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Date » 2010 » February

The New DSM

Feb 10 2010 | Comments 11

As you’ve no doubt heard by now, a revision of the Diagnostic and Statistical Manual of Mental Disorders is underway. Public comments are being solicited One of the doctors who worked on the last version, Allen Frances, tells Judy Woodruf on the PBS Newshour that the last changes, though well-intentioned, caused an epidemic of overdiagnosis of autistic disorders, childhood bipolar disorder and ADD.

But new changes must be made. As anyone who follows this subject knows, many, many children have been aggressively diagnosed with bipolar disorder, a label that often subsequently confers the blessing of antipsychotics. Antipsychotics, don’t forget, have never been tested on children. We have no idea how such harsh medications affect the developing brain. The drugs increase risk of diabetes, metabolic disorder and tardive dyskenisia — among other mishegas — in adults. God only knows what we’ll discover a generation from now, when these kids are grown up.

So how did we get here with childhood bipolar? There’s a great report on you should read in its entirety, but I’ll give you some excerpts:

Since the mid-1990s, the number of children diagnosed with bipolar disorder has increased a staggering 4,000 percent. …

… many of the kids now categorized as bipolar were, once upon a time, diagnosed as having conduct disorder. Kids with conduct disorder are seen as very combative, aggressive, and prone to destructive behavior. But the treatments for conduct disorder are woefully limited, says Carlson. …

Which is why when every day psychiatrists were told that they could now think of this set behaviors as manic-depression, not as conduct disorder, they got so excited, says Carlson. “They thought, ‘Heck, if that’s what it is, we have a bunch of medicines that are supposed to be helpful for mania — maybe I can make it better,’ ” she says. This has deep appeal to doctors face to face with parents who are heartbroken over the difficult time their child is having.

Another advantage to the bipolar label, Carlson points out, is that the insurance industry saw bipolar as a biological or medical problem, while conduct disorder was seen more as a parenting problem, so insurance companies were reluctant to reimburse for it.

“If you’ve got something that says it’s not a medical problem,” says Carlson, insurance is not going to pay for it. “Conduct disorder is bad parenting, lousy environment, poor supervision, you’re a bad seed. It ain’t a medical problem. Bipolar they’ll pay for.”

Finally, Carlson argues, parents themselves were relieved on some level. Because this set of behaviors was no longer seen as conduct disorder, the psychiatrist sitting across the desk from them was no longer blaming them for the terrible things that were happening to their child.

So clearly there are some real advantages to using the bipolar label. The problem, says Carlson, is that because bipolar disorder is understood as a chronic lifelong problem, you really want to be very careful about how you apply it.

“If you have a child who’s got this behavior but you’re not sure how it’s going to evolve, to say to somebody, ‘You’ve got to be on this medication for the rest of your life’ is sentencing someone to something that’s premature. And in the case of some of these medications, where we’re not sure of some of the metabolic side effects; you may be exposing them to a risk that they don’t need to have.”

Of course, many advocates, activists and journalists have been saying for years that the childhood bipolar diagnosis is highly problematic. And there’s been no one more vocal than Philip Dawdy of Furious Seasons. Check his site for his take on the proposed revisions, including the one on childhood BP.

liz | 8:43 PM | Uncategorized

Video: Suicide, Death and Other Goodies

Feb 5 2010 | Comments 25

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liz | 10:54 PM | Uncategorized

Effexor to Cymbalta: Not So Bad

Feb 5 2010 | Comments 30

You know, if you rely on the Internet to inform you about medication side effects, you might have a panic attack before you’ve even got the Ativan in your system to calm you down. When I started Effexor, I read such horror stories that I was absolutely terrified, and though some of the info was true, that drug pulled me out of an unbearable abyss. I was truly losing it — the depression was becoming psychotic and I was contemplating suicide. And who knows why, because such things are mysterious, but it worked.

The thing about Effexor that I didn’t like was my dependence on it. For instance, if I miss a night of Lamictal, I’m okay. I do get some facial twitching, but that’s more amusing than bothersome. It’s not like I’m going to vomit my face off.

With Effexor, I was unable to even be off by an hour. I’d start to get really dizzy and nauseated, and it was just awful. I felt like a slave to it. In fact, when I was on Seroquel and Ativan, I could easily (though sleeplessly) miss doses for one night. Not so with Effexor.

Recently I realized I haven’t been happy for a while. I haven’t been depressed, exactly, but seriously dysthymic. And I was having some intrusive PTSD stuff — I kept flashing back to awful times in my life when I was psychotic and very ill, and it would make me want to crawl into bed. So I told my doctor about it, and he suggested bumping up the Effexor, given that it worked so well. I pretty much always listen to him, because he’s brilliant and kind, but this time I put my foot down: no more Effexor.

He was fine with that. He said, let’s just switch you to Cymbalta and do a slow withdrawl of the Effexor. And I panicked. Everyone has told me that withdrawal from Effexor is a living hell. Brain zaps, vomiting, shaking, sweating — it sounded like my withdrawal from Klonopin, which was only achieved with the benefit of phenobarbital, and only after about 10 years of trying.

But the thing about having a chronic condition of this sort is that you go through a lot of shit and you come out the other side. So my attitude when I’m confronted with a med challenge is this: Bring it on. And in my bluer moments: You don’t know who you’re fucking with.

Funny thing, though: Nothing’s happened. I’ve cut the Effexor in half and added the Cymbalta and I am utterly without withdrawal symptoms. If I believed in God, which I don’t, I might say it was divine intervention. But it’s not. It’s just that things aren’t as bad as you think they’re going to be.

So that’s my story these days. The PTSD stuff has lessened a little, but it’ll take time. I’m feeling more obsessive lately, which I’ll write about later. But hey, as I always say, I can handle anything. As Seneca remarked at dinner last night: “Fire is the test of gold; adversity of strong men.” And women, too.

liz | 11:16 AM | Uncategorized