nashua chapter of the Depression and Bipolar Support Alliance, a support group. The group is open to all mental conditions and meets weekly.

I really liked this story about Tom because it shows that you can make a difference at any age – and you can start living at any age!

Depression and Bipolar Disorder Gene Not Linked to Serotonin

Many antidepressants work by changing serotonin levels in the brain, which is why these classes of antidepressants are called Selective Serotonin Receptor Inhibitors (SSRIs). In May 2006, a study was published in the American Journal of Medical Genetics that suggests that a gene for major depressive disorders (including bipolar disorder) was found, and is not linked to serotonin. ScientistLive.com published a commentary about this study.

This gene is called P2RX7 and is found in humans and animals. This marked an advance in understanding the genetic basis of depressive disorders. Professor Barden was a lead investigator in the study and was quoted to say, “What is particularly exciting is that P2RX7 has nothing to do with serotonin.” Barden speculated that future antidepressants may directly target the P2RX7 gene, and current antidepressants may take weeks to have an effect because current antidepressants bypass P2RX7. In animal studies. directly targeting P2RX7 was shown to have an antidepressive effect.

Barden concluded that how P2RX7 works is still unknown, and may be part of a larger genetic network that is responsible for depression.

I’m including the Original Abstract for those of you curious about the scientific jargon:

Barden N, Harvey M, Gagné B, Shink E, Tremblay M, Raymond C, Labbé M, Villeneuve A, Rochette D, Bordeleau L, Stadler H, Holsboer F, Müller-Myhsok B. 2006. “Analysis of Single Nucleotide Polymorphisms in Genes in the Chromosome 12Q24.31 Region Points to P2RX7 as a Susceptibility Gene to Bipolar Affective Disorder.” Am J Med Genet Part B 141B:374-382.

Abstract

Previous results from our genetic analyses using pedigrees from a French Canadian population suggested that the interval delimited by markers on chromosome 12, D12S86 and D12S378, was the most probable genomic region to contain a susceptibility gene for affective disorders. Association studies with microsatellite markers using a case/control sample from the same population (n = 427) revealed significant allelic associations between the bipolar phenotype and marker NBG6. Since this marker is located in intron 9 of the P2RX7 gene, we analyzed the surrounding genomic region for the presence of polymorphisms in regulatory, coding and intron/exon junction sequences. Twenty four (24) SNPs were genotyped in a case/control sample and 12 SNPs in all pedigrees used for linkage analysis. Allelic, genotypic or family-based association studies suggest the presence of two susceptibility loci, the P2RX7 and CaMKK2 genes. The strongest association was observed in bipolar families at the non-synonymous SNP P2RX7-E13A (rs2230912, P-value = 0.000708), which results from an over-transmission of the mutant G-allele to affected offspring. This Gln460Arg polymorphism occurs at an amino acid that is conserved between humans and rodents and is located in the C-terminal domain of the P2X7 receptor, known to be essential for normal P2RX7 function. © 2006 Wiley-Liss, Inc.

Labeling Bad Behavior as Mental Illness Belittles Those Who Truly Suffer From Them

Daniel Vasquez, Consumer Columnist at Sun-Sentinel.com believes that “Calling rude, nasty behavior mental illness misses the point” and that acts of rudeness, obsession, and violence is getting labels from doctors and drug companies to feed the social desire to medicate away problems.

Mr. Vasquez specifically mentions news about “Internet Addiction Disorder” (IAD) and “Intermittent Explosive Disorder” (IED) and wonders whether these are real problems or just jerks’ excuses. National Institutes of Health (NIH) now recognizes IED and suggests that IED may help explain road rage and domestic violence. I personally share Mr. Vasquez’s skepticism where IED is concerned. Mr. Vasquez also believes that people who used their cars as weapons should be charged as criminals and not treated like they are mentally ill.

Mr. Vasquez consulted with a psychotherapist to get a balanced perspective – I give him credit for that! The psychotherapist stated that a person who is controlled by urges needs help.

Mr. Vasquez’s nephew suffers from bipolar disorder and mild schizophrenia, so he has first hand experience at the devastating effects of mental illness. Thus he feels that our cultural love of labels has led to misdiagnosis and treatment that weren’t necessary and in some cases hurt the individual even more.

One Comment

Bruce wrote:

As a psychologist, I’d have to agree with the main argument presented here. If you’ll listen to the following song, you’ll know what it’s really like to suffer from mental illness. This song, inspired by my performance of Johnny Cash songs at a prison, is about an inmate who suffered from more than one psychiatric disoder. See if you can identify the disorder, based on the symptoms depicted in the song: JC Therapy words and music by Dr. BLT http://www.drblt.net/music/JcTherapy.mp3

Saturday, July 15, 2006 at 4:23 pm

NavyCompass.com Talks About Domestic Violence in the Military

Recently I highlighted the prevalence of domestic violence in military families, and how often victims fear seeking help. NavyCompass.com is a website for members affiliated with the navy, and has published an article urging victims of domestic violence to seek help.

In “Victims of Domestic Violence Shouldn’t Fear Seeking Help“, JO2 Adrian Melendez stated that the naval support is there with victims of domestic violence, and that the biggest challenges in putting a stop to violence is the fear of victims in seeking help. By the time a case is reported, the abuse has been going on for a long time and the situation may have become worse and dangerous.

Other factors that hinder report is fear that reporting an incident will disqualify the spouse from receiving naval support. This is essentially fear stemming from potential financial devastation. The navy describes ways to prevent this from happening so that the victims will come forward to report abuse.

Remember, domestic violence can happen to both men and women.

African Americans & Depression: Novel for Awareness

Bebe Moore Campbell is a best selling African American novelist who has published a novel called 72 Hour Hold, in which an upscale Los Angeles shop owner has a daughter suffering from bipolar disorder. African Americans may have similar prevalence of bipolar disorder as other Americans, but may be less likely to be diagnosed and treated.

Campbell’s personal experience with a mentally ill relative inspired her novel, and has since co-founded a regional National Alliance on Mental Illness in Inglewood, California.

Kenneth Meeks of BlackEnterprises.com had an exclusive interview with Campbell to increase awareness of mental health issues within the black community. Important points from their interview included:

In mental illness there are 2 affected parties: the patient and the caregiver

Most still don’t want to “talk about it”

Social Stigma is still the main reason why people don’t seek help or stay in treatment

People do want support from the community

Coaches and Sexual Abuse

North Jersey published an important story about the betrayal of trust by coaches who molested the children they coached.

The backdrop of this story was the public accusation of a figure skater who said a famous coach and sexually abused him. This article is especially important for parents to become aware of how sexual predators use various emotionally oligating and abusive tactics to lure victims into silence. As Craig Maurizi described his relationship with his coach Richard Callaghan:

“He was my father for those years. Even though he screwed me over so badly, he helped me. That’s where the big emotional conflict is. In these cases, these people do good things for you. That keeps you on the hook.”

2 Comments

nance wrote: Mark Samuel, Nurse Sex Offender Convicted On Sept 8,2005 RN:Mark Samuel was sentenced to five years in Jail with all but two years suspended,having been convicted in January 2004 of unlawful sexual contact with a 6 year-old girl . Mark Samuel counseled the girls mother. when the counseling ended , the three became friends attending family fuctions together. The violations occurred during sleepovers at the Nurses residence during the summer of 2003. Mark Samuel has been released from prison and is now at risk to the community of North Bay Ontario Mark Samuel emyployed 2007 for Assertive community treatment Team North Bay, ON Northeast Mental Health Center P.O. Box 3010 4700 Highway 11 N North Bay, ON,CA. Sunday, November 11, 2007 at 4:16 pm

nic wrote: Hi nance…I am looking for more info on this case and mark samuel and seem to come across that you have posted this everywhere so thinking maybe you could help me get more info on this! can you please email me in private daycareguru@ymail.com . Friday, September 2, 2011 at 11:57 am

You Can Get SAD During Summer Too

I thought Seasonal Affective Disorder happens during the winter when daylight time is shorter. Apparently SAD can happen during the summer too, as this article pointed out, because there are two types of SAD.

The difference is that the summer version of SAD reads a bit like hypomania – you can get agitated and have insomnia and loss of appetite and have higher energy levels. That doesn’t sound like “depression like” symptoms characterizing the winter variant of SAD. For those with bipolar disorder, having summer SAD could trigger full blown manias rather than hypomanias, which can be problematic.

Non drug but unproven strategies for treatment of summer SAD may include wearing dark glasses or keeping rooms dark. These are different from treatment of winter SAD where patients are advised to get a dose of light.

5 Comments

Lynn wrote: I have always thought something was wrong with me in the summer. I get super tired, where I can barely stay awake, my eating goes out the window and am irritated a lot. I suffer from hot flashes and I’m only 31. It’s been like this since I was a kid. I remember thinking I hated the time change. So my husband and I put in a pool and that seems to help to be able to escape from the heat and exercise. Sunday, June 15, 2008 at 9:01 pm

Jane wrote: Hi Lynn, I’m glad that the pool is helping. I do better with longer days (summers) than I do winters. Good thing I currently live in a warm state (CA).Tuesday, June 17, 2008 at 2:31 pm

Larry wrote: I live in the southwest where summer temps are regurlarly 110-115 degrees. I used to love the summers, but now that I live here in the southwest I notice I’m miserable and depressed a lot during the summer. So maybe this SAD isnt so complicated. I mean what is so pleasant about 115 degree heat anyway. Or on the flip side if you get SAD in the winter and you live in an area that has four feet of snow all winter then, duh you’re gonna hate it. Saturday, November 12, 2011 at 7:16 pm | Permalink | Edit

Jane wrote: Larry: you bring up a very valid and interesting point — depression may not be limited to “winter blues” but more “hostile temperatures.” I remember feeling angry and depressed when I was a little girl, living in Saudi Arabia — and that was one very hot dry place. It would be so hot we’d never leave tape cassettes (this was back in the 70s and 80s!) in the car because the plastic would melt. Saturday, November 12, 2011 at 9:25 pm

Hanna wrote: OK. What in the world is going on. Ever since i was a child i thought something must have been wrong with me during the summer. It always ALWAYS started during when the end of final, late spring throughout Summer and ended right before school started. It was really weird even when i was in a different country i felt this sense of depression, sadness over come me and i felt completely helpless and anxious for something at the same time. I still feel that way but sometimes i try to busy myself in activities to keep my mind off of it but i find myself with the same gut feeling every time. I wonder if there might be a cure for this because i hate when i get like that during the summertime while every one is in such an excellent mood. A lot of people have noticed this summer depression in me although only ocassionally and not reoccuringly. They just notice or ask me why my mood changes so much sometimes especially during the summer. This might sound like a stupid suggestion, but would green tea, herbal tea help with this? Ive heard of this helping with depression in general and was wondering whether this might be effective with this as well. Monday, January 9, 2012 at 2:06 pm

Emotional Abuse is About Violations of Humanity and Dignity

A woman was recently sentenced to 6 years in prison for 2 counts of child abuse.

The woman and her husband had locked their (step) children in small rooms and starved them. The judge who sentenced the woman believed that the woman treated the children like animals and deprived them of their humanity and dignity. The woman was also accused of using humiliation tactics in her abuse. On the other hand, the accused’s side was a parade of people who begged for the judge’s mercy and said that the woman was a loving individual.

The victims’ lawyers summed up the heart of the case as follows:

“The evidence bore out that she is a step-monster,” Schroeder said, referencing a term Wilson used to describe herself to the children’s school teachers. “She has shown no remorse, and she continues to portray the children as the culprits. She’s being punished because the children made her do it.”

You may draw parallels between emotional abusers and sexual offenders. We often have an image of what abusers should look like: monsters with dark ugly faces and disheveled appearances or ogres with warts at the ends of their noses. Yet tmost abusers look normal and kind and like neighbors next door to whom you would entrust your babies.

That’s why abusers are so dangerous. These are otherwise regular and nice human beings – at least they are nice to most and dangerous to their victims.

Nevada Has 3rd Highest Suicide Rate in the US and More than a Third by Young People

Alex Newman’s article, “Struggling with suicide” points out a sobering statistic: College students die from accidents and suicides, and each year, young people ages 15-24 kill themselves. About 1 out of 4 of those young people are college students.

When a Nevada college student killed himself, the state declared this a public health crisis.

American Association of Suicidology is an organization for understanding and preventing suicides, and released figures that showed Nevada has the 3rd highest suicide rates in the US in its 2003 data. Wyoming is #1 and Montana is #2. You can click here to get the PDF statistics.

Alex’s article includes helpful resources for warning signs, statistics, and speaking with someone about suicide. Many of these come from a compilation of resources including information from AAS.

Mental Health in Children: 1 in 10 Children in UK Suffers

There also appears to be a socioeconomic link to this trend of increasing mental health problems in children, where poorer areas showed higher rates of mental health disorders. Unfortunately, these children may also not receive the care or treatment they need.

Scotsman.com news noted an authority saying that Scotland has pockets of poverty stricken areas. These are especially vulnerable when children require strong family units and social networks for good mental health. Additionally, people living in economically deprived areas may not be aware of mental health issues or seek help for their children.

One of the comments to the article pointed out the breakdown of the parental unit that has caused to the deterioration of children’s mental health. Extreme stress from divorce and other family strife can inflict psychological and emotional trauma to children and perhaps trigger mental health disorders in children who may already be more susceptible to certain mental illnesses.

Caring for a Mentally Ill Parent

Jill Stark writes about 15-year old Jessica who takes care of her mentally ill mother. This is a story that many children and teens with mentally ill parents can relate to: at a time when others are looking forward to their futures and making plans, Jessica and peers in her position go on “night patrol” to watch over her mom.

This story also speaks of the lack of support that teens like Jessica face, when she becomes the parent when her mother’s condition destabilizes. Jessica has to constantly be there for her mother and forego parties that most teens take for granted.

Children and teens in these situations are particularly vulnerable to developing mental health problems, as well as dealing with feelings of shame. When there are other siblings in the family, the eldest shoulder parental responsibilities to their own siblings as well.

The most important fact that children and teens in these situations must realize and believe is that this is not their fault.

2 Comments

Leanna wrote: Hi:) I really liked your blog. I feel for people with mental illnesses. I am so interested, I even chose helping people with mental disabilities as a topic for a project at my school. In my class, we are making our own blogs and PSA. My blog is about helping people who are mentally ill get off of the streets and collect resources. Anyone interested in looking at my blog(very unfinished blog) is more than welcome. My link is http://homelessmentallyillinla.blogspot.com/ and please feel free to leave comments and suggestions. thank you:) Tuesday, December 4, 2007 at 1:25 pm

Jennifer wrote: Hi, I just wanted to say thank you to Jessica for sharing her story. My brother and I cared for my Mum who went through years of paranoid pyschosis when we were growing up and some of the things you said were so true for us. I remember feeling very ashamed about my Mum’s illness, and then feeling ashamed that I felt ashamed! I found it hard to explain to even my closest friends and so I think that you are so brave. When my mum was ill, it felt like there wasn’t anyone out there who was struggling with the same problems and I’m so glad that you can attend a group where you can talk with other young people in similar circumstances. Certainly more of these are needed and especially where I live in the UK. Thank you again: I hope that 2 years on things have improved for your family. Best Wishes, Jen,x Wednesday, October 7, 2009 at 6:00 am

Bipolar Disorder Magazine: Hope and Harmony

I saw a news article on a magazine on bipolar disorder and was pleasantly surprised that the articles and back issues were available online.

It’s also nice to see some pharmaceutical company sponsors (front page, right hand column) because without these sponsors I’m sure many of the articles would not be available for free on the website.

I especially enjoyed Lizzie Simon’s article in the current issue on “Stigma: talk or walk.” (click to get pdf file) She brings up a good point – what happens when the person with the stigma against mental illness happens to be intellectual (i.e. “smart”)?

Well, to put things in perspective, one can build a whole case around any belief and find supporting evidence against the existence of mental illness as much as the evidence supporting the existence of mental illness. And I suspect there are PhD dissertations in both areas. There are plenty of doctorate level professionals and research scientists who have seen biochemical changes and genetic changes to contradict the woman who built her whole research project on the conspiracy theory that drug companies must have created these illnesses for profit and to strip away the self reliance of an individual.

Disclosure: I used to work in the pharmaceutical industry and may hold more constructive views of the industry than others – unless, of course – I’m criticizing some of the ridiculous approaches drug companies use to market and product their products. I also had suffered from depression and therefore am biased to believe that I had a biochemical imbalance that was helped by both medication and psychotherapies.

Two Sides of the Debate Around Screening for Teen Suicide Risk

Relating to my previous entry on suicide in young people, there is a debate around screening for suicide risk via psychological evaluations.

Because of the concern for teen suicide, psych evaluations are growing and critics say that this has not been shown to prevent suicides. Critics also say that these screenings often lead to the teens receiving prescription medications. Many of these medications including antipsychotics have not bee approved for use in children and teens, yet the use of psychiatric drugs in young people have dramatically increased.

This of course, has economic implications for the drug industry.

On the other hand, proponents of screening programs include those who had lost loved ones to suicide. The more controversial proponents include antipsychiatry parties like scientology and its visible celebrity spokesman (we know who he is).

One Comment

Cat wrote: More than just teens are being medicated! Why are teens suicidal? Why do they want to to?! Consider losing more than one person to you. Its hard, but you can get by. However if you keep losing more and more the weight of the pain continues, especially when they are in close time intervals. Then you have the people who are also upset for the same reason. You honesetly think its fair…? To try to hide your pain to help another? Its not! No one knows how to go about these problems without causing more problems. You have to be delicate cause its not as if they could become any more broken up. All thats left is the shatter. I have constant pain, not much I can do about it. I try. I cry. I give up… No one wants to tell anybody anything because they don’t want to be hated! They don’t want want to be considered Crazy and lose whatever they have left! IF YOU WANT TO STOP SUICIDES STOP PROMOTING THEM! STOP MAKING KIDS FEEL CRAZY! MAKE THEM FEEL LIKE THERES A REASON NOT A WAY TO CARRY ON FOR COUNTRY PROFIT! We are not crazy unless YOU say we are. Unless the COUNTRY wants us to believe we are for money to fill the pockets of greedy people and the country’s Debt! THINK ABOUT IT FIRST! Then screenings will not be necessary. <3 Cat Monday, November 5, 2007 at 9:56 am

New Jersey Doctors Must Counsel on Postpartum Depression

Tom Cruise isn’t going to like this one.

In April 2006, New Jersey governor Jon Corzine mandated doctors to educate pregnant women and family members about postpartum depression. New mothers will be screened for postpartum depression. The law will become effective this October, making NJ the first state to enact this legislation. You can read the details on the Psychiatric News website. Thanks to Sue for pointing this out.

Domestic Violence in Soldiers’ Families

Some are saying that the abuse culture fostered by the military – that violence may even be “necessary and honorable” – may contribute to a perceived widespread pattern of domestic violence in military families. There is no solid data comparing rate of domestic violence between military and civilian families.

The US Department of Defense reported 227 domestic homicides spanning a 6 year period between 1995 and 2001 where 5 of those murders occurred in 2002. The government admits that this problem needs to be addressed, and a task force was formed for this purpose. However, the track record of properly implementing on the task force recommendations – including disciplinary action when caught – appeared spotty at best.

Given the current state of war, there may be a link between deployment and the rate of domestic violence, making task force implementation more essential. Christine Hansen oversees the Miles Foundation that helps survivors of military personnel related domestic abuse and observed that abuse incidences increase right before deployment for war, and then upon return from active duty.

What is hindering progress in domestic violence associated with military families was suggested to include social stigma of domestic violence (don’t want to talk about it) and feeling like military personnel could do no wrong.

Medication: Wellbutrin XL for Seasonal Affective Disorder

On Monday, June 12, 2006 US Food and Drug Administration (FDA) approved bupropion XL (brand name Wellbutrin XL) for the prevention of depression in seasonal affective disorder (SAD). This approval was notable not only because this makes Wellbutrin XL the first drug approved for SAD, but also because the approval was for prevention of depression associated with SAD.

Seasonal Affective Disorder is depression that correlates with the time of the year when the amount of daylight changes. Therefore, depression episodes occur during the fall and winter, when daylight hours decrease.

The approval was based on 3 double-blind, placebo-controlled trials in adults with a history of major depressive disorder in autumn and winter. Response rate was 84% Wellbutrin treated and 72% Placebo treated.

There is a black box warning for suicide risk with Wellbutrin XL, as with other antidepressants, on its use in vulnerable populations including in children and teens.

US Patients Heading to Canada for Unapproved Depression Therapy

Earlier in the week a Wall Street Journal article reported “Patients Seek Off-Label Depression Therapy: Magnetic Stimulation Shows Promise in Intractable Cases; Heading to Canada for Help.”

Although the treatment is not approved in the US for depression, US residents are heading to Canada to pay around US$7000 for 3-4 weeks of treatment. The treatment is a device-based therapy and works by delivering electromagnetic pulses to the brain. You can find more information on device-based depression therapy in a past article from NakedMedicine.com.

Off-label uses of psychiatric medication is actually very common practice, even though the article reported that doctors caution patients to wait until FDA approves the device for depresison treatment. Ironically, Canadian health insurance plans wouldn’t cover this procedure because the plans did not believe there to be enough evidence to show its effectiveness.

Current clinical trials are underway for gaining approval of this device in depression treatment. Anytime when there is off-label use, that means clinics are using it without following regulatory authority and may not be using the same approaches that have been tested in clinical trials. Patients also are paying out of their own pockets. This procedure may take 15-25 sessions depending on the patient. In clinical trials, the procedure was observed to be helpful for some patients, but certainly not all patients.

For now, only electroconvulsive therapy (ECT) and vagus nerve stimulation (VNS) are 2 nonmedical treatments approved for treating depression. VNS is only approved as an add-on therapy.

Medication: FDA Wants to Stop Some Antihistamine Sales

Wall Street Journal reported that the US Food and Drug Administration (FDA) wants some manufacturers to stop making prescription cold and allergy medicines containing carbinoxamine because the drug has not been approved by the government. There are at least 120 medications containing this compound and the only company that has gained FDA approval to sell this drug as a tablet or oral solution for allergic reactions is Mikart Inc. There has been 21 deaths reported in children due to use of this product since 1983.

Intermittent Explosive Disorder Behind Road Rage? Or Is IED A Lot of Hype?

Last August I posted about how anger may have become its own disorder instead of as a symptom of another disorder.

It looks like “intermittent explosive disorder” has resurfaced in the headlines. A few days ago I heard on the radio an “expert” who talked about how intermittent explosive disorder has caused the road rage phenomenon we have become familiar with today. I live in California and I can think of many reasons why I’d feel some road rage – often self-induced because I didn’t give myself enough time and when I’m in a rush to get somewhere, I’m more likely to drive aggressively and be less forgiving of other drivers’ mistakes.

Here’s a slew of headlines from Google News about how intermittent explosive disorder could be behind many road rage incidences. The collection of links also included Ben Grabow’s take on the road rage phenomenon and how we may be too quick to label road rage as an anger disorder rather than looking at other “non-organic” causes behind road rage.

I want to take this seriously, because we’ve had incidences of people getting shot on the road, attributed to “road rage” or random acts of violence. Still, I think we’re continuing to splinter symptoms into its own disorders so we can take medications to treat the symptoms instead of really understanding the root causes. We don’t even have depression and bipolar disorder down pat where diagnoses and treatments are concerned.

Cutting: 1 in 5 Students at 2 Ivy League Colleges Cut

I was not too surprised to read this, but still, I found shocking that “1 in 5 at Cornell, Princeton practices cutting.” Here is an article from Cornell’s ChronicleOnline that discusses this issue in some detail.

The 2 Ivy league schools listed in the article were Cornell (my alma mater) and Princeton. Not long ago on this site, I commented on high suicide rates of Asian American students at Cornell. I had interviewed Dr. Deborah Serani on self-injury on NakedMedicine.com and Dr. Serani also wrote an article about self-injury there.

Students injured themselves through cutting, burning or other means, and psychologists are hearing more about self-injury in young people as a way to relieve stress or “make emotional wounds visible.”

I started writing more about emotional abuse on this website because it was one of the stimuli that led to my own depression. I’m beginning to realize that emotional wounds can manifest in many different ways beside depression and bipolar disorder.

Something that Dr. Serani had touched on that needs to be pointed out is how there are websites that glorify self-injury. These websites perpetuate this dangerous coping mechanism by providing an illusion to vulnerable teens and young adults that “this is how you can connect and belong.”

Sticks and Stones May Break My Bones, But Words Can Scar Me For a Very Long Time

Researchers at Florida State University published a study that showed children who were verbally abused grow up to be prone to depression and anxiety. According to the university’s news release, “Invisible scars: Verbal abuse triggers adult anxiety, depression“, adults who were verbally abused had almost twice (1.6 times) the number of depression and anxiety symptoms as those who were not verbally abused, and were twice as likely to have suffered a mood or anxiety disorder during their lifetime.

Dr. Sachs-Ericsson was the principal investigator in the study and said, “We must try to educate parents about the long-term effects of verbal abuse on their children. The old saying about sticks and stones was wrong. Names will forever hurt you.”

The study was published in the Journal of Affective Disorders and represented data collected from over 5000 people ranging from ages 15 to 54. The study also implicated a role in cognitive behavioral therapy as part of treatment, to replace conditioned thought patterns with new thought patterns that are less harmful for a verbally abused person.

I was surprised to read that the researchers were surprised almost 1/3 of the participants reported the abusive behavior to come from parents. Verbal abuse reported included insults, swearing, threats, and spiteful comments or behavior. I wouldn’t be surprisd if these also included inflicting shame on the child and making the child feel worthless or evil – something I’ve experienced growing up.

Over time, the child grows up to internalize these “tapes” and even begin to reinforce the hurtful statements herself. The child then grows up to become hyper self-critical. This is something I’ve also experienced, and can say that at least for me, the long-term consequences of verbal abuse is staggering.

I commend Florida State University researchers for conducting and publishing this study. I hope it helps give a voice to those who had been victimized, and I want this to be a wake-up call to those who still think that words can’t harm a child.

Bipolar Disorder: A Story of Night Fishing

Mr. Shadden suffers from bipolar disorder and used to fish at night. Night fishing was where he found his peace and food – steelheads – to eat.

Then the Washington Department of Fish and Game banned night fishing where Mr. Shadden used to fish because residents were being disturbed and steelhead fish was endangered. Mr. Shadden was devastated by the ban and believes his life is being threatened by the night fishing ban. Mr. Shadden also views the night fishing ritual as food for his soul, because this was where God spoke to him.

Mr. Shadden didn’t like taking his medication because he gained a lot of weight and said he felt like a zombie and sat on his couch. Like many bipolar disorder sufferers, when he begins to feel good on the right meds he would stop taking the meds because he would feel like he didn’t need it anymore. Then his cycles would begin.

This story is not just about a bipolar disorder sufferer and his desire for fishing at night. It’s about how important rituals can be for patients, because it provides spiritual sustenance, and in Mr. Shadden’s case, physical sustenance.

Child Abuse: Change Begins with Awareness

Those of you who are long time visitors know that child abuse and especially emotional abuse is a topic dear to my heart, because of my personal experiences with childhood emotional (sometimes physical) abuse.

Angela Mettler writes that awareness important in fighting child abuse, and understanding what this means.

According to South Dakota law, child abuse and neglect is when a child is inflicted physical and/or emotional harm, mistreatment, abandonment, or exploitation in many shapes and forms. Reports can be phoned in, sent in (written) by mail, or in person – and anonymously when required.

Often we think of child abuse cases as the most dramatic, visual ones – bruises and cuts and physical injuries. We often don’t see the hidden signs of abuse, and these are the emotionally abused children who give behavioral clues that something is terribly wrong in their lives.

Where child abuse is concerned, I’ll use this quote from Napoleon Bonaparte:

“Ten people who speak make more noise than ten thousand who are silent.”

Many Dimensions of Bipolar Disorder Sufferers

When we think about patients who suffer from bipolar disorder we tend to have a set view of how they should look or act. That’s why having celebrity “spokespersons” can be helpful in reducing social stigma of a condition, and help others understand that there is no one way a patient with a certain condition would appear.

That’s why I found UK’s TV presenter Gail Porter interesting. Telegraph UK titled the article on Gail, ‘I refuse to be called brave’ and describes how Gail became bald and lost her body hair from alopecia.

About half-way down the article, buried in one paragraph, was a mention of Gail’s history of bipolar disorder:

Behind her mega-watt on-screen smile lurked a troubled soul with a long history of mental health problems. She suffers from bipolar disorder (also known as manic depression) and has been anorexic. When she was pregnant with her daughter Honey, now three, she was a borderline obsessive-compulsive, rising at 6am to clean her home and check her CDs were in alphabetical order.

The article continues to describe Gail’s experience with Anorexia and Alopecia. When you look at Gail’s “before and after” pictures, from her website galleries and how she now looks, it’s understandable why the focus is on the anorexia and alopecia – these are very visible conditions and make a dramatic visual impact.

Bipolar disorder, depression, and many mental health conditions are hidden from view, and only comes out in a relationship setting. This is why advocates and consumer education about the hidden diseases like mental illnesses are will continue to be very important in our society.

Seroquel Study Results for Treating Mania and Depression in Bipolar Disorder Types I and II

AstraZeneca manufactures the drug Seroquel (quetiapine fumarate) and announced results of a 509 patient study at last week’s American Psychiatric Association meeting.

Seroquel is currently FDA approved for treating bipolar disorder I acute mania and schizophrenia. The announced study results looked at Seroquel to treat depression in bipolar types I and II patients, to confirm results of a prior study.

Seroquel is being positioned as treatment to both stabilize mood and relieve depression, to eliminate the need to use a mood stabilizing drug and an antidepressant. Having one less pill to take may help patients with bipolar disorder adhere to (stick to) their drug therapy.

Late last year, the company submitted a supplemental supplemental New Drug Application (sNDA) with the FDA for Seroquel in treating depression in bipolar disorder patients.

What I found interesting is the high response rate of the placebo (sugar pill) arms. At the end of the 2 month study (8 weeks):

• 60% of patients who took Seroquel at 300 mg/day responded

• 58% of patients who took Seroquel at 600 mg/day responded

• 45% of patients who took placebo responded.

It looks like a higher dose didn’t give a higher response rate, although higher doses of drug usually comes with higher percentage of side effects.

Caution: Seroquel should not be used in patients with dementia-related psychosis (usually elderly patients), and has also been associated with changes in body metabolism including hyperglycemia and ketoacidosis.

Five Predictors of Bipolar Disorder: Assessment Tool

Today marked the last day of the 159th Annual Scientific Meeting of the American Psychiatric Association (APA).

A study was presented that identified predictors of bipolar disorder risk for patients who were already diagnosed with depression:

• anxiety

• feelings of people being unfriendly

• family history of bipolar disorder

• a recent diagnosis of depression

• legal problems

These predictors were used in an assessment tool that is now available on a drug-company-sponsored website called “Say How You Feel.”

Suicide Prevention Day and Increasing Awareness on College Campuses

Last month I posted about Oregon Senator Gordon Smith’s memoir about his son who committed suicide.

On Wednesday, Oregon State University students, faculty and community members had a meeting to increase awareness of suicide for a Suicide Prevention Day luncheon.

Suicide is prevalent in our society and especially on college campuses. About a month ago, I had also posted on a high suicide rate of Asian American students at Cornell University, my alma mater. Action is necessary even when talking about suicide is uncomfortable.

Students can resist seeking help, and students with bipolar disorder and depression pose high suicide risks as well.

If you’re thinking about suicide, read this first.

One Comment

Dawn Frainier wrote: In January 2011, I attempted suicide. I was inubated after an overdose. A year later with the help of antidepressants and counseling, I am doing well. I am now attending a business college. I am in my second semester and I am doing my persuasive paper on increased sucide awareness. I feel this topic is of utmost importance. I am pushing for school psychologists and psychiatrists on every campus possible. Feedback and some information would be greatly appreciated. Thursday, February 23, 2012 at 1:25 pm

Study Suggests Drug Abilify Delays Mania Relapse in Bipolar Disorder

Today, drug makers Bristol-Myers Squibb Company and Otsuka Pharmaceutical Company reported results of a 161-patient study that compared the time to relapse between patients who took the drug Abilify versus patients who received a placebo (“sugar pill”) for at least 6 weeks.

Compared with patients on placebo, those who took Abilify were 48% less likely to relapse into mania.

43% of the patients in the placebo group relapsed, versus 25% of the patients in the Abilify group.

See more from Google News.

Jane’s Note: While this study result is encouraging, the study is rather small, with only 161 patients.

Blog for Parents of Children Living with Bipolar Disorder

G. J. wrote an excellent post on the lessons that he’s learned about parenting children with bipolar disorder.

There are 18 (yes, 18!) points in all, and you would not want to skip any. To give you a flavor, here’s a summary of G. J.’s points:

1. Treat each child individually.

2. Expose them to, and encourage, diverse interests.

3. Encourage spirituality.

4. Encourage giving.

5. Jobs give purpose and self esteem.

6. In our house, we never tolerated our kids being unkind to anyone or each other.

7. Have fun together.

8. If trouble arises, don’t hesitate to help.

9. Open communication is a must.

10. Value your children’s opinions.

11. Go overboard for a good cause.

12. Love your spouse openly.

13. Encourage a vocation and hard work, but don’t put too much importance on career or money.

14. Volunteer for organizations in which your children are involved.

15. Form relationships with your children’s teachers.

16. Become your child’s biggest advocate, and fight for an answer, even for those answers that don’t come easily.

17. Never withhold love as a punishment.

18. Have fun with your children.

Honestly, these are lessons for basic good parenting – period. Thank you, G. J.!

Managing and Coping Takes a Lot of Energy

Whatever we decide to call it, those of us who suffer from depression or bipolar disorder can spend a lot of our energy managing and coping with our symptoms.

A major trigger for my depression throughout my life had been the consequences of (childhood) emotional abuse.

Until recently, I hadn’t realized how much work managing this trigger is – or more accurately – managing the outdated coping mechanisms I used for dealing with emotional abuse.

Sometimes I’m not sure what drives me to depression faster – coping with emotional abuse or coping with my frustration at my slow progress to cope with emotional abuse.

Well, let’s just say both will get me on a road to depression unless I become alert to what is happening in my mind.

One Comment

Tired too wrote: I have work related depression and was also misdiagnosed as bi-polar originally. But it was officially confirmed that I am “clinically” depressed for some years now. I wish I had known that stress can lead to sickness that leads to depression and that depression knows no boundaries and that only time will tell what happens next. The battle seems to be endless for both my health and the worker’s comp case that I have been enduring for the last 5-years. … Saturday, May 13, 2006 at 2:06 am

Hiding from Other People

The other day I was talking with an acquaintance who suffers from Bipolar Disorder type II, among other illnesses. When she told me she had bipolar disorder she lowered her voice because it was like sharing a dark secret.

So I told her that I have suffered from chronic and severe depression and had been misdiagnosed with BP-II before. I also told her that I’ve relapsed and I understand the fear of telling someone that you have depression or BP and see the other person recoil from you…

“… like you’re a kook,” my acquaintance said, clearly relieved that I was someone “in the know.”

I said that was why we are so good at pretending and hiding from other people. We believe we had to, to protect what social interactions we may gain.

The price we pay is that the more we hide from others, the less we come to know of ourselves.

Depression Story and Hope from Ireland

Ann* from Ireland fell into a deep depression after losing her husband of almost 40 years. In describing her experience to reporter Cróna Esler of Western People, Ann said that “every single day was a struggle.”

Unlike many of us who have suffered from depression most of our lives, Ann’s depression was triggered by a profound loss. Like many of us, Ann struggled with the social stigma of depression.

Thankfully, her close friend Linda urged Ann to seek help.

Ann began attending support / awareness group meetings and found them worthwhile even when the first step had always seemed the most difficult.

*Pseudonym

Mental Health System Needs A Lot of Help

Over at NakedMedicine.com, Dr. Rob posted about how the mental health system – especially the State mental health system – is a scary place to be.

Dr. Rob’s article touched upon several salient points that affect patients who suffer from mental illness:

Many primary care doctors and family doctors have to become “amateur psychiatrists” now

People may still fear going to see psychs because of social stigma and psychiatrists are often unavailable/short-staffed.

State psych hospitals are places were the most critical patients are sent, yet as Dr. Rob pointed out, assumes an environment of “lack of hope.”

It’s important for both patients and drug companies alike to recognize that family doctors and primary care doctors do indeed see a significant number of mental health disorders. Sometimes diagnosis of some mental illnesses can’t be done in a few minutes’ time, but this is often the reality of a primary care setting (or at least this is what I’ve seen in a state with heavy managed care like California). Misdiagnosis will often lead to the wrong treatment… although (caution: my cynic is coming out) so many psych drugs have multiple indications now that some drug marketers may honestly believe their drugs work for huge clusters of mental ailments.

In a place where the toughest-to-treat (or perhaps even untreatable) patients reside, it’s important to secure funding for at least adequate environs that will not exacerbate already fragile mental conditions. For those dealing with psychic pain, what can possibly be worse than to be locked into a place that reeks with feelings of hopelessness and despair?

Bipolar Disorder Abbreviations: BP or BPD

Thanks to Mom-Interrupted over at Mercurialmindbipolarblog for commenting on my last post and for pointing out that BPD also stands for “Borderline Personality Disorder”!

I’ve used the BP abbreviation to mean “bipolar disorder” in the past, and BPD to mean “borderline personality disorder.”

But I used BPD when reading Courtney’s blog post (see my previous entry) because my brain didn’t make that connection in time

These abbreviations can get confusing.

Anyway, thanks to Mom-Interrupted for writing me, and now we know at least one other blog that talks about bipolar disorder issues.

Personal Stories About Bipolar Disorder Calls Attention to Illness

Mary and Doug belong to New York City’s Bipolar Disorder Support Group. Both suffered from bipolar disorder and described early onset of their illnesses. For Doug, the highs were followed by crashing lows in his severe form of bipolar disorder that ultimately landed him in a hospital. Mary credited her religion with her not following through on her suicide ideations.

Both now are stable and leading productive lives through medication and receiving support for their support group.

Mary and Doug’s stories offer a rare glimpse into the personal lives of those with bipolar disorder, and how easy it was to hide their problems. Their stories also show how proper treatment and support have made a difference.

In an unrelated story, Hampton Falls is holding its Bipolar Disorder conference on May 5 (today!). Personal stories about bipolar disorder was also published in the Maine circular.

Bipolar Disorder Blogs

I was so surprised to read that Courtney over at Progressive U didn’t find many blogs by those with bipolar disorder!

I don’t know if this website qualifies as a “Bipolar Disorder Blog” since I now cover a range of mental health issues that I really care about, for example:

• Bipolar disorder (because I was originally misdiagnosed with BP type 2 and started Jane’s Mental Health Source Page to learn more about BP)

• Depression (my correct diagnosis)

• Emotional abuse

• Social issues and stigma around mental illness

… and more recently, cultural norms and how these create situations that exacerbate mental health problems and even cause suicide – like my recent article on the effects of pressure at school and the high rate of Asian American student suicides.

8 Comments

l.g. larsen wrote: I was surprized to read that post as well. Especially because it came to me in a “Google Alert”. Perhaps she meant in that particular forum. I have been involved in various bipolar and mental health internet communites for over five years. Generally the term BPD does not stand for Bipolar Disorder, but rather Borderline Personality Disorder. BP is the preferred way to refer to Bipolar. I just thought I would mention this because when I read your post on the other site I almost misunderstood you for being mis-diagnosised with Borderline Personality Disorder. Wednesday, May 10, 2006 at 12:45 pm

Bill S wrote: I need HELP! I have very rapid Can anyone recomend a source for financial help for Bipolar. ‘Cause of course I have spending sprees and I just sometimes can not help it! I have no money, No insurance and no one will listen. Does anyone else feel left out? Does anybody really care? I can only see myself homeless on the corner dying. I just wish the pain would go away! Friday, May 12, 2006 at 7:28 pm

Debbie P wrote: I too am bipolar and am in such financial dispair I am considering suicide. I stole $15,000 from my employer and unless I repay it I will be incarcerated for a long period of time. I have no family that will help me. If there were some agency that could lend me money I would be able to repay it. Is there any help for me? Saturday, January 6, 2007 at 7:06 pm

Greg wrote: Hello. I maintain a Bipolar Blog called The Bipolar CEO (www.bipolarceo.com). I have bipolar II and have been a CEO for 2 companies and a senior executive for 5 others. Still, my bipolar disorder has caused me to have 13 different jobs in 25 years and I’ve been fired from 6 of those. My blog both chronicles my current life, as well as talks about my childhood, college years, diagnosis, relationships, medication, family, etc. I’m also working on a memoir novel, and the blog keeps me writing. Sunday, October 14, 2007 at 8:41 pm

Becky wrote: Hi, I’ve been diagnosed as ADHD, and borderline bi-polar. I’m always having trouble keeping my mouth shut. I say the wrong thing or it just comes out backward. Then I get mad real easy too! Saturday, July 5, 2008 at 3:06 am

Shane wrote: What is bipolar disorder…Fixmybipolardisorder.blogspot.com is dedicated to providing a people who have questions about what bipolar disorder is. It’s also more widely known as another term called or associated with (manic-depression). I would like to take you inside a world that can often seem as If days and nights never end. You or someone you know may feel as If you are in an never-ending cycle. We as people with Bipolar like to call it as… Living In Cycles. Cycles are best described as fast and furious mood swings or behaviors. Often times these behaviors are of extreme in nature. I will touch on this a little bit later as I get more in-depth upon my world of Bipolar. Why we are different: A short and simple explanation would be most people have normal everyday mood swings. But us with Bipolar have more of a long-term raging mood behavior and often times It can be detrimental to them or people around them. I realize there are plenty of good sources of text based information on the web. There’s thousands of pages on mental health and very good articulated web pages dealing with this subject matter also. So much information is out there that it becomes a daunting and tiring task when sometimes you just want to find the answer quick and easy without all the fluff.. I will edit the world of bipolar disorder (formerly called manic depression) for you and then I will post what I feel is the most relevant information on my site for your review. What is Bipolar Disorder? 1. The distinguishing characteristic of Bipolar Disorder, as compared to other mood disorders, is the presence of at least one manic episode. Additionally, it is presumed to be a chronic condition because the vast majority of individuals who have one manic episode have additional episodes in the future. The statistics suggest that four episodes in ten years is an average, without preventative treatment. Every individual with bipolar disorder has a unique pattern of mood cycles, combining depression and manic episodes, that is specific to that individual, but predictable once the pattern is identified. Research studies suggest a strong genetic influence in bipolar disorder. Monday, September 8, 2008 at 9:46 pm

Andy wrote: This is a really interesting read. I was diagnosed with Bipoalr at the age of 17 and really had a torrid time at School because there was confusion between me just been a moody teen and Bipolar. Thankfully mental health is taken more seriously these days and the NHS do a fantastic job. For people researching bipolar I write a Blog that is full of my personal experiences and information. I hope you find it useful. Mental Health has Posetive a posetive side that is often overlooked. http://www.lithiumandchips.com (for the blog) Saturday, August 27, 2011 at 9:13 am

Insurance Policies Often Set Up Patients to Fail

Dennis Romboy and Lucinda Dillon Kinkead’s article, “Struggle for control: Mental-health care coverage is lacking” gives us a glimpse of how our view of mental illness as “something different from physical illness” spills over to our healthcare system.

For insurance companies, coverage policies give mixed signals to patients. Often, that signal is, “You’d get coverage if you were catatonic and completely non-functional, but if you’re trying to function and live a normal life – well – good luck.”

A high number of suicides occur in patients suffering from a mental illness but were not receiving treatment. Sometimes, the insurance policies can set up a dangerous situation to happen because it forces doctors to play a numbers game with patients so that the patient can continue to get coverage.

I remember when I was undergoing treatment, my doctors had to play the same game to help me get insurance coverage. At the time I was a starving grad student and couldn’t afford therapy if insurance didn’t cover it. My psychologist offered to cut her rate so that I didn’t have to pay too much out of pocket. I was making progress and she didn’t want me to fall by the wayside.

However, the game was “You need to get well, so the insurance company could see progress and continue to cover you. But you can’t get too well, because insurance companies would see no point in continuing to cover you.”

One Comment

Ginkgo100 wrote: Another way insurance companies set patients up to fail is by making the process of finding covered providers impossible for people with some mental illnesses. If you suffer from depression severe enough to make concentration difficult, severe enough to ruin the motivation and optimism necessary for perseverance, it can be impossible to navigate some companies’ byzantine systems for finding an appropriate provider who is covered. Monday, August 18, 2008 at 6:15 pm

Jane Pauley Speaks Out About Bipolar Disorder

Jane Pauley gave the keynote at the annual Foundation for Mental Health’s luncheon and talked about struggling with bipolar disorder. What was noteworthy was not just an increased social awareness of mental illnesses including bipolar disorder, but to put personal experiences into words.

Pauley said that “society is on the verge of a ‘tipping point,’” where those who suffer from mental illness won’t have to hide, and used the analogy of how cancer patients used to suffer social ostracism. In the past, society viewed cancer as a character weakness, and would quarantine patients in “cancer houses”, viewing them as having done something wrong to deserve the cancer.

I’m always encouraged when celebrities or visible personalities speak frankly about their experiences with mental illness. It not only takes the edge of social stigma, but gives hope to those who live with the illness that some level of normalcy and hope are possible.

One Comment

john wrote: Jane, can you advise on the perspectives that Asian cultures, specifically Japanese may have about Bipolar disorder? I am trying to get someone close to me who is Japanese to understand bipolar disorder. I don’t think psychotherapy is prevalent, valued or even understood in Asian cultures. Monday, October 22, 2007 at 11:19 pm

Depression: Might Not Become an Attorney

In some states, the application to becoming admitted into the state’s bar (and be able to practice as an attorney) includes a question about mental health.

Connecticut is one of those states – with question number 35 amended for July 2006. Applicants must also submit psychiatric records. Other states with similar questions in their application process included Colorado, Florida, Delaware and Kentucky.

Questions are:

“During the last ten years, have you been treated for any of the following: schizophrenia or other psychotic disorder, bipolar or major depressive mood disorder …” (plus 12 additional mental health conditions – Connecticut application).

“During the last 10 years, have you been hospitalized for treatment of any of the following: schizophrenia or other psychotic disorder, bipolar or major depressive mood disorder …” (plus similar wording as Connecticut’s application – Florida application).

Concern around this request for disclosure includes prospective lawyers who need help not daring to seek help in case their records show their mental health diagnosis.

What do you think? Given the responsibilities of an attorney – does these states have a case in asking for this type of information?

One Comment

Glenn Hollar wrote: If the US senate has a hard time understanding the new health cae bill from Obama how can common folks? When will we be able to understand what he has done? Saturday, April 17, 2010 at 11:09 pm

Thank You, Tom Pauken II!

I was so inspired when I read Tom’s personal account with bipolar disorder.

I don’t even think trying to summarize what Tom has written will do his story justice, I only ask that you please read, “A Personal Perspective of Manic Depression: This reporter gives a first-hand account about the bipolar disorder” for yourself. Tom has given me permission to reprint his article, which I’ve published on NakedMedicine.com.

In reading Tom’s story, I remembered those darkest days of my life when I was deep in the throes of severe depression and PTSD. To say that I was living in a nightmare 24-7 was an understatement. At that time of my life, I honestly believed that if my car veered off the highway and I was killed, no one would notice. At that time of my life, I sometimes fantasized about being murdered so I could be put out of my misery.

Some of us put on an act and we hide it well. Tom’s first visit to a psychiatrist sounded familiar. His psychiatrist was amazed that Tom was able to accomplish so many things in college and get good grades and look like he’s moving ahead in life. My psychologist was amazed that I was “in a PhD program and functional” and not lying dead in a ditch somewhere.

Yet there was something within Tom, within me, and within countless people who suffer from depression and bipolar disorder – something stronger than even the illness itself.

I don’t know what this is, but I can only describe it as a transcending strength that rises above the physical and biochemical ailments that have plagued us most of our lives. As we fight the fight within our minds and bodies, that strength inches us forward and pulls us through situations that no one would believe we could live through, and we did.

We lived through it to tell about it.

Choosing a Therapist (or Psychiatrist)

Choosing the right therapist or psychiatrist is as important as choosing the right medications or treatment for your depression or bipolar disorder. Dr. Serani’s article on How to Choose a Good Therapist at NakedMedicine.com gives these main important lessons:

Know which type of therapist you’re looking for. Therapists come from different educational backgrounds, and some have religious affiliations (for example, clergy)

Know where to find roster of therapists

And the most important – and toughest part – “interview” your therapist.

Dr. Serani listed 10 questions to ask in the interview. Some of these questions may make you feel somewhat uncomfortable, because you don’t want to look confrontational.

What may be helpful is to ask the therapist or psychiatrist if it’s OK if you ask him or her a few questions, so you can better understand who they are, and where they’re coming from. Most therapists and doctors would be happy to oblige. If the therapist or doctor act offended, defensive, or rude, then that’s a warning flag you don’t want to ignore.

The relationship between you and your therapist and/or psychiatrist is critical in your treatment. Therefore, shop around and don’t be afraid to ask tough question – your mental health may be at stake.

Sexual Assault Awareness Month

Sexual Assault Awareness Month is observed in April in the United States, and is dedicated to making a concerted effort to raise awareness about and prevent sexual violence.

The first observation of Sexual Assault Awareness Month occurred in 2001, where the National Sexual Violence Resource Center (NSVRC) provided resources to advocates nationwide to help get the word out about sexual assault. You can contact your state, territory, or tribal sexual assault coalition for information, activities, and event coordination by clicking on this.

Other Links

all organizations alphabetically listed | sexual violence specific | children / youth | college / university | deaf and hearing-impaired advocacy | drug and alcohol | elders | faith-based | federal government | health | institution / professional abuse | law enforcement | legal | lgbt | male victims / survivors | men’s groups | multicultural | native american | offenders / perpetrators | pornography / prostitution / trafficking | public policy | research and statistics | stalking | survivors’ support | web-based resources | other

Reference: All information herein was obtained by: NationalViolenceResourceCenter

Does the Child Really Have Bipolar Disorder?

Along the lines of what I had briefly described in Mother of Invention and “Disease Mongering”, the controversy of diagnosing children with bipolar disorder is only going to increase. This controversy will probably split mental health researchers into two main camps: those who believe in diagnosing children with bipolar disorder, and those who believe children have become overdiagnosed with a variety of mental illnesses when they aren’t sick.

In One Corner….

What Elizabeth Slowik wrote in “Bipolar disorder on rise among children” (April 4, 2006 – The Grand Rapids Press) may be typical of how a parent may realize something is wrong. She first noticed her baby’s uncontrollable crying and sensitivity to sensory stimulation, then sought help when her child was 2. Her child was diagnosed with bipolar disorder at age 4, and began treatment. Many parents felt some relief when learning their children may have a disorder, because it means there may a treatment for it.

… And In The Other Corner

Yet this is exactly what Cardiff University’s David Healy said is wrong with the picture. He is concerned that children are becoming too quickly diagnosed with bipolar disorder for all sorts of temperaments that parents may have trouble controlling. Healy was especially critical of professionals who are pushing the American Psychiatric Association’s allowing the bipolar disorder diagnosis for children whose moods fluctuate through the course of one day – not for weeks at a time as it currently stands.

There may be other factors that trigger erratic behaviors in children, but professionals may be too quick to diagnose and too quick to medicate.

Self-Harm in Australia

Recently at NakedMedicine.com, I did an interview with Dr. Serani on self-injury. This is coming from a U.S. perspective.

In Australia, a government-funded initiative is underway to help train school counselors on self-harm (self-injury or cutting). Currently there is no data on prevalence of self-harming in Australia.

A company called Streetwize is working on a comic book that will help increase awareness of self-harm in Australia: “Streetwize, with funding from NSW DoCS and in partnership with the NSW peak-homelessness body YAA (Youth Accommodation Association), is currently working on a new comic about young people who self-harm or are at risk of self-harming. The project also includes a Worker’s Kit, for service providers in the refuge / SAAP sector, which will look at some intervention strategies with young people who self-harm. DoCS will initiate training for workers at the close of the project.”

More information may also be found at Beyond Blue, Australia’s National Depression Initiative.

From Grief – Action and Change – 2 Stories

I wanted to share these two stories with you. They show how two people had channeled loss and grief into actions that create change – change that can help others.

Becoming an Activist after Sister’s Suicide

Antonia Clifford’s sister Jenine was being treated for bipolar disorder, and this combined with issues of sexual identity (Jenine revealed to Antonia that she was bisexual) created a lot of stress for the teen.

Then, as these things were wont to unfold, Jenine killed herself after what seemed like a happy family vacation.

According to National Institute of Mental Health, there are data linking higher suicide rates amongst highschool students and homosexuality or bisexuality issues. Antonia became active in the community through her grief. She cowrote a play on homophobia and started collecting petition signatures to start a diversity club at her highschool that would address gay rights, environmental, and social issues.

Diana Heil writes about Antonia’s story in The New Mexican.

Memoir About Son’s Depression and Suicide

When Oregon senator Gordon Smith called his college-age son Garrett, he got a greeting that said, “I’m not feeling well, please don’t call me anymore.” Then Mr. Smith was visited by the police, who informed him that Garrett had committed suicide.

Mr. Smith wrote a book called, “Remembering Garrett; One Family’s Battle With a Child’s Depression” and described Garrett’s depression, bipolar disorder, and suicide. It wasn’t until depression and suicide struck home that Mr. Smith realized how many young people in Smith’s Utah state have killed themselves – in fact, Garrett was 1 of 8 students there who committed suicide. Until then, Mr. Smith also knew little about depression, bipolar disorder, or the warning signs of suicide.

Susan Whitney of Deseret Morning News writes about Mr. Smith’s story.

T-Shirts for Mental Disorders?

Humorous? or Humorless? (click to open image in new window)

I came across this from my blogpal Staff Psychologist. He was highlighting the cutting edge that things like this do.

Is this a lighthearted attempt to help people learn to live with a significant illness or does it miss the mark entirely and smack with the whiff of stigma?

The original website is http://www.printmojo.com/Disordertees

I love good humor. But….. I don’t like these.

What do you think?

6 Comments

Jane wrote: I found these T-shirts to be in poor taste, and can imagine those who buy them may include people who don’t suffer from the disorder but thought the T-shirts make a funny statement. I noticed that the T-shirts didn’t include depression or bipolar disorder (though I can see a BP shirt coming), maybe because funny taglines haven’t been thought of yet. You made a good observation elsewhere that we wouldn’t dream of creating T-shirts that say “I’m not bold, I just have cancer.” Yet, we see these T-shirts for mental illness. It goes to show that there are those in society that thinks certain aspects of mental illnesses are funny, and can be made fun of. While it’s healthy to laugh at oneself once in a while, I don’t think this is the spirit of these T-shirts. Sunday, April 23, 2006 at 9:41 am

Guest Author, Dr. Serani wrote: One of the main goals in my professional career is to minimize stigma regarding mental illness. I just think a t-shirt like this narrows the perception of such disorders, and as such, continues to keep stigma alive and well. Sunday, April 23, 2006 at 11:40 am

Cris wrote: I have a Bipolar T-Shirt shop with some humorous and some serious t-shirts about Bipolar Disorder and Depression. Sales are pretty good and I’ve done a survery and not one person said my t-shirts are promoting the stigma of either illness. I have Bipolar Disorder 1 and sometimes it takes a sense of humor for me to get thru it. Evidently there are others like me. I know my t-shirts are not for all of us but for those who want to express themselves the way I do, they are there. Friday, May 26, 2006 at 8:34 am

Jane wrote: Hi Cris, I visited your T-shirt site, and I find your messages very different from the kind that Deb Serani referenced in her post. The messages that you have on your T-shirts are humorous, but not in a way that does promote social stigma of the symptoms of mental illnesses. In fact I think your T-shirts are very positive in many respects, by encouraging honesty about bipolar disorder and not feeling embarrassed or ashamed about living with a biochemical imbalance. I have laughed at my own symptomatic manifestations and think that not always taking oneself so seriously is a good thing. I do think that there is a line between humor that lifts up people up and humor that brings people down. And I think the type of humor that does not encourage what you are encouraging with your T-shirts is in poor taste. Friday, May 26, 2006 at 1:04 pm

Guest Author, Dr. Serani wrote: Dear Cris I also went to visit your site. And I enjoyed your shirts. They are, like Dr. Jane said, humorous but not stigmatizing!! Sunday, May 28, 2006 at 6:47 am

Sara wrote: I LOVE Crissy’s shirts. Just trying to decide which to get. Tuesday, January 29, 2008 at 4:07 am

National Depression Week (U.K.)

For my U.K. friends, last week (April 17-23) was National Depression Week 2006 per Depression Alliance, UK’s leading charity for people who suffer from depression.

The theme this year was complementary therapies, based on queries the organization received from people interested in self-help treatment and complementary treatments with their depression therapies.

The website also has a nice alert for those considering St. John’s Wort, and what precautions people must take when considering self-medicating with this herb.

For my Canadian friends, May 1-7 will be Mental Health week across Canada. Please check for updates under Canadian Mental Health Association’s website, in the section titled, “Media & Events.”

Power of Support in Healing and Recovery

Tom’s story of dealing with mental pain after recovering from the physical pain struck a cord with me.

When I was in my early twenties and suffering through depression, I tried to deal with it alone, and as smart as I thought I was, I just couldn’t “talk myself out of it.” And believe me – I tried and tried.

Although this article is quite short, it speaks to the importance of having a support network of people who understand what you are going through, so that your recovery process is optimized. Get away from people who responds to your honesty about depression with statements like, “But you’ve got no good reason to feel depressed”!

I’ve also read a scientific review article that talks about the importance of having a strong social network to reduce our susceptibility to stress-induced infections. Social networks and feeling connected – is important for our health on so many levels.

However, this is not as easy as it sounds. For those of us who understand depression, we know we tend to self-isolate and withdraw. The last thing we feel like doing is “opening up” and connecting with people. The trick, then, is finding a group where we can feel safe enough, where we can identify with the people there, who understand what we’ve gone through and are feeling.

Media Influences on Mental Health Perception

Since Dr. Steven Hyler published his article, “Stigma Continues in Hollywood” in 2003, the entertainment industry seems to be taking some action on their role in shaping public perception of mental illness.

Dr. Hyler had suggested the following approaches to neutralize the consequences of negative perceptions that were presented by Hollywood:

Write letters to producers of films and TV shows perpetuating stereotypes

Participate or engage in public awareness events that include celebrity testimonials (for example, Jane Pauley has recently been talking about her experiences with bipolar disorder, Brooke Shields on the effects of postpartum depression)

Leveraging the power of the internet – obviously one of my favorite ways to bring the human voices behind each story about mental illness

More sympathetic characters when portraying mental illness in the media

NakedMedicine.com Gains HONcode Accreditation

My new healthcare information website, www.NakedMedicine.com gains HONcode accreditation. My mental health source page (this website) has been accredited since 2000, and I know for a fact that the HONcode team really checks up on its accreditation, making sure that websites are still complying with the 8 principles.

I created www.NakedMedicine.com recently, to present healthcare information based on three main drivers:

Accessibility

Honesty

Integrity

Although the site primarily is suited for healthcare providers, researchers, and consultants, it is also excellent for the well-educated consumer looking for more scientific depth and evidence behind a healthcare claim.

Mental Health Clinical Studies Lacking Key Information

In Psychiatric Times March 2002 Vol. XIX Issue 3, Deborah Lott’s article, “Are Studies Misguiding the Choice of First-Line Treatments?” describes how Boston University’s psychologist Drew Western and colleagues reviewed 34 studies on psychotherapies in peer-reviewed journals, and is now suggesting that some of the first-line treatments may have been based on studies that weren’t as scientifically sound.

The 34 studies Western and colleagues reviewed were published in an 8-year span (1990-1998). These studies included panic disorder (17 studies), generalized anxiety disorder (GAD, 5 studies) and depression (12). Studies that did not meet minimum criteria for randomized control trials were not considered.

Some of the observations by Western and colleagues:

Long-term follow-up to look at lasting effects of treatment were often missing (beyond, 12, 18, or 24 months)

Some studies did not report why certain patients were not included (also known as “exclusion rates”)

Panic disorder treatment showed the most impressive results where 63% of patients showed improvement

54% of patients with depression showed improvement but the analysis of existing study data did not show long-term effects

52% of generalized anxiety disorder patients showed improvement but no data was published for long-term follow-up

Why does this matter? Well, most physicians base their prescribing and treatment decisions on published studies. When many studies don’t look at long-term effects, what can we say about the effects of certain drugs used in the long term of as mental health treatment?

Of course, we also want to be very cautious of conclusions drawn from “meta-analyses” like this one. One of the drawbacks and criticisms in meta-analyses is that you may be comparing apples and oranges. You can’t pool a collection of studies for depression together and treat them like one clinical study – because there are too many different factors to consider. And conclusions drawn may not be accurate.

One thing that we can be certain though – long-term follow-up is needed in clinical studies. This is the only way we can look at how well some of these treatments work in the long-term.

This discussion is extremely long. Those who are interested can read it on Psychiatric Times.

Options Beyond ECT

• There are now several approaches that help treat refractory or resistant depression beyond electronconvulsive therapy (ECT). Some of these you may be familiar with, including:

• Vagus Nerve Stimulation (VNS)

• Deep Brain Stimulation (DBS)

• repetitive Transcranial Magnetic Stimulation (rTMS)

A VNS implanted device was previously approved by the FDA for treatment of depression after some manufacturing issues that originally had the feds reversing the approval.

In 2005, a VNS medical device was approved by the FDA as a long-term, adjunctive treatment (means “in addition to a primary treatment”) for adults with chronic or recurrent treatment-resistant depression whose depression did not respond to at least four antidepressant treatments. You can read more details from an industry analyst’s post at NakedMedicine.com.

Suicide: Finding Lily, Effect of Suicide on Ex-Spouse

Finding Lily is Richard Clewes’ story of how his former wife’s suicide impacted him. Richard’s ex-wife suffered from bipolar disorder.

Clewes wrote the book – his debut – as a way to find peace in the aftermath of her death. I couldn’t find the book on Amazon, but it is available on Amazon.ca at this link, and you can read more at the book review at Globe and Mail.

3 Comments

Katherine Hayward wrote: A friend of mine, Pam Churchill met Richard Clewes through a mutual friend, Heather. Pam bought his book for me, and reading it, I feel he has written my words and feelings. There is something so comforting about this post suicide journey spouses take, when you learn it is shared and that the feelings and the experiences are so parallel. My husband of 27 years commiited suicide March 2, 2005. I learned that grief is physical pain and that pain doesn’t kill you although sometimes you really wish it would. My journey through this process has been one of personal growth and understanding, one of forgiveness for both my husband and myself. I have discovered how truly wonderful friends and family can be and I have been able to get past the anger, the feeling of betrayal and get to a place of peace. I loved my husband dearly but I too found the disease of depression sucked the life out of me, our marriage and everything that was once good and wonderful. I would love to hear from Richard. I would love to meet him sometime and talk about this book, and our common experiences. It is a unique experience shared only by those who have lost a loved one to suicide, no other grief really compares, and it is insulting for those people who think they KNOW what this is like to imply such. Sincerely, Katherine Hayward Wednesday, June 21, 2006 at 7:39 am

Jane wrote: Hi Katherine, Thank you for visiting this website and for sharing your story. Not many people realize that psychological pain often translates into physical pain, and what you said about your personal experience with grief supports this. I am glad to hear about your personal journey through this. I wish you well! Jane Wednesday, June 21, 2006 at 8:15 am

Suzy Kohlmeier wrote: I recently read Richard’s book, Finding Lily, and was overwhelmed with sadness at the realization (? or maybe just thoughts about, ) of what Erin went through. I knew her, but did not know her very well, and had often wondered where she was and what she might have been doing. I knew that she had been running her store and always meant to re-connect with her. Sadly, I didn’t….and even more sadly, she is no longer here. I found the book to be haunting and tragic. I would have to say to Erin that I am sorry for your pain and struggle and to Richard….I am sorry for your loss. Sincerely, Suzy Kohlmeier Friday, July 14, 2006 at 10:32 am

Quote of the Day

“Among those whom I like or admire, I can find no common denominator, but among those whom I love, I can: all of them make me laugh.” by W. H. Auden (1907 – 1973)

Self-Help Books Not As Helpful?

Last year, some doctors in the U.K. were literally prescribing self-help books for mildly depressed patients.

Bob Olson thinks this may be a dangerous assumption. He sent out a press release to ask if self-help books may be prolonging some people’s depression. A conflict of interest, if it can even be called that, is Bob Olson has written a book about it, which be be purchased through his website, and he gives seminars on his own experiences with self-help books and depression.

My personal experience with self help books is that they were mostly interesting, although when I was chronically depressed I didn’t have the fortitude to read through most of the ones I’ve had. I also didn’t have a “breakthrough” even with psychotherapy alone, until I was on the right kind of medication – that is to say – medication that had an effect on my depression. I was on lots of other medication that had no effect or frankly made my depression worse with its side effects.

One can never have too much willingness to help oneself. Often for depressed patients, that can include self-help books, but it can never replace a thorough medical and psychiatric exam by a good doctor.

Yesterday’s Lost Episode

In yesterday’s episode of ABC’s show, “Lost“, we were taken back to Hurley’s history in a mental institution. I knew that Dave was a fixture of Hurley’s imagination as the doctor whipped out his polaroid to take a picture of Hurley and Dave in the game room.

I’ve been thinking about something else, though. When Sawyer offhandedly called Hurley “crazy” and Hurley attacked Sawyer in a fit of anger. Wouldn’t that confirm what Sawyer was saying? Yet I understood why Hurley did it. When I’ve been called “crazy” in the past, I felt angry and defensive. Defensive because I knew I wasn’t crazy. Angry because I was scared the person who made the remark may actually be right.

I felt confused, when I was suffering from depression, and hearing the word crazy, sometimes directed at me.

Entertainment Industries on Bipolar Disorder

The media and entertainment channels have been criticized in the past for skewing the perception of people who suffer from mental illnesses, including bipolar disorder. Social stigma may be contributed in part by how the public views images of people who have bipolar disorder.

The Entertainment Industries Council, Inc. (EIC) has created an initiative on bipolar disorder, with a link on it’s website, asking Bipolar Disorder – Is It Really Depression?. EIC is a non-profit organization founded to provide understanding of social issues within entertainment and to audience members who watch the products of the entertainment industry. This bipolar disorder initiative is funded in part by AstraZeneca Pharmaceuticals LP (“AZ”). AZ makes psychotropic medications, at least one of which is approved for the treatment of symptoms of bipolar disorder.

Prozac Blues Addresses Social Implications of Depression

A professor of Women’s Studies at Virginia Tech created a skit called Prozac Blues to tackle the social issues of depression around women’s roles and expectations.

Using those stories, Kilkelly and the other collaborators pulled from their own experiences and those of others to create a theatrical performance addressing issues surrounding depression and the use of prescription drugs to treat the illness. Through the use of images and small skits, “Prozac Blues” hopes to instigate discussion among the Blacksburg community on the issues surrounding the diagnosis of depression, gender differences of the illness and living with someone who is depressed.

In general, women are twice as likely as men to suffer from depression, and social factors that may contribute to propensity for women to become depressed may not be discounted. However, women may be seen as “just being emotional” when they talk about feeling depressed. While women’s roles have broadened, the expectations of women being “superwoman” – maintaining a career while nurturing a family with demonstrable success in both arenas – can create pressures. This may in turn lead to a reliance to prescription medications for different sorts of mental discomfort and disorders, and a skit called “Depression Jeopardy” as described in the article suggests the confusion around overlapping symptoms that many different psychotropic drugs are supposed to address.

Medication: ADHD Drug Debate

My guess is that Ms. Evelyn Pringle does not like the pharma industry because all her investigative reporting is about the evil-doings of pharma. When true, exposing wrongdoing is a good thing, since it will encourage companies to clean up their acts.

I’ll immediately admit that I have worked in the drug industry, have raised issues about some industry practices both when I was an employee and when I became a consultant, and currently work with drug companies as a consultant. For some, this may make me an automatically biased party. I don’t know if I need to argue against that, although I make a point to see both the positive and negative actions that the drug industry has incurred over the years.

In her opinion piece, “Just What Kids Need – Sparlon – Another ADHD Drug” Ms. Pringle does raise legitimate questions about the safety issues and drug trial designs for Cephalon’s drug. Additionally, any attempt on Cephalon’s part to sell the drug “off-label” is illegal and basis for these activities must be scrutinized and investigated. However, one of the experts she cited talked about the conflicts of interest of the authors in the drug trials. The expert said that the authors who did the research had so many affiliations with so many drug companies, “the large number of pharmaceutical company ties with the authors of the study do not lend confidence to the reader even beyond the aforementioned concerns.” I think this conclusion is misleading.

Here’s the fact: If you’re any good at what you do and are considered “influential” by your peers, there will be companies who desire your smarts and advice, and are willing to pay for your expertise. Most of us will think it’s fair exchange to get paid for our time and knowledge as well, which is provides the basis for “employment” or independent “consulting”. The drug industry is no different. It wants to have the best and the brightest physicians in their areas of study to work with the companies’ drugs and let the companies know whether the drugs are any good at all. Usually the best and the brightest physicians see drug companies as manufacturers of some of the most interesting compounds that they want to work with, which motivates many top researchers to reach out to drug companies to see if they can get their hands on the latest compounds in development. When conducted appropriately, this type of collaboration advances healthcare and can help patients who can benefit from the treatment. When conducted inappropriately, collaborations become a guise for kickbacks.

By saying that just because you’ve worked with 10 drug companies you must have sold your soul to drug companies and therefore are incapable of doing any honest science is misleading and an insult to some of these physicians’ reputation. In fact, some physicians make sure they work with multiple companies to ensure that they don’t look like they’re too loyal to just one company. Since most of these physicians care about their reputation (the top thought leaders usually are, being thought leaders and all), they are generally motivated to keep their scientific merit at the forefront of any collaboration – no matter which company.

Of course, there are bad eggs out there, as we have seen in all industries. We have greedy people and dishonest people and just-plain-evil people in our society. They infiltrate all industries including healthcare.

On the other hand, presenting information in a one-sided or biased manner so that you can sensationalize the issue serves few. Entertainment is fine but not at the expense of fair-balanced Patient Education.

Off My Soapbox: Dr. Ned talks about ADHD Meds or No Meds. The Drake Institute offers non-drug treatment options for ADHD. Politicians getting into the ADHD debate (PDF file). Daytona Beach News asks if kids are being overmedicated.

Mental Ill More Likely as Victims of Violence

Nathan Welton’s piece shed light on a widespread belief that mentally ill people are instigators of violence, when behavioral health experts say that mentally ill patients are more likely to be victims of violence. No doubt, this piece was written in an aftermath of a shooting, where a Pismo Beach man shot up Denny’s and killed himself. Every time when we see on television a violent act involving someone we believe to be mentally ill, part of us grow fearful of mental illness in general, and some of us may continue to assume that our safety may be compromised around someone who is suffering from a mental illness.

However, I’m a bit confused to the statement in the article, “According to behavioral health experts, the mentally ill with bipolar disorder, paranoia, schizophrenia and other related disorders are up to 23 times more likely to be the victims of violence but usually no more likely to commit it.” – specifically, the part where I’ve italicized and bolded. Does this mean mentally ill patients are not 23 times more likely to commit a violent act (but maybe at a lower number – like 10 times more likely)? Or does this mean mentally ill patients are no more likely to commit a violent act than a random sample of “normal” people?

I highly recommend this article, which also talks about misconceptions of mentally ill patients being drug abusers, and the role of life experiences.

Mental Health: Acting As If, to Educate about Mental Illness

In “Roles that shine a light on the dark: Mental Health Players educate public about mental illnesses“, Harriet Comfort is the director of the Mental Health Players, in which actors educate the public about mental illnesses by performing how someone with a particular mental illness may interact with a family member or colleague. Some members of Mental Health Players suffer from bipolar disorder, though others in the group do not suffer from a mental illness.

This is a wonderful concept, not only from a humanistic point of view, but from an educational point of view. The best way to learn something thoroughly is to be able to teach it. From Mental Health Players’ outreach efforts, the best way to impart understanding of an illness commonly assigned to character weakness may be to “act as if”, and walk in the shoes of someone who suffers from the illness.

Hope and Mental Health

Helga Meyer introduces readers to an emerging field of psychoneuroimmunlogy in The Pueblo Chieftain and the power of the positive placebo called “hope.” According to Ms. Meyer, it is important to fulfill our three basic needs to have something to do, someone to love and something to hope for.

I went to the society’s website at http://www.pnirs.org but I still don’t understand what this discipline is about. I’ve dispatched an email to a neuroscience friend and hopefully we’ll soon find out what research studies are being conducted in this field, and perhaps more information on Hope as a positive placebo (maybe more).

Lincoln was the “Loneliest Man in the World”

Charlotte Observer wrote about Abraham Lincoln’s experience with depression and how a study found that 18 of 37 U.S. Presidents suffered from mental illness, including bipolar disorder, anxiety, and alcohol abuse. When we think about how our environment can trigger symptoms in those of us predisposed to mental illness, it’s not surprising that a high-pressure job like the presidency can escalate mental illness symptoms. Lincoln and other public figures bear testimony to Lincoln’s belief “That some achieve great success, is proof to all that others can achieve it as well.” As we continue to make inroads with dispelling stigma about depression and mental illness, we encourage ourselves and others to seek help so that we can live a fulfilling life and serve others in spite of any illnesses we bear.

Cancer Patients Often Don’t Seek Mental Health Help

I recently signed up for networking blogging about Cancer to try it out, and have been checking headlines about cancer. Recently (November 2005), the American Cancer Society announced the results of a study of 251 patients with advanced cancer and a low awareness of mental disorders that accompanied cancer. Living and coping with cancer is life-changing, and with serious illnesses, can make one vulnerable to depression and other mental illnesses. The numbers of cancer patients who were diagnosed with mental illnesses were low in the study, but what is worrisome is that more than half of those who were diagnosed did not seek help for their mental illness.

Although cancer is a daunting illness to live with and survive from, patients’ attitudes and outlook can play a huge factor in their qualities of life and even their prognosis (although science has yet to adequately study this). Other studies have also shown that patients with cardiovascular events like heart attacks are prone to depression, so cancer patients aren’t alone. Therefore it is very important for critically ill patients – including cancer patients – to be as vigilant about their mental health as they are about their physical health when approaching their disease treatment. Source: American Cancer Society

Not Someone I Would Have Expected to be Anywhere Near Suicide

A friend’s suicide prompted the Cedar City resident to urge others to watch for loved ones whose “blues” seemed more prolonged than usual and those suffering from depression to seek help. Particularly telling is “…and he wasn’t someone I would have expected to be anywhere near suicide.”

People in tremendous psychic and emotional pain can be very good at hiding their pain from others and isolating themselves. If you are thinking about suicide...

Student’s Mental Health

Excellent Idea! Kudos to Elon University of North Carolina for creating a website for students about mental health. Especially critical is the section on stigma – how stigma of mental illness can hurt suffers who fear to seek help – and how students can begin shattering this stigma by becoming aware of words describing mental illness. The section on fighting stigma asks students to “Be aware of your own actions and words.”

There is a movie clip that brings the message of mental illness stigma to ask, “With so many people affected, is it fair to uphold so many negative images of mental illness?” The website has information about depression, bipolar disorder, anxiety, schizophrenia, eating disorders, personality disorders, self-harm, and suicide.

There is also a link about treatments to give students introductory information on options and need for support. The website also has a fledgling discussion forum that I hope becomes populated with questions and messages of support and hope.

Insane Polypharmacy

I can’t say I disagree with how ludicrous and alarming the practice of nonsense “polypharmacy” is.

Read Susan’s story and you will have an idea of how overmedicating creates more problems for patients that may be solved by – well – more medications.

In the end, I really have to wonder whether Susan’s anxiety – her original condition – would be better served by a change to a different anxiety drug that would alleviate her condition enough without off-balancing the benefit with a whole new set of problems requiring further medication.

Just because we seem to have a medication for every symptom of mental illness doesn’t mean we should tackle all the symptoms with multiple meds without questioning seriously where that delicate balance of risk versus benefit is tipping.

Mental Health Access in Oregon

Students at the University have to pay $20 per visit to the psychotherapist, for a total of 5 visits, and prescription drugs are not covered. Given how expensive medications are – and medications are often an integral part of treatment – I’m confounded at the rationale for such a mental health “plan”. Five visits aren’t going to cut it, and $20 is a lot for most of us where copays are concerned – let alone for a student on college budget.

When I was in college, I suffered from severe depression, and unfortunately I did not know this (I thought I was acting spoilt, that I was feeling bad for no good reasons, and alternating between sleeping fourteen hours a day and sleeping two or three hours a day was just “normal college stress”). If I had known that I was suffering from depression, however, and I was confronted with this type of a mental health plan, I probably would not have gone for help, because “too expensive” would be my perfect reason to avoid dealing with a serious issue.

Patch for the Treatment of Major Depressive Disorder

EMSAM, a transdermal delivery system that delivers monoamine oxidase inhibitor (MAOI). MAO inhibitors have long been used to relieve depressive symptoms, although today if you go to a psych office you’re likely to be prescribed one of the “newer” meds like selective serotonin-reuptake inhibitors (SSRIs). MAO inhibitors, like tricyclic antidepressants (TCAs) seem to have fallen out of fashion in the depression medication world, although these have long been viewed as the “gold standard” therapies for treating depression.

Learn more about this patch: Company’s Press Release | News items relating to this patch

Medication: Clozapine Change in Monitoring Schedule

Clozapine (brand name Clozaril) is used “second-line” to treat schizophrenia and requires monitoring of blood cell counts. This is an atypical anti-psychotic drug that is used after a patient failed to respond to standard schizophrenia treatment (the standard treatment is called “first-line” treatment).

If you take clozapine as part of your therapeutic regimen, please ask your doctor about what this labeling change means for you.

Changes to monitoring blood cell counts for Clozapine treatment has been sent to health care providers and is as follows:

Dear Health Care Provider:

Novartis would like to inform you of recent changes to the following sections of the prescribing information (PI) for Clozaril. (clozapine) tablets: BOXED WARNING, WARNINGS, CONTRAINDICATIONS, PRECAUTIONS (Information for Patients and Pharmacokinetic-Related Interactions subsections), and ADVERSE REACTIONS (Postmarketing Clinical Experience subsection)

MONITORING FREQUENCY

After reviewing recommendations provided by the Psychopharmacological Drugs Advisory Committee (PDAC) of June 2003 regarding the white blood cell (WBC) monitoring schedule required for all clozapine users, the Food and Drug Administration (FDA) concluded that the current monitoring schedule should be modified. The changes to the monitoring frequency schedule required revisions to the BOXED WARNING (Attachment 1), WARNINGS, and PRECAUTIONS (Information for Patients) sections of the PI. The major changes regarding the frequency and parameters of the monitoring schedule are summarized below:

- Requirement that the absolute neutrophil count (ANC) be determined and reported along with each WBC count.

- New parameters for initiation of Clozaril treatment: WBC t 3500/mm3 and ANC t 2000/mm3.

- Initiation of monthly monitoring schedule after one year (six months weekly, six months every two weeks) of WBC counts and ANCs in the normal range (WBC t 3500/mm3 and ANC t 2000/mm3).

- Addition of cautionary language to prescribers describing the increased risk of agranulocytosis in patients who are rechallenged with clozapine following recovery from an initial episode of moderate leukopenia(3000/mm3 > WBC t 2000/mm3 and/or 1500/mm3 >ANC t 1000/mm3). After recovering from such an episode, these patients are now required to undergo weekly monitoring for 12 months if they are re-challenged.

Call 1-800-FDA-1088 (1-800-332-1088)