As I’ve written and spoken about before, my sister suffers from a bipolar disorder and my nephew from schizoaffective disorder. There has, in fact, been a lot of depression and alcoholism in my family and, traditionally, no one ever spoke about it. It just wasn’t done. The stigma is toxic. And, like millions of others who live with mental illness in their families, I’ve seen what they endure: the struggle of just getting through the day, and the hurt caused every time someone casually describes someone as “crazy,” “nuts,” or “psycho”.

What’s remarkable is not her frankness about this personal history, but her motivation to act, which seems almost like a wholesale rethinking of her career and what it’s meant in popular culture. In Fatal Attraction, for example, she played a woman obsessed with Michael Douglas (those were the days, right Michael?). She loses control of the obsession and becomes terrifying. As Close writes, the movie was a great success, and audiences loved to hate her character.

Alex Forrest is considered by most people to be evil incarnate. People still come up to me saying how much she terrified them. Yet in my research into her behavior, I only ended up empathizing with her. She was a human being in great psychological pain who definitely needed meds. I consulted with several psychiatrists to better understand the “whys” of what she did and learned that she was far more dangerous to herself than to others.

The original ending of Fatal Attraction actually had Alex commit suicide. But that didn’t “test” well. Alex had terrified the audiences and they wanted her punished for it. A tortured and self-destructive Alex was too upsetting. She had to be blown away.

So, we went back and shot the now famous bathroom scene. A knife was put into Alex’s hand, making her a dangerous psychopath. When the wife shot her in self-defense, the audience was given catharsis through bloodshed — Alex’s blood. And everyone felt safe again.

The ending worked. It was thrilling and the movie was a big hit. But it sent a misleading message about the reality of mental illness.

This is a bold admission from a woman who derived so much success from this role, but there’s no escaping what she says. It has long bothered me — and, I suspect, other advocates — that the message there is one of terror and fear.

Not only does Close take on her role in that film, she assesses the entertainment industry as a whole:

Whether it is Norman Bates in Psycho, Jack Torrance in The Shining, or Kathy Bates’ portrayal of Annie Wilkes in Misery, scriptwriters invariably tell us that the mentally ill are dangerous threats who must be contained, if not destroyed. It makes for thrilling entertainment.

There are some notable exceptions, of course — Dustin Hoffman in Rainman, or Russell Crowe’s portrayal of John Nash in A Beautiful Mind. But more often than not, the movie or TV version of someone suffering from a mental disorder is a sociopath who must be stopped.

I like to think that her speaking out will change this. As she so eloquently says, silence is the problem. Read more of her elegant prose here. It is well worth it. There you’ll find links to the initiative she’s promoting.

Thank you, Glenn, for speaking out against silence. You rock.

Still, I realize that when I start working again, I’ll be able to reduce the Seroquel again to 25 mg or maybe 0 mg without much of a problem. Once I’m in a routine, I tend to do quite well. So, as those of us in recovery say every day with increasing confidence: This. Too. Shall. Pass.

Madigan: They didn’t flatter you with that lighting.

David Oaks: You’re looking so handsome! I had no idea. Your eyebrows are very sexy. (I’m completely sincere.)

“But critics worry …” That’s journalism-speak for “We don’t have any specific sources who say this, but we’ll generalize it so we have reason to focus on …”

… violence. That’s what they’re focusing on. Why am I not surprised?

So of all the things they could talk about related to Mad Pride — and related to mental health — this is what they’ve come up with: criminals and violent crime. Ugh. TV is so predictable and depressing.

Okay, so now we’re telling the story of a kid with hallucinations and delusions (the CIA, yadda yadda) who KILLS HIS MOTHER? Does the average American viewer understand how fucking rare this kind of thing is? That it’s not the necessary result of deciding not to take meds?

On to the withdrawal story: Clearly, the program wasn’t looking for a success story. This poor woman who decided to do the show so they could feed off her misery — I knew that’s what they wanted. Is she doing the withdrawal in conjunction with a doctor? Who the hell knows? The show doesn’t tell you. It hardly tells you her name. And …

Oh! There it is again: “Critics worry … ” (that she’s going to be “a time bomb” without her meds). Who are these critics worrying about this girl? Frank Rich? David Denby? I’d love to know.

“Violence is unpredictable with or without drugs.” Brilliant script.

Blurry homeless images. Madigan cello-ing. … This show is so bad, it’s like a joke. I guess it all goes back to what producer Ia Robinson told me, when we discussed my being on the show: She doesn’t have any friends or family who have mental problems, so the whole topic was like “walking on the moon.” Yes, that’s the phrase she used. The show should’ve been blasted out to Mars.

Except Joey P. He’s delightful and a voice of reason.

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.

Shares of Clinical Data Inc. (CLDA) rose after the last late-stage study on its treatment for major depressive disorder achieved the targets for efficacy and tolerance, clearing the way for the treatment’s new drug application to be filed later this year.

The biotechnology company jumped as much 14% Tuesday morning after saying its treatment, vilazodone, was generally well tolerated …

But the study also showed high rates of some side-effects, including diarrhea and nausea.

…

Biologic Investment Research analyst Kevin McNamara didn’t think the study was positive at all. He pointed to the high amount of patients who suffered from diarrhea – 31% – and nausea – 26% – saying the effectiveness of the treatment wouldn’t set it apart from the field.

“The incidence of diarrhea is outrageous, that’s the only groundbreaking thing about this study,” McNamara said. “There just is not another place in the market [for vilazodone].”

…

Clinical Data, which wasn’t immediately available for comment, pointed out in its release that only one patient out of 240 left the study because of diarrhea while three quit because of nausea.

And with two positive Phase III studies now in the books, Clinical Data says it should file its new drug application for vilazodone by the end of the year.

Clinical Data Rises On Study Results For New Antidepressant

1. are planning to go off med(s)
2. are interested in alternative methods for coping with illness, such as exercise and holistic interventions
3. are willing to share your story of withdrawal and coping — even if it’s awful and embarrassing — with the American public

Email me at lspikol@philadelphiaweekly.com

The investment firm Fidelity recently surveyed employees at various companies who had opted for a high-deductible health plan linked to a health savings account. About half of those workers said they or a family member had chosen not to seek medical care for minor ailments as many as four times in the last year to avoid paying the out-of-pocket expenses.

As any doctor will tell you, small health problems left untreated can become big problems, warns Kathleen Stoll, director of health policy at the health care advocacy group Families USA. “This is just one of the many high-deductible pitfalls consumers need to watch out for,” Ms. Stoll said.

Patient Money: The Many Hidden Costs of High-Deductible Health Insurance

Explanation:

A package of bills sponsored by Senate President Richard J. Codey that are designed to protect patient safety and improve employee training and oversight at state psychiatric hospitals was approved yesterday by the Senate Health, Human Services and Senior Citizens Committee. … Sen. Codey worked closely with the Public Advocate’s office in drafting these bills, in part, to address a number of injuries and deaths that had arisen recently at state facilities such as Ancora Psychiatric Hospital.
Bill S2492, would require the Department of Human Services (DHS) to establish a training program for staff members who work directly with patients at state psychiatric hospitals in order to ensure the delivery of safe, secure, and therapeutic care.  Utilizing best practices in patient treatment, the curriculum would include topics such as state and federal reporting requirements, patient safety, disease prevention, health wellness activities, anger management, skilled decision-making and how to deal effectively with life-threatening emergencies. … The bill would require DHS to establish an on-site educational assessment and remedial instruction program at each state psychiatric hospital in order to evaluate the proficiency of all staff members who work directly with patients.

The bill would also require the commissioner of DHS to establish minimum educational standards for staff members at a hospital who work or will work directly with patients. … Employees already working directly with patients at the time of the bill’s enactment would be required to undergo an evaluation to determine if they meet the educational standards or require remedial instruction through the on-site education program.Any employee that refuses to participate in the training program or fails to meet the educational standards and refuses to participate in remedial instruction, would be terminated from employment at the hospital. …

The second bill, S2493, would require current and future employees of state psychiatric hospitals, developmental centers and veterans’ memorial homes to undergo drug testing for controlled dangerous substances as a condition of employment.

The last bill in the package, S2494, would require DHS to report the number of physical assaults and deaths that occur at state psychiatric hospitals. The report would be a public record, posted on the official DHS website, and updated quarterly, but would not contain any identifying information about patients or staff members.

As a longtime fan of Sen. Codey’s commitment to mental health matters, I do think it’s a good move. But is it transformative? As an astute TTWS reader notes:

It’s hard to see how these three bills alone will transform patient care at New Jersey’s state psychiatric hospitals which includes Ancora, let alone insure the care long required by law, New Jersey Statutes Annotated 30:4-27.1(c), It is the policy of this State that persons in the public mental health system receive inpatient treatment and rehabilitation services in accordance with the highest professional standards and which will enable those hospitalized persons to return to their community as soon as it is clinically appropriate.

Too often words and deeds fail to intersect at our nation’s psychiatric hospitals. Transform and its variants are now used so frequently that any change is considered transformative. More recently at another New Jersey state psychiatric hospital where a new building was going to lead to transformation (click here, paragraph 5), the reality belied the representations, ex. Developing therapeutic alliances between patients and staff remains a challenge, with differences in race, ethnicity, social class and education creating a ‘them versus us’ scenario.

“When I use a word it means just what I choose it to mean — neither more nor less.” Humpty Dumpty

Today I found a double whammy: an article about the recession and resultant depression, which is not only concordant in terms of themes, but also rhymes. The major mental health charity organization in Britain, Mind, released a study that says that men are more prone than women to recession-related blues. Yet men are less likely to tell someone about it and get help. From BBC.com:

Paul Farmer, chief executive at Mind, said: “The recession is clearly having a detrimental impact on the nation’s mental health, but men in particular are struggling with the emotional impact.

“Being a breadwinner is something that is still crucial to the male psyche so if a man loses his job he loses a large part of his identity putting his mental wellbeing in jeopardy.

“The problem is that too many men wrongly believe that admitting mental distress makes them weak and this kind of self stigma can cost lives.”

Stephen Fry, our beloved, is supporting Mind’s campaign to educate men. One thing that’s notably different in Britain: the admirable insistence on therapy. Peter Cooper, of the British Psychological Society, was quoted as saying: “The type of help that men need includes psychotherapy but what they are also desperate for is pragmatic practical help.”

No mention of meds. Jolly well done.

Men ’suffering recession blues’

Not so with Effexor. I don’t even have to wonder if I’ve taken it; my body alerts me quite readily. I get really dizzy and spacey, and if I let it go till the next day, I’m essentially dysfunctional — half-asleep, half just an idiot. I’ve heard plenty of anecdotal stuff about “brain zaps,” and I’ve never had a problem with that. Just vertigo, mostly. But it’s enough discomfort that I can’t be without it. I feel like it controls me too much. It reminds me of my addiction days.

So, though I thought it helped me a couple years ago, I think I’ll move on. And if I get too depressed, I’ll just eat more candy. Um, yeah.

Don’t answer that. I got an email from Maiken Scott, behavioral health reporter for WHYY, the PBS affiliate in Philly. She wrote:

Last year, I met with Dr. John O’Reardon, a U Penn scientist who invited me to cover a new treatment for severe depression as it develops and undergoes scientific testing. This approach is called DBS, or Deep Brain Stimulation. It is already being used successfully in the treatment of symptoms associated with Parkinson’s Disease. Dr. O’Reardon is passionate about helping people with treatment-resistant depression, and he cares deeply about his patients. Yesterday, I was in the OR at Pennsylvania Hospital, and watched the procedure. I had previously met with the patient. Her name is Tara, she is 50 and has suffered with depression for almost 40 years – we spoke at length before her surgery. I have started to file stories and we’re covering this as it develops both on air and on the web. I plan to follow her for the rest of the year, as she recovers and as scientists learn whether this treatment will bring her relief.

Sounds very interesting to me, and Maiken is a really good reporter. Check it out here.

What made me angry is that I know plenty of incompetent drivers who shouldn’t be on the road, and they don’t suffer from mental illness. I also know drivers who have severe mental illnesses who acquit themselves quite admirably on the roadways (myself included). It’s a violation, in my opinion, of a person’s civil rights to prevent them from applying to get a license.

One woman who did get approval was empowered by it. She failed the permit test again and again, but it never ceased to be a goal, which fit in with the messages given by the community health center: Make sure the clients set goals for themselves; it gives them hope. Perhaps it was an unrealistic goal for her. I don’t think she’ll ever drive. But it was the trying that mattered, and if she ever gets behind the wheel, I hope she drives far away into the sunset with a great song on the radio. Just for fun.

A Guy, a Car: Beyond Schizophrenia by Ronald Pies M.D.

For some reason that line comes to me sometimes, in childish I-told-you-so situations. So when I read the AP article titled: “Panel: Seroquel not 1st choice for depression,” I thought of that line. If Philip Dawdy saw the movie, he probably thought of that line too.

Of course Seroquel doesn’t work for depression. It’s an antipsychotic, people. It was created to treat schizophrenia, which — despite Big Pharma’s craven desires — IS NOT THE SAME AS DEPRESSION.

Here are some relevant tidbits, including some deliciousness about Seroquel causing diabetes. I went a little crazy with the bolds:

WASHINGTON (AP) — Federal health experts said overwhelmingly Wednesday that the side effects of AstraZeneca’s schizophrenia drug Seroquel are too worrisome to make it a first choice against depression.

However, the panel of Food and Drug Administration advisers also said the drug could be useful as a supplemental therapy for patients who are not finding relief with other antidepressant drugs.

Seroquel, which posted sales of $4.5 billion last year, is already approved to treat schizophrenia and bipolar disorder. Now the London-based drugmaker wants the FDA to approve it for patients with depression and anxiety disorder, a much larger population that includes more than 20 million U.S. patients.

But FDA regulators expressed concerns about allowing nearly 10 percent of the U.S. population to use a drug with side effects including weight gain, high blood sugar and potential heart problems.

Panelists voted unanimously that the drug was not safe enough for use as a first choice, stand-alone treatment of depression and anxiety disorder, given older, more established drugs.

“I saw no clear advantage demonstrated in efficacy,” said Dr. Wayne Goodman, an NIH researcher who chaired the panel. “There were side effects, and I would expect unintended consequences associated with wide-scale use of the drug.”

FDA is not required to follow the advice of its panels, though it usually does.

Seroquel is part of a new generation of psychiatric medications, called atypical antipsychotics, thought to be safer than older medications. But a paper published in the New England Journal of Medicine earlier this year found that patients taking newer medications have the same likelihood of dying of a sudden heart problem. The study from researchers at the Vanderbilt University found there were about three deaths per year for every 1,000 patients taking older or newer antipsychotics.

“Our study provides evidence that this drug may produce a side effect that is of extreme concern to patients,” said Vanderbilt’s Dr. Wayne Ray, who was invited by the FDA to present his findings.

Many physicians already prescribe Seroquel and other antipsychotic medications to manage depression and anxiety. But FDA approval would allow AstraZeneca to market its powerful antipsychotic for those uses.

The company said there is a significant need for new depression treatments, pointing out that the disease returns in a third of patients treated with existing antidepressants. Many patients stop using the drugs due to side effects like insomnia, sweating and decreased sex drive.

Largely absent from the panel’s discussion was the ongoing debate about Seroquel’s possible role in contributing to diabetes, a controversy that has generated thousands of lawsuits against AstraZeneca in recent years.

However, more than a dozen members of the public — including spouses of patients who died while taking the drug — called on the FDA panel to deny approval of Seroquel for depression, with many citing its metabolic side effects.

“It is your job to keep Seroquel off the market for this expanded use unless the company can conclusively prove that it does not increase the risk of diabetes,” said Dr. Diana Zuckerman of the National Research Center for Women and Families.

Lawyers representing some 15,000 former Seroquel users claim AstraZeneca knew nearly a decade ago that the drug caused diabetes, but kept that information secret.

A brief released by the plaintiffs attorneys Wednesday morning claims that internal AstraZeneca memos and data show Seroquel is both risky and not very effective.

One study showed Seroquel was not effective against depression but a comparator drug was. Several other studies of Seroquel failed to prove that depression symptoms stopped or waned significantly by six weeks, according to the brief.

Thanks to Susan for letting me know about this.

Mom blames improper meds for son’s condition

Oh, and as for that headline? That’s the Courier-Post’s way of covering its ass, legally speaking. But after this article, I hope the state — not just “Mom” — blames the hospital for starting her son’s miserable trajectory.

Yet people with multiple health problems — a condition known as multimorbidity — are largely overlooked both in medical research and in the nation’s clinics and hospitals. The default position is to treat complicated patients as collections of malfunctioning body parts rather than as whole human beings.

“Very often, there is nobody looking at the big picture or recognizing that what is best for the disease may not be best for the patient,” said Dr. Mary E. Tinetti, a geriatrician at the Yale School of Medicine.

And treating one disease in isolation, she added, can make another disease worse. In controlling diabetes, for example, doctors often seek to reduce levels of a blood-sugar marker called hemoglobin A1C. “But we know that for some people with complicated diseases, that’s not always the best move,” Dr. Tinetti said.

Treating an Illness Is One Thing. What About a Patient With Many?

Dawdy’s got an interesting post over at Furious Seasons critiquing the FDA’s recent approval process vis-a-vis the use of Lexapro in kids 12-17. He explains his opposition to the use of the med in teens quite clearly; the only thing I would quibble with is the assumption that withdrawal is the same in every case.

Many people who come off of Paxil, Effexor or Lexapro don’t get brain zaps, particularly if the withdrawal is done slowly. People lose patience with the tapering process and want to go faster, and sometimes do so to their detriment. At any rate, we shouldn’t assume that everyone who takes the meds has the same responses.

However, there’s a serious question here, in my opinion, about the safety and efficacy of initiating treatment with Lexapro to begin with. As Dawdy points out, the evidence is slim that it works in teens, and the brain is still developing at that age. Many people I know who grew up on meds are all fucked up, both in terms of their sense of self and their brain chemistry. They’ve been habituated to medications too early.

Go to Furious Seasons for more.

BOSTON — Parents accused of drugging to death their 4-year-old daughter with an overdose of prescription medication should be tried for first-degree murder, not less-severe charges, the Massachusetts Appeals Court ruled Monday.

In a decision that outlined horrific allegations of neglect and intentional drugging, the appeals court said there was enough evidence to find probable cause that Carolyn and Michael Riley “murdered Rebecca with deliberate premeditation and with extreme atrocity or cruelty.”

The decision overturned the ruling of a lower court judge, who reduced the charges to second-degree murder after finding there was no evidence of premeditation.

The Rileys say they were following the orders of Rebecca’s psychiatrist, who had diagnosed the girl with bipolar disorder and attention deficit hyperactivity disorder. But prosecutors say the couple kept Rebecca and two older siblings loaded with psychiatric drugs to keep them quiet and to collect Social Security disability payments.

Rebecca Riley was found dead on the floor of her parents’ bedroom on Dec. 13, 2006.

A state medical examiner determined that Rebecca died of a lethal combination of prescription drugs. The case reignited a long-running debate within the psychiatric community about whether young children can accurately be diagnosed with bipolar disorder and whether they should be given powerful psychiatric drugs.

The appeals court called the evidence against the Rileys presented to the grand jury “disturbing and graphic.”

“Michael, who was abusive, preferred his car to the children,” the court said.

The seven-page ruling also outlined evidence that Michael Riley directed his wife to give the children Clonidine, a blood pressure medication sometimes prescribed for attention deficit hyperactivity disorder, “to quiet them down and make them ‘pass out”‘

“Whenever they began to annoy him, he told Carolyn to shut them up with Clonidine — telling her to ‘give them their pills’ and ‘give them their meds’,” the appeals court wrote.

The defense maintains that Rebecca died of pneumonia.

Carolyn Riley’s lawyer, Michael Bourbeau, said he was disappointed with the appeals court decision, but will not appeal the ruling to the state’s highest court.

Yeah. Good idea.

Read the Boston.com story here.

But whatever your fears, there may be some good news: Some non-addictive, non SSRI anticonvulsants may be useful in treating GAD — at least according to a new article in Psychiatric Times.

The rationale for the use of anticonvulsants in anxiety disorders is supported by neurobiological underpinnings that make these compounds a likely alternative for short-term treatment in patients who do not respond to benzodiazepines or who have a contraindication (an addiction disorder, respiratory problems, or who are at risk for falls). However, data are limited, and current criteria for levels of evidence and lines of treatment recommendations suggest strong evidence only for pregabalin in patients with GAD with or without comorbidity (Table 2).

Pregabalin and gabapentin have been shown to be promising in social phobia. Data about gabapentin in panic disorder are somewhat mixed; they suggest a possible role only in patients who are moderately to severely affected. In any case, these compounds must still be considered second- or even third-line treatment.

Further studies are needed on the neu­robiology of anxiety disorders and neuropharmacology of anticonvulsant drugs to develop pharmacological treatment strategies that target symptom patterns and patients’ needs.

The author of the study is Marco Mula, MD, PhD, a research associate and consultant in neurology and neuropsychiatry in the department of clinical and experimental medicine, section of neurology, The Neuro­psy­chi­atry Research Group at the Amedeo Avogadro University in Novara, Italy. At the top of the piece, it says, “Although he received no financial support for the prepa­ration of this article, Dr Mula reports that through the years he has received travel support and speakers fees from various pharmaceutical companies who are involved in the manufacture of antiepilectic drugs, in­cluding Novartis, Pfizer, UCB-Pharma, Janssen-Cilag, and Sanofi-Aventis.” You can decide for yourself if that disqualifies him for offering objective evidence. I take no position one way or the other.

Can Anticonvulsants Help Patients With Anxiety Disorders?

AstraZeneca, maker of the blockbuster anti­psychotic Seroquel, is battling to keep information about the drug out of the public’s view … for the public’s own good.

This month in Orlando, lawyers for the drugmaker will argue that unsealing company documents, including unpublished clinical trial data and letters from the FDA, could harm “a vulnerable patient population.”

“This (disclosure) could jeopardize public safety by causing confusion and alarm in patients, who may then discontinue their medication without seeking the guidance of a medical professional,” lawyers for the drugmaker said in a recent filing in federal court.

This is utter and complete bullshit. AstraZeneca is running scared from revelations that could turn them into another Eli Lilly, so they’re inventing this ridiculous excuse to pretend they’re protecting People Like Us from learning the truth about their meds. To be clear: That’s the premise here—that I’m so mentally unstable that I can’t handle the truth.

So better to keep me in the dark about the dangers of my medication, otherwise I might run out and shoot people or jump off a building or something.

I am outraged by this. The article, by Times staff writer Kris Hundley, breaks it down further and examines all the issues. It also says, “The company said it is aware that the U.S. Attorney’s Office in Philadelphia is investigating Seroquel’s marketing practices, most likely based on whistle blower complaints.” I’ll try to get more information on that if I can.

Seroquel maker wants to seal info from you, “for” you