Mental Health Blogs

Archive for June, 2009

I know so many people with various mental disorder diagnoses who have taken a benzodiazepine in addition to whatever other medication they were on (and often they were getting a benzo for side effects of, say, anti-depressants) over the years and I’ve seen many of these people run into very severe withdrawal and addiction problems as a result. The usual suspects are Klonopin, Xanax, and Ativan (there are others of course). Sales of Xanax last year hit $350 million, up almost 50 percent since 2003 and 85 million prescriptions were filled for the top 20 benzos in 2008, an increase of 10 million scrips over 2004, according to this article on anti-anxiety drugs and their problems in today’s Washington Post.

Their problems are legendary.

“The ordeal of withdrawing from benzodiazepines can rival that of kicking a heroin habit, according to some who have had success. Abrupt withdrawal can result in hallucinations, seizures and even death, experts say.

“Last year, after jail officials in Cleveland denied R&B singer Sean Levert’s repeated requests for his Xanax, he hallucinated for hours and ultimately died from the effects of withdrawal, according to the coroner’s report cited in court records. His widow sued the corrections center and medical staff. The suit is pending.”

The article certainly serves as a reminder to me of how commonly these drugs are used–85 million scrips could easily translate into more than 10 million people taking benzos–and how their use has boomed, despite all the bad things doctors know about the drugs, during this very anxious decade.

I’ve not experienced benzo addiction or withdrawal personally, but I know it’s utter hell and I’ll try to pay more attention to these issues. I think some docs are prescribing these drugs far too casually and for too long a period of time.

During my 18 years in the mental health system, I was only ever prescribed Ativan at 1 mg. a day to take as need to, drum roll, treat agitation I was experiencing from Seroquel and Lamictal. My then-psychiatrist and I worked out a deal where he would only write me a scrip for 15 pills every two or three months and would only renew the scrip in person instead of over the phone or by fax. He said he wanted to make damn sure I didn’t get hooked on the drug and I’m thankful he took that approach, even though I’d been waved away from benzos by other docs and patients for many years at that point.

Ativan was a nice enough drug for me, but then I never took it for more than a day or two at a time.

A friend once gave me a Xanax–I forget which dosage–and it knocked me out so hard that I fell asleep on my usual bus and missed my regular stop by one mile. Not so nice.

Go to Source

This is one of the most discouraging articles I’ve read in a while: today the Los Angeles Times reports on the case of a 6-year-old girl in LA who is diagnosed with schizophrenia and her parents’ desperate attempts to deal with her, find housing, etc. It’s a tough read, especially because by its end we learn that the girl is on a cocktail that includes Thorazine, possibly the worst of the first-generation antipsychotics.

The article is well done and duly notes that schizophrenia among children so young is incredibly rare.

Go to Source

I was blown away on Saturday when, during cable news coverage of Michael Jackson’s death, two doctors offering analysis were very critical of Jackson’s reported long-term, chronic use of both painkillers and anti-depressants and noted that they could affect someone’s heart health (while that’s likely obvious to one and all with painkillers, it’s probably not so obvious with anti-depressants). Sadly, I cannot find transcripts of either doctor on Fox News and CNN, but I can assure you they said it and it was a stunner to me, given how the mainstream media ignored the connection between anti-depressant use and sudden cardiac death in women, as reported by researchers in the Nurse’s Health Study. It’s also a stunner to me in light of how naive we’ve been as a culture when it comes to using anti-depressants very casually while assuming that there’s no long-term impact from using the drugs.

Jackson was allegedly on a staggering cocktail of prescription drugs: thrice daily injections of Demerol; Dilaudid; Viccodine; and 120 mgs. a day of Zoloft and 40 mgs. a day of Paxil. He was supposedly taking the anti-depressants for OCD and social phobia issues. What Jackson was taking at the time of his death isn’t entirely clear, since his toxicology report won’t be available for many weeks and also since last night his personal physician, Conrad Murray, reportedly told Los Angeles police detectives that he hadn’t injected Jackson with Demerol and, in the words of the doctor’s lawyer, “There was no Demerol. No OxyContin.”

He said nothing about anti-depressants, however.

So we shall see how all this prescription business plays out. Of course, Jackson was known to have used painkillers for many years to treat chronic pain problems and it’s entirely possible that he’d become addicted to them. It’s entirely possible that Michael was hooked on anti-depressants as well. Certainly, SSRIs can be very addictive (or create physical dependency, if you prefer) for some people.

That said, I want to make it clear that I am not blaming Zoloft and Paxil for Jackson’s death. I am not saying that taking either drug will give any specific person a heart attack. But I am saying that, for now, that the two anti-depressants are inextricably entwined and linked to the death of MJ.

The research on long-term anti-depressant use is thin to begin with and there’s not a lot of research on links between anti-depressant use and heart problems, but it is obvious to me that there is clearly something going on here and, as I wrote back in March, the nurse’s study should be a big wake up call to doctors who’ve had patients on anti-depressants for many years and for patients themselves.

Go to Source

I’m working on a way to make this post about psychiatry. Sort of getting there.
In today’s NY Times Magazine, Peggy Orenstein notes in “The Way We Live Now–The Overextended Family,” that she doesn’t want to Skype videochat with her parents. Too much intrusion, there need to be some boundaries. Orenstein likes sending digital pictures, she doesn’t like email. And somehow, she’s aware that while she’s not sure she wants to videochat with her folks, she recognizes that she might want to chat with her kids.

To Skype or not to Skype, that is the question. But answering it invokes a larger conundrum: how to perform triage on the communication technologies that seem to multiply like Tribbles — instant messaging, texting, cellphones, softphones, iChat, Facebook, MySpace, Twitter; how to distinguish among those that will truly enhance intimacy, those that result in T.M.I. and those that, though pitching greater connectedness, in fact further disconnect us from the people we love.

She goes on to write:

Video chat, while obviously cheaper, would seem to have the same skewed ratio: too much access, too little control. But that’s speaking from the standpoint of a daughter. My perspective shifts significantly — as it does on so many subjects — when I mull this one over as a mother. It’s one thing to consider how much about me my parents have a right to know; it’s another to contemplate how much about my daughter I have a right to know — or even want to know.

I suppose the article caught my attention because I have a couple of those teenager people. One goes to college a half a country away, and when I suggested we videochat, I was told he doesn’t do that. He’ll email, he’ll talk (actually, it’s more grunting), and the most reliable form of communication is the text message, but he’s not interested in IM-ing me, videochatting, or being my friend on Facebook. He doesn’t follow me on twitter, and somehow I doubt he reads Shrink Rap.

So the psychiatry tie in? Oh, Roy would feel no need to look for one. This time, I’ll let it go.

—–
Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed.

Go to Source

We try to have fun with this, but we’re 3 real live psychiatrists and we all take our work very seriously. Lately, we’ve been getting a lot of insulting and offense comments in response to our posts. We’re fine with opinions that differ from ours– but please, no obscenities.

—–
Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed.

Go to Source

From the New York Times, an article that made my day: Excess Pounds, But Not Too Many, May Lead to Longer Life.

The report, published online last week in the journal Obesity, found that overall, people who were overweight but not obese — defined as a body mass index of 25 to 29.9 — were actually less likely to die than people of normal weight, defined as a B.M.I. of 18.5 to 24.9.

By contrast, people who were underweight, with a B.M.I. under 18.5, were more likely to die than those of average weight. Their risk of dying was 73 percent higher than that of normal weight people, while the risk of dying for those who were overweight was 17 percent lower than for people of normal weight.

The finding adds to a simmering scientific controversy over the optimal weight for adults. In 2007, scientists at the Centers for Disease Control and Prevention and the National Cancer Institute reported that overweight adults were less likely than normal weight adults to die from a variety of diseases, including infections and lung disease.

—–
Listen to our latest podcast at mythreeshrinks.com or subscribe to our rss feed.

Go to Source

Here we go:

“Life & Style reports that Michael Jackson was taking a cocktail of up to seven prescription drugs in the months before his death.

“And a Jackson family lawyer told CNN he ‘feared’ the drugs could kill the pop star.

“The star had been taking prescription painkillers including anti-anxiety drugs Xanax, Zoloft and painkiller Demerol in recent months, sources close to Jackson told Life & Style. The insider close to the star said he took a suspected overdose of drugs on Thursday morning, which caused respiratory and cardiac arrest.

“Jackson family lawyer Brian Oxman confirmed Jackson may have had trouble with prescription drugs as he prepared for his London show.

“‘This was something which I feared and something which I warned about,’ Oxman said on CNN. ‘I can tell you for sure that this is something I warned about. Where there is smoke there is fire.’

“Mr Oxman compared Michael to Anna Nicole Smith, alleging that Michael had ‘enablers’ just like her.”

I don’t even know what to say, except that there will be much, much more to come on this story.

On a personal level, I am crushed by Michael’s death. I grew up on the Jackson 5 and loved “Off The Wall” and “Thriller.” Obviously, Michael became a very weird adult, but he sure as hell deserved an opportunity to redeem himself. It’s sad that those London concerts will never happen.

That he died of what appears to be sudden cardiac death makes me wonder greatly about what his toxicology results will be.

Go to Source

Last week, PsychCentral.com’s John Grohol handed out some journalism awards for writing on mental health issues online, driven by recent media awards from Mental Health America which completely ignored the online world. Freelancers Shannon Brownlee and Jeanne Lenzer won for a Slate.com article on conflicts around “The Infinite Mind” radio show; the New York Times for its “Patients’ Voices” series; Danny Carlat won for being Danny Carlat; CL Psych won for being CL Psych; Jeremy Dean at PsyBlog won for writing about limited research behind so-called brain training programs; The Last Psychiatrist won for being The Last Psychiatrist; Vaughan Bell at MindHacks.com won for disemboweling fMRI claims; and, “Like him or hate him (he tends to be polarizing),” yours truly won for thumping out this blog and offering the public court documents and so on.

I certainly appreciate the hat tip, particularly as this year marks the first time since 1999 that I have not won a print journalism award of some kind. That’s mostly due to the fact that the freelance market has melted down–a publication I wrote for on occasion told me last week that they have no more freelance money for at least the rest of the year, which is simply stunning–which means I don’t get to do much print work these days. Sadly.

More importantly, a PBS documentary “Depression: Out Of The Shadows” recently won a Peabody Award (one of the biggies in TV journalism) as well as recognition from Mental Health America (see above link). But now the Columbia Journalism Review picked up on the fact that the much-discredited Emory University psychiatrist Charles Nemeroff had appeared on the program and made some spurious claims:

“Some might argue that little about this episode matters, since Nemeroff’s downfall took place in October and Depression: Out of the Shadows aired five months earlier. Yet a simple Google search would have alerted McPhee to the fact that Nemeroff, though the author of hundreds of research papers and well respected in his field, has been dogged by conflict of interest allegations for years. In 2003, he came under fire for praising three pharmaceutical products in the journal Nature Neuroscience without disclosing he held a financial stake in their success, one of which he held the patent on….”

“But what made the praise bestowed on this PBS documentary particularly troubling were the erroneous, drug-industry serving statements made by Nemeroff within the film—statements which had the potential to negatively affect public health, and which the documentary left unchallenged. During a segment on the FDA’s 2004 decision to require “black box” safety warnings stating that antidepressants can increase the risk of suicide in children and teenagers, a risk it extended in May of 2007 to users under twenty-five, Nemeroff seized the occasion to claim that the federal safety warning was mistaken.”

Oh, yes. The CJR writer questions the validity of the Peabody award in regards to all of that. Personally, I don’t have much taste for being a journalist questioning other journalists’ awards, so I’ll leave it at that. I felt the program was OK-ish and in writing about it last year ignored an appearance by Emory University’s conflict of interest king Charles Nemeroff as I was simply exhausted by earlier news about the doc. I was furious about the program’s pimping for ECT, however.

For what it’s worth, I sure didn’t set out to be polarizing when I began this blog almost four years ago and I don’t try to be polarizing each day. I realize that that dynamic is out there and that I have that reputation, earned or not, and that it sometimes loses me readers and contributors. The reality is that I have taken a very firm stance that the public–the ones footing the bill for psychiatry and Big Pharma–has an absolute right to know how convoluted the game has become and who is behind the curtain and so on.

As I noted last year when I wrote about responses to my writing on David Foster Wallace’s suicide, if no one pushes the intellectual envelope and if no one asks difficult questions, then nothing ever changes. And things have got to change.

Go to Source

There are a few bits of news in this post but they are tough to organize: suffice to say that the politics around the forthcoming DSM-V are becoming very intense and nasty and, slightly connected, psychiatrist-bloggers Doug Bremner (Emory University) and Danny Carlat (Tufts University) are drawing the ire of some colleagues for writing honestly about psychiatry’s epic conflict-of-interest problems, earning both a marginalization campaign from others in psychiatry. Yes, it is getting ugly out there.

First, Bremner notes an in-press article at Psychiatric Times by Allen Frances, a psychiatrist who chaired the DSM-IV committee, is deeply critical of the deeply secretive DSM-V process and delivers a stern assessment of the process, the kind that might embiggen the heart of an anti-psychiatrist (article obtainable at Bremner’s site):

“The work on DSM-5 has, so far, displayed an unhappy combination of soaring ambition and remarkably weak methodology.”

Bremner summarizes further:

“[Frances] then goes on to explode the statements by Kupfer that the DSM-5 will lead to a ‘paradigm shift’ in psychiatry, which he describes as an ‘absurd statement’ based on the fact that there still is not a single lab test for diagnosis, and the gains are small and incremental in descriptive research. In the absence of evidence, changes in diagnostic criteria are arbitrary and often driven by a single strong member of the sub-committees. Furthermore, the incorporation of sub-threshold diagnoses as official psychiatric diagnoses will be a ‘bonanza’ for drug companies who will expand their markets to new legions of the ‘newly’ mentally ill and rush to ‘educate’ doctors about the new criteria, which they will use to expand drug usage. It will also serve to expand stigma.”

I agree with Frances’ points. I’ve made similar points before and, of course, when I’ve noted the incrementalism of bipolar disorder type 2 and how it created a new, mostly unnecessary market for pharma companies, I’ve taken a thorough drubbing. So it’s nice to see that Frances, by implication, has my back on some of this.

Bremner himself has created a “Shadow DSM Team” to track the new DSM. This seems to have landed him in some hot water with colleagues, as a post he wrote last month on proposed Developmental Trauma Disorder in children mentioned that some involved in developing possible criteria for the disorder came from institutions (Brown, Dartmouth) with huge conflict-of-interest problems. For this Bremner is paying a price:

“I got an email from someone on the DSM Anxiety, OCD, PTSD and Dissociative Disorders committee whom I thought was a ‘friend’ un-inviting me to be an author on a paper about another topic (that was after I had already spent several days working on the paper).”

There’s some nice revenge. What’s interesting is that Bremner has always written about Emory’s many conflict of interest problems and that seems to have PO’d some at that school who then used a long-ago Bremner post (part serious, part satirical) about my smoking and losing my housing over the same to demand that Bremner disassociate his blog from the fair, driven-snow reputation of Emory. That’s how lame it’s getting out there in academic psychiatry.

It gets lamer still. Danny Carlat reports on his blog that some folks within the American Psychiatric Association are trying to keep him off a guidelines review committee over a comment someone left on his blog earlier going after Stanford’s Alan Schatzberg, who recently became president of the APA. Read his post for the details.

I know that Bremner and Carlat are both disturbed by the academic snubbing from their colleagues and I imagine their surprise is large as well since the two are moderate critics within their field, mostly of conflicts of interest and rampant pharma-funding of continuing education. I say they should wear their shunning as a badge of honor and realize just how deeply out of touch with reality some of their colleagues seem to be.

Perhaps we can come up with a new disorder in DSM-V to describe the condition.

Go to Source

No, I’m not finished with it.

Last night I had the house to myself (the remote) so I settled down to a warm teev to see what the world has to say about Governor Sanford.

What a nice looking guy, seriously. You can see why we’re all so upset. He seems so presidential, has a little of the Lincoln jaw.

Anyway, the media is brutal and I’m pretty worried about the Gov’s mental health. A sensitive man like him could get suicidal listening to what I heard last night, pundits and comics blasting him to smithereens. So we won’t blast here, not much.

On the other hand, there’s so much to blast.

You play you pay, Governor. And we learn all kinds of things, do we not, from our elected officials.

David Letterman feels sorry for not only the first family, but also the good people of South Carolina who have to endure this embarrassment. The governor, facing television cameras tells us:

(a) he went hiking
(b) he was exhausted
(c) he needed to get away
(d) he’s really, really sorry–the list went on like the thank you speeches at the Academy Awards, and
(e) oh yeah, he had an affair.

He should have come clean, continues Letterman, should have told us straight up: I was taking care of business. You don’t say, I was hiking on the Appalachian Trail. Say, I had s a board of trade meeting in South America. I’m looking at silos.

Letterman’s top ten excuses. We’ll add our own in a second.

10. Did I say hiking? I meant, cheating!
9. I had to do something after the devastating news about Jon and Kate!
8. I learned everything I know from Governor Spitzer.
7. Let’s talk about more important things, like the Nestle Tollhouse cookie recall.
6. I learned everything I know from Governor McGreevey (apparently McG had an affair with his limo driver)
5. It’s Ahminadajab’s fault.
4. If you met my wife, you’d leave the country, too.
3. I’m auditioning for the Amazing Race (whatever that is)
2. If you run the state and have to leave the country for a week, since when do you need to tell someone?
1. It wasn’t me, it was my alter ego, Bruno.

So let’s add a few!

10. I can’t communicate well with my wife, can’t tell or show her what I need or want, it’s too embarrassing to talk that way.

9. After all, she’s really scary. Have you met her?

(She looks like the nicest person you’ll ever want to meet, and she doesn’t need him, by the way, her family owns the Skill tool company and has an MBA).

8. I have no imagination, zero.

7. I believe that it is women who are responsible for keeping their men interested, and that means they should be tan, preferably show tan lines.

6. If you have a close friend then how are you supposed to be able to stop that friendship from becoming sexual? Especially if you share so many of the same things, like you both have children? And why wouldn‘t you ask her for her email address?

5. I have an honest face, the people love me, I can get away with this. I think I can, I think I can, I think I can.

4. Denial is just a river in Egypt. Maybe I’ll go there, too, check out some silos.

3. I’m in politics. What do you want?

2. I have a spiritual adviser so I’m working on it. Love the sinner, hate the sin.

1. And as Bob and Ray, that famous radio comedy team used to say, paraphrasing Nixon

NUTS! I’ll never run again!

therapydoc

Go to Source