From one of my most beloved organizations, MindFreedom, comes an effort to challenge notions of normalcy as the American Psychiatric Association meets to unveil the DSM-5. From MindFreedom.org:
Free thinkers unite in an international campaign to question how psychiatric corporations try to control us and our democracy through their misguided idea of “normal.”
Be part of peaceful protest of the American Psychiatric Association, everywhere, especially Philadelphia, on 5 May 2012.
Occupy the American Psychiatric Association!
MFI calls on mental health consumers, psychiatric survivors and allies to Boycott Normal in response to the American Psychiatric Association’s preparation for a fifth edition of Diagnostic and Statistical Manual of Mental Disorders.
DSM-5 would be the latest edition of what is widely known as psychiatry’s “label bible,” used to determine if people can be diagnosed with mental ‘disorders’ or ‘illness.’
Today, we challenge normality and celebrate creativity and diversity. Please join us!
Want to get involved? If you’re in Philly, email Susan Rogers at email@example.com. She’s the nicest person on earth, so you won’t be sorry. Also, click HERE.
I was in CVS the other day waiting to fill my prescription for Dexedrine, when I overheard the guy in front of me being told they were out of Adderall. The pharmacy tech suggested he go to another store, but the guy said he’d been to every place in the city and couldn’t get Adderall anywhere. Fortunately, CVS did have Dexedrine, but the fact that there is a shortage of drugs for attentional issues is completely appalling and unacceptable in a supposedly first-world healthcare system.
The problem is that the Drug Enforcement Administration only allows a certain amount of Ritalin and Adderall to be produced because of the abuse potential, particularly by college kids who take the stuff like candy to stay up at night studying. The FDA, which monitors supply of the meds, is particularly distressed by the shortages and has tried to get the DEA to change its quotas. But the DEA is claiming there’s no problem, and that patients who encounter a shortage can just switch meds.
Ooh boy. I think we all know how that goes. Yeah, sure, just switch from Adderall to Ritalin–that’ll work. I remember the only time I tried Ritalin, my tongue swelled up and I ended up flat on my back in a CD store, having passed out with some weird allergic reaction. Adderall, however, was benign in terms of side effects for me. The DEA seems to be oblivious to the fact that children (who are the majority consumers of these drugs) can’t just switch around.
While there are more branded meds in supply, not everyone can afford them. This means people go without treatment, another devastating problem for kids (and for adults too, of course).
The article detailing all of this is by Gardinar Harris in the New York Times and can be found HERE.
The size of this headline right now on Huffington Post is huge:
EnVivo Pharmaceuticals is touting positive results of research into a drug they’re developing for schizophrenia. The drug right now is called EVP-6124, but will eventually be called Relaxafin or something equally ridiculous. The Phase 2b study of the drug was tested on 319 “chronic schizophrenia patients” in the U.S., Russia, Ukraine and Serbia, a practice that continues to interest me. I wonder, for example, if diagnostic criteria differ in those countries and how cultural differences shape the notion of who is called a chronic case. Phase 3 will focus on the drug’s efficacy in treating cognitive symptoms of schizophrenia. For the full press release, go here.
In other news, Targacept is about to go into Phase 2 trials of TC-5619, which the makers are hoping will treat both schizophrenia and ADHD. For the schizophrenia trial, this study will be conducted in the U.S. (25 percent) and Eastern Europe (75 percent) and will enroll 450 participants. For the ADHD trial, the 85 enrollees will be primarily in the U.S.
What’s especially interesting to me about this latter study is the focus on symptoms of inattention in ADHD, which, according to Targacept, are not currently being addressed pharmacologically. What concerns me greatly, however, is that this means we’ll have another drug on the market that is basically intended to treat children. Some children may benefit. But others may be medicated to their detriment and unnecessarily.
Speaking of which:
In the recovery movement, which is the zeitgeist in the delivery of mental health services at this time, we are supposed to look past someone’s diagnosis. I am not “a bipolar” or “depressive” or “schizophrenic.” I have been diagnosed with such, but the relevance of that diagnosis is highly suspect. Because aren’t I just Liz? Liz who is addicted to Dunkin Donuts hazelnut coffee, Liz who likes chihuahuas in sweaters, Liz who tries to do gluteal exercises to increase her butt’s circumference — without success. So many things make up my Liz-ness, right? So who cares what some doctor said?
Generally speaking, I agree with this approach. For many years we have been labelling people in an attempt to treat them, and the results aren’t exactly stellar. So why not change protocols, DSM by damned?
Yet as a person who works on the frontlines of mental health care, I sometimes do find myself stymied by a person’s behavior, and a diagnosis can (infrequently) help. Because there certainly are definable characteristics of certain illnesses that can help me understand where a person is coming from. It also helps in distinguishing substance abuse from simple illness.
Here’s what I mean. Say I meet a guy who talks to me about his power over floating CGI-enhanced rabbit-shaped angels — who says he can get me anything I want by talking to them and persuading them. This is not true. By any measure we use to determine reality, the CGI-enhanced rabbit-shaped angel is clearly a fiction. But what if he slurs while he tells me this? What if he leaves that day and I have to understand what’s going on so I can advocate for him? Wouldn’t many people think, “That guy is on some serious crack.”
Now, we’d like to think a mental health professional would be more sophisticated than that, but then, you’d be assuming a level of knowledge that some MHPs simply don’t have (I say that with love). So if you look at this guy’s medical records and it says he has been diagnosed 10 times by 10 different doctors in the last 10 years as a person with schizophrenia, that might be good knowledge to have. Additionally, if his records state that he has never used drugs or alcohol, that’s also good to know.
I’m not saying that guy is only his diagnosis. I’m saying that hearing what psychiatrists have labeled him with for a decade might be useful information for me to have if I’m going to help him.
Similarly, the search for diagnosis can be a good road to travel. In today’s Washington Post, a mother asks Marguerite Kelly what her depressed daughter should do — meds or exercise? Kelly gives an answer that anyone should get in the absence of clinical assessment:
It’s time for your daughter to find an experienced board-certified internist who listens well and is curious enough to test her for viruses, low thyroid, high cortisol, candida and many other conditions that can cause depression. If she’s healthy, she then should be evaluated by a psychologist or a psychiatrist, who will ask her about any trauma or loss that she’s had, any history of depression in the family, any bad PMS occurrences or any sadness in the winter, all of which can trigger depression.
This is a good protocol in search of a diagnosis. That being said, my psychiatrist reminds me again and again he doesn’t care what my label is; he just wants to help me feel better. And it’s true that it doesn’t matter if you call it OCD or bipolar of DID or PPP (for Poo Poo Poo), if you’re counting every crack in the sidewalk, it’s probably time for some help.
These are my thoughts for today, messy though they are. I’d love to hear your thoughts.
Invega has now come out with a different formulation: the sustained release. Apparently, this is the first atypical to be approved for the once-monthly injection formulation, though there are other neuroleptics used in this fashion. Personally, I’d love a once-monthly instead of the everyday pill. Bring it, yo evildoers at AstraZeneca! I’m ready for my Seroquel shot!
Or maybe not. A new Lancet study says older antipsychotics, like clozapine, are safer over the long term than Seroquel, Zyprexa and Risperdal. From the L.A. Times health blog:
Researchers in Finland, where clozapine is still widely prescribed for schizophrenia patients, found that users of the drug were less likely to die than those who took any one of three other second-generation (also called “atypical”) antipsychotics — Seroquel, Risperdal and Zyprexa — or those who took the first generation schizophrenia medication pherphenazine (once marketed as Trilafon).
Sufferers of schizophrenia have long been known to die earlier than the general population, markedly more often by suicide and by complications of diabetes. They are far more likely to engage in behaviors that lead to earlier death as well, including tobacco use, substance abuse and sedentary lifestyles. The Lancet article found that a schizophrenia patient who took any of the studied medications for seven to 11 years was less likely to die prematurely. And the longer she took it, the less likely she was to die an early death.
American physicians have largely abandoned Clozaril, which has been on the U.S. market since 1989, in favor of Zyprexa, Seroquel, Risperdal and Abilify — all newer drugs that have been aggressively marketed to doctors and patients as safer and more effective than the first-generation of antipsychotic drugs, including pherphenazine and haliperidol (better known by its commercial name, Haldol).
Meanwhile, the numbers of people being prescribed these powerful psychiatric drugs have skyrocketed. In 2008, 50 million prescriptions for antipsychotic drugs — overwhelmingly the newer ones — were filled.
Thanks to advocate Fran Hazam for forwarding Dr. Lloyd I. Sederer’s article “Can You Trust Your Psychiatrist” from HuffPost. Citing influence from Big Pharma — and basically explaining the way the influence filters down to you — Sederer breaks down what you need to do to ensure the best care:
First, be an informed consumer. Just like with a car or washing machine you can learn about medications and other treatments for mental health problems. Turn to websites like your state mental health agency or the National Institute for Mental Health, the National Mental Health Association and the National Alliance for Mental Illness. Google key words about what you want to know, as you would for breast or prostate cancer, diabetes, and heart disease. Ask others who have successfully navigated the mental health care system and taken medications. As has been said, caveat emptor — let the buyer beware — and be prepared.
Second, ask questions of your doctor and other health professionals. Rather than being a marketing arm of the pharmaceutical companies, be a prudent buyer. Don’t be shy — you are your best advocate. When you visit your doctor ask two questions: why are you suggesting this treatment for me and what alternatives do I have? When in doubt get a second opinion: any doctor who does not welcome a second opinion is not worth keeping.
Finally, recognize that medications for mental disorders often help but generally are not sufficient. Great reliance on medications has fostered inattention to individual and family therapy and skill building programs.
Emphases mine. For the rest of the article, click here.
Despite the glib title of this ongoing TTWS feature (Blank Made Me Do It), there are some cases that are quite serious and upsetting. The one of Randall Robbins II is that kind of case, if only because it brings up–for the umpteenth time–this issue of those black-box warnings on antidepressants. From the L.A. Times:
Randall Robbins II, who pleaded guilty to second-degree murder in the 2002 strangulation of 17-year-old Brittany Eurek, argues that both Pfizer and his doctor should have known that Zoloft might have made him attempt suicide and commit murder.
He says the drug intensified his agitation, suicidal desires, hysterical behavior and hostility and diminished his self-control.
Those arguments are similar to claims made in a few other cases since 2004, when antidepressants gained new warning labels highlighting the risk of suicidal behavior in people under 18.
In 2007, the South Carolina Supreme Court upheld the conviction of Christopher Pittman, who is serving a 30-year sentence for killing his grandparents when he was 12. The court rejected his argument that he was involuntarily intoxicated by taking Zoloft and didn’t know what he was doing when he killed his grandparents and burned down their home in 2001.
A year earlier, the North Dakota Supreme Court affirmed the conviction of a man who killed a 19-year-old woman with a shotgun and later tried to blame the 2003 slaying on the antidepressant drug. Zachary Schmidkunz is serving a 35-year prison term.
What puzzles, somewhat, is the conflicting behavior of Pfizer, though their continuing legal victories do justify it. On the one hand, there is the black-box warning, which specifically concedes that this kind of reaction to the drug is possible. On the other hand, there’s the response to a case like Robbins’:
“Pfizer’s evaluation of Zoloft data never has revealed any signal of an increased risk of violence related to either use or discontinuation of use of Zoloft,” [spokesman Chris] Loder said.
The FDA also says the underlying mental illnesses that antidepressants are used to treat are the most important causes of suicidal thoughts and actions.
So is that tantamount to Pfizer saying they don’t believe their own warning? Robbins, who’s in prison for the murder, is now suing Pfizer for $1 million and serving as his own lawyer. (Isn’t that always a bad idea?) Go here for more.
After a long battle with cancer, PW staff writer, Guardian columnist, punk-rock novelist, NME gadfly, gender-twisting rebel comedian and poet Steven Wells has gone on to other things. Well, not really. According to Steven, there’s no such thing as the afterlife, and if there is, I guarantee he’s really, really pissed off right now. I can just picture him at St. Peter’s Gates, saying, “Fuck me! This shit actually exists?”
We’ll all miss Steven so much, and I’ll say more about that later. For now, I’m wishing the best to all family and friends who are hurting. That’s what Steven really cared about in the end, though he was very passionately annoyed by knitting, as well.
Steven was often told he was anti-American. I loved his passion, and he cracked us the fuck up every day. This video was part of a series he did for PW called Steven Wells’ America, in which he took sacred cows and basically grilled them for dinner. Below, he reflects on the religiosity of an America that voted for Bush a second time (Steven was a staunch atheist). Toward the end he smiles a bit, so you know that he knows he’s being ridiculous. And that’s part of what was so cute about Steven — he’d rant, but then laugh at himself.
liz | 10:41 AM | BIG PHARMA, Funny or Offensive?, GLBT, Song of the Day, alternative treatments, anxiety, celebrities, children, cute fix, depression, hospitals / hospitalization, media, meds, military, philadelphia, phobias, politics, random, religion, suicide, violence
Andy, author of Electroboy, is pretty pissed off about his experience with Abilify. Here’s what he means:
Ironically, Behrman used to be a spokesperson for Bristol-Myers Squibb, the maker of Abilify — which sort of mirrors my own experience as former (unpaid) speaker for Astra Zeneca about Seroquel. The Wall Street Journal has an article, “A Celebrity Patient’s Backing Turns Sour,” about Andy. It begins:
Bristol-Myers Squibb Co. has worked with hundreds of patients in its promotional efforts. The drug maker says every collaboration, except for one, has been positive for both Bristol-Myers and the patients who tell their stories.
Andy Behrman is the one.
In 2004, Bristol-Myers held a retreat for 1,250 sales representatives, to prepare them to market a powerful psychiatric drug for a new use — bipolar disorder.
A video of Mr. Behrman, a 42-year-old bipolar patient, filled a gigantic screen. He recounted how a Bristol-Myers drug, called Abilify, had changed his life. Unlike other medicines he had tried, Abilify had no …
And today Andy sent out an email:
Three years ago, after working as a spokesman for Abilify, a hugely profitable drug manufactured by Bristol Myers Squibb, I published an online article about the drug’s terrible side effects. I said it was the worst drug that I had ever been prescribed and that it had nearly killed me.
Within twenty minutes of the article being posted on a website owned by the New York Times, the article came down. Turns out, BMS was a sponsor of the website.
Today I am preparing to sell a new book, Adventures in the Drug Trade, which details my nightmarish experience with Abilify, my treatment by Dr. Mark Frye, a former UCLA psychopharmacologist now at the Mayo Clinic and curiously no longer a medical consultant for BMS, and my experiences as a pusher of their not-so-wondrous wonder drug.
I believe that BMS will go to almost any lengths to stop me and the publication of the book. It’s time to hold drug makers like BMS accountable for their corrupt practices and harmful products. Just as culpable, if not more so, are the licensed physicians that aid and abet them. Do no harm? I don’t think so.
The sad reality is that the drug companies won’t tell you the truth about the side effects of their drugs and for that matter, neither will your doctor. Did you know that pharmaceutical companies actually send some of these doctors on an all-expense-paid ten-day Caribbean cruises just for “writing prescriptions?”
I suspect a lot of people who read this blog do know that, but now Behrman knows it too — and so will a lot of mainstream readers if he gets his book published.
The only thing I want to say here, aside from wishing Andy good luck with his fight, is that I wouldn’t want to tar all doctors with the same brush. My psychiatrist does tell me the truth and he refuses to take any Big Pharma compensation. He is very clear about his policies in that regard up front. Many of his colleagues are the same. They have integrity and passion for their patients and want to advocate for them.
I’d also like to point out that if you take a new medication and you’re concerned that your doctor is not being frank with you, do your homework. It is easy in the Internet age to find information about side effects. If you don’t have access to a computer, ask your pharmacist to give you the package insert for the medication. It clearly lists the possible side effects, along with statistical probability. If you feel such stats aren’t credible due to the source, you can be sure that at the very least the side effects listed are ones that people did experience.
Be careful out there, folks. Big Pharma — just like Big Oil or Big Tobacco or Big Anything — doesn’t give a shit about you.
liz | 10:05 AM | BIG PHARMA