apparently, ‘picking out’ psych meds is like trying out cereal

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Sometimes while  I watch some mindlessly good television or when I listen to some Rich Eisen podcasts, I take online surveys via those sites that pay you for taking them.  Some of the surveys are rather interesting, and occasionally it’s a way to get to know what products may be in the pipeline for various brands.  The other day, I took a survey that wasn’t about shopping, alcohol or cars; it was about bipolar meds—which I’m happy to answer questions about since I’m familiar with many of them.  So, I began the survey only to realize several things, both about me as a psych patient and about the industry that supplies these medications.

One, it reminded me very early on in the survey that I’ve taken a lot of them (see screen shot 1-sorry about the poor quality of photo). The truth is, while I did not check every single drug they listed on this page, I probably may have taken some of those but just don’t remember them as well.  Also, I’m pretty sure I’ve taken other meds not listed on this page that don’t qualify as bipolar meds per se, but are still mood altering.  It was a horrifying moment to see the glowing list in front of me and having to confront my history. But the fun of this survey had only just started.

A few pages after having to confess my medication history, an interesting question was posed to me (as seen on screen shot 2: this one can be magnified): how likely am I to try the following bipolar meds?  They gave me a short list of the newer p-meds out on the market, and asked me to give my inclination toward them. There was no description of the chemistry of these medications, what class of psychiatric meds they’re in, or really anything else.  Just the names.  Like whether I’d try Quaker Oats brand cereal versus ones by Erewhorn.  While I admit that I had already taken most of them on this list, too, it made me almost cringe in having to wonder what kind of patients those of us with mental illnesses have become.

The survey eventually led to showing of several different commercials and print advertisements, and then asked me stuff like my reaction to the commercial, etc.  And then it asked how likely I am now to ask for that particular drug to my doctor.  It was rather insulting that these companies think I’d be persuaded to ask for a drug because their ads looked pretty.  But furthermore, what is the purpose of having a psychiatrist if we, the patients, just point and ask for these medications, like we’re picking out our favorite easter candy? Well, according to this survey, our doctors really have just been reduced, to put it bluntly, to that of a drug dealer.

From taking this lovely survey, two big conclusions were drawn.  As many people already know, the drug company’s job, while it is to help people through chemistry, is to be a profitable company.  And like any product, they will market them to the public as allowed by law.  But perhaps what’s more important to learn for people taking medications is that the responsibility is largely on us,the customer, to be alert about medications being pitched to us like a new cleaning detergent.  It’s hard to be discerning when we’re so desperate to get through another day or even a minute of agony that comes with mental illness. But we really have no choice but to pay attention to what we’re ‘asking for’ or being given samples of by our doctors.  And we should expect our doctor, the person we paid for in order to get their professional advice, to steer us to make informed decisions when taking new meds.

I wish I had taken a few more screen shots of this survey since it was quite fascinating.  But more than that, it made me worried about the direction that the treatment of mental illness is taking in regard to the approach that tries to make us try medications like we’re choosing our next favorite cereal.

antidepressants lead to more depression?

Patients who use anti-depressants are much more likely to suffer relapses of major depression than those who use no medication at all, according to new research. In an article that is likely to ignite new controversy in the hotly debated field of depression and medication, an evolutionary psychologist concludes that patients who have used anti-depressant medications can be nearly twice as susceptible to future episodes of major depression. (read the story in ScienceDaily)

Below is the abstract for the research which was published in Frontiers in Psychology:

Some evolutionary researchers have argued that current diagnostic criteria for major depressive disorder (MDD) may not accurately distinguish true instances of disorder from a normal, adaptive stress response. According to disorder advocates, neurochemicals like the monoamine neurotransmitters (serotonin, norepinephrine, and dopamine) are dysregulated in major depression. Monoamines are normally under homeostatic control, so the monoamine disorder hypothesis implies a breakdown in homeostatic mechanisms. In contrast, adaptationist hypotheses propose that homeostatic mechanisms are properly functioning in most patients meeting current criteria for MDD. If the homeostatic mechanisms regulating monoamines are functioning properly in these patients, then oppositional tolerance should develop with prolonged antidepressant medication (ADM) therapy. Oppositional tolerance refers to the forces that develop when a homeostatic mechanism has been subject to prolonged pharmacological perturbation that attempt to bring the system back to equilibrium. When pharmacological intervention is discontinued, the oppositional forces cause monoamine levels to overshoot their equilibrium levels. Since depressive symptoms are under monoaminergic control, this overshoot should cause a resurgence of depressive symptoms that is proportional to the perturbational effect of the ADM. We test this prediction by conducting a meta-analysis of ADM discontinuation studies. We find that the risk of relapse after ADM discontinuation is positively associated with the degree to which ADMs enhance serotonin and norepinephrine in prefrontal cortex, after controlling for covariates. The results are consistent with oppositional tolerance, and provide no evidence of malfunction in the monoaminergic regulatory mechanisms in patients meeting current diagnostic criteria for MDD. We discuss the evolutionary and clinical implications of our findings.

Michael C. Neale, Charles O. Gardner, Lisa J. Halberstadt, Susan G. Kornstein, Paul W. Andrews. Blue Again: Perturbational Effects of Antidepressants Suggest Monoaminergic Homeostasis in Major Depression. Frontiers in Psychology, 2011; 2 DOI: 10.3389/fpsyg.2011.00159

#petlove

When I come home, I am greeted each and every time by my cat, Simon (see above). Lately, he’s been sitting on my sweater that’s on the table, but other times, he trots on by to say hello. It’ll be seven years in September since I adopted him as a little kitten from the humane association. In the time that I’ve known him, I haven’t had a suicide attempt. Is it coincidence or has my cat affected my mental health? Journal of Personality and Social Psychology (an online publication by the American Psychological Association) just published a paper titled “Friends with Benefits: On the Positive Consequences of Pet Ownership” which contends that pets indeed are good for our mental health. “Specifically,” said the lead researcher Allen R. McConnell, “pet owners had greater self-esteem, were more physically fit, tended to be less lonely, were more conscientious, were more extraverted, tended to be less fearful and tended to be less preoccupied than non-owners.”

Below is their abstract:

Social support is critical for psychological and physical well-being, reflecting the centrality of belongingness in our lives. Human interactions often provide people with considerable social support, but can pets also fulfill one’s social needs? Although there is correlational evidence that pets may help individuals facing significant life stressors, little is known about the well-being benefits of pets for everyday people. Study 1 found in a community sample that pet owners fared better on several well-being (e.g., greater self-esteem, more exercise) and individual-difference (e.g., greater conscientiousness, less fearful attachment) measures. Study 2 assessed a different community sample and found that owners enjoyed better well-being when their pets fulfilled social needs better, and the support that pets provided complemented rather than competed with human sources. Finally, Study 3 brought pet owners into the laboratory and experimentally demonstrated the ability of pets to stave off negativity caused by social rejection. In summary, pets can serve as important sources of social support, providing many positive psychological and physical benefits for their owners.

This research is a pretty big deal considering that most previous research into the benefits of pets has looked only at the relationship between two variables, but didn’t show any real correlations. In addition to the social support provided by the pets, the researchers also found that pet owners were just as close to key people in their lives as to their animals, indicating no evidence that relationships with pets came at the expense of relationships with other people, or that people relied more on pets when their human social support was poorer.

It is a fascinating study, especially since it’s a very quantitative one involving experiments rather than compiling a bunch of anecdotal, qualitative evidence from pet owners.

‘Men’s Health’ guide to less stress

There’s an interesting list in Men’s Health titled “52 Ways to Control and Conquer Stress.” Some of the tips are actually practical. I copied and pasted a few of them below….

Drink More OJ
Researchers at the University of Alabama fed rats 200 milligrams of vitamin C twice a day and found that it nearly stopped the secretion of stress hormones. If it relaxes a rat, why not you? Two 8-ounce glasses of orange juice daily gives you the vitamin C you need.

Put a Green Dot on Your Phone
This is your secret reminder to take one deep breath before you answer a call, says Susan Siegel, of the Program on Integrative Medicine at the University of North Carolina school of medicine. Not only will you feel better, but you’ll sound more confident.

Spend Quality Time with a Canine
Yours or someone else’s. According to research at the State University of New York at Buffalo, being around a pet provides more stress relief than being around a two-legged companion. As if we needed a study to determine that.

Go to Starbucks—with Your Coworkers
Researchers at the University of Bristol in England discovered that when stressed-out men consumed caffeine by themselves, they remained nervous and jittery. But when anxious men caffeine-loaded as part of a group, their feelings of stress subsided.

Shake It Out
When you’re facing that big-money putt, shake out your fingers, relieving the tension in your forearms, hands, and wrists and shifting your focus to the only thing you can control: your preshot routine. You won’t think about making—or missing—the shot, says Alan Goldberg, Ed.D., a sports-psychology consultant in Amherst, Massachusetts.

Listen to Music at Work
And make it the blandest playlist you can create. According to a study at Pennsylvania’s Wilkes University, Muzak lowers your stress levels at work, while also reducing the risk of the common cold. We knew Celine Dion had a purpose.

Shut Up and Smile
Freaking out about a speech? Smile, look at the audience, and keep quiet for 2 seconds, says T.J. Walker, president of Media Training Worldwide. It’ll slow you down and create the impression that you’re relaxed and in control. The audience will then feel more comfortable, leading you to actually be relaxed and in control. Now start talking. Unless you’re a mime. In that case, as you were.

Talk with Your Hands
To keep calm in a job interview, rest your arms on your lap, with your elbows bent slightly, and have your fingers almost touching, says Walker. This will keep your body relaxed, which will keep your tone conversational.

Run Fast
Bike hard. Punch the heavy bag. And we don’t mean your mother-in-law. A University of Missouri at Columbia study found that 33 minutes of high-intensity exercise helps lower stress levels more than working out at a moderate pace. What’s more, the benefits last as long as 90 minutes afterward.

Hit the Sauna After Your Workout
In an Oklahoma State University study, those who combined sauna use with group counseling had greater stress relief, feelings of relaxation, and sense of accomplishment compared with those who only had their heads shrunk.

Remember the Lyrics to Your Favorite Song . . .
. . . name at least 30 states, or assemble the All-Time Band of Guys Named James (the James Gang doesn’t count). In other words, give your mind any all-consuming challenge, as long as it has a definite finish—unending problems cause more stress, says Toby Haslam-Hopwood, Psy.D., a psychologist at the Menninger Clinic in Houston.

Lay The Journey to Wild Divine
It’s a CD-ROM game that works like this: Three biofeedback sensors worn on your fingers sense your stress level and translate it into your ability to perform tasks such as levitating virtual balls or controlling birds in flight. The more you play, the more mastery you gain over your emotions. Go to wilddivine.com for more information. It sells for about $300.

Find a Breathtaking View
Now take a breath—and a good long look. You’ll walk away from the brink with a sense of context and a bigger perspective, which will make the 5,000 things on your to-do list seem less daunting, says Allen Elkin, Ph.D., director of the Stress Management & Counseling Center in New York City.

See the rest here.

Study: City living isn’t easy. And sociologists are hypocrites

SOURCE: C. B. PEDERSEN & P. B. MORTENSEN ARCH. GEN. PSYCHIATRY 58, 1039–1046 (2001

There’s a thought-provoking article on Nature.com about city living and risk of schizophrenia. Schizophrenia is twice as common in those who are city-born and raised as in those from the countryside, and the bigger the city, the higher the risk (see graph above). So there’s a study out that is looking at how city life might increase the risk of mental illness.

According to a group led by Andreas Meyer-Lindenberg of the University of Heidelberg’s Central Institute of Mental Health in Mannheim, Germany, their functional brain imaging showed that specific brain structures in people from the city and the countryside respond differently to social stress.

When Meyer-Lindenberg stimulated the study subjects’ brains through a simple study of telling them they were performing below average while taking an arithmetic test, the amygdala, which processes emotion, was activated only in people currently living in a city. And the cingulate cortex, which helps to regulate the amygdala and processes negative emotions, responded more strongly in those brought up in cities than in those who grew up in towns or rural areas. The initial experiment showed such clear associations that Meyer-Lindenberg didn’t think anyone would believe them. So he did a similar experiment on another 23 subjects, this time adding visual feedback that allowed participants to see the investigators’ frowns. He found the same sturdy associations.

Meyer-Lindenberg wants to expand this study by looking at how other risk factors identified by social scientists — such as being an immigrant — affect stress processing. “We will use tools from social scientists to help us quantify things like perceived discrimination, social support networks, or stigma,” he says. But according to him, his social-science colleagues (e.g. sociologists) aren’t all that interested.

The study is definitely interesting, but what I found most disturbing from this article is the lack of interest from sociologists regarding this study. As a ‘junior sociologist’, it bothers me that the very people who claim to care about inequalities in society don’t necessarily want to find ways to rectify such problems.  Apparently, anything having to do with finding practical solutions isn’t of interest to these social scientists because that would mean that there’s less social problems to bark about. It’s like sociologists don’t really have any inclination to ‘make the world a better place’; they only complain and feign a stance that makes them look feel like they’re better than everyone else. Maybe all they actually care about is getting published in their own journals and patting themselves on the back.

I think this rant can go on and on, but I’m going to take a break from it for now.

sleep tips from the NYTimes

I’ve been trying to get a good night’s sleep this entire week, and I think I’ve turned a corner last night. I used ambien for the first time since that little debacle almost a week ago, but I did sleep through the night and woke up rather refreshed and not nervous. In my pursuit of good sleep, I came across a good article on the New York Times titled “A Good Night’s Sleep Isn’t a Luxury; It’s a Necessity,” by Jane E. Brody. The story’s a good mix of personal experiences and a review of recent studies that emphasizes why sleep is so important.  Accompanying the article was some recommendations for a restful sleep.  Below are the ten ways they listed as alternatives to counting sheep.

1. Establish a regular sleep schedule and try to stick to it, even on weekends.
2. If you nap during the day, limit it to 20 or 30 minutes, preferably early in the afternoon.
3. Avoid alcohol in the evening, as it can disrupt sleep.
4. Don’t eat a big meal just before bedtime, but don’t go to bed hungry, either. Eat a light snack before bed, if needed, preferably one high in carbohydrates.
5. If you use medications that are stimulants, take them in the morning, or ask your doctor if you can switch to a nonstimulating alternative. If you use drugs that cause drowsiness, take them in the evening.
6. Get regular exercise during the day, but avoid vigorous exercise within three hours of bedtime.
7. If pressing thoughts interfere with falling asleep, write them down (keep a pad and pen next to the bed) and try to forget about them until morning.
8. If you are frequently awakened by a need to use the bathroom, cut down on how much you drink late in the day.
9. If you smoke, quit. Among other hazards, nicotine is a stimulant and can cause nightmares.
10. Avoid beverages and foods containing caffeine after 3 p.m. Even decaf versions have some caffeine, which can bother some people.

It’s almost bedtime for me here. I hope I will be able to sleep okay tonight and move closer to getting back to the ‘usual’ self.

Ri-DIRK-ulous

I’m watching the game 6 of the NBA Finals between the Dallas Mavericks and the Miami Heat. It’s been a set of exciting games, with the Mavs leading the Heat 3-2. I’m not usually that much of a NBA watcher, but this series has been a pretty interesting one. Though most critics are speculating on a Heat win, I am rooting for the Mavs. Moreover, I’m rooting for the Mavs’ star player, Dirk Nowitzki. He’s a 7-ft, German guy who really is an amazing player.

Why am I talking about Dirk Nowitzki on this blog? First, I was just inspired by Dirk’s perseverance. In game 4, he was running a 102 degree fever and still managed to score over 20 points, including the game-winning shot. But perhaps more than that is his heart. He lost the NBA finals in 2006, and when I hear him talk about it, it is obvious that it was a crushing blow to him. But what you see in him now is that he is confronting all his demons from several years ago.  I think it’s hard for any of us to lose something we wanted and then regain courage to go at it again, at full or even fuller strength than what we gave last time. We are usually so hurt by such experience that we may never want to even make another run at it. It’s so hard to be brave about something once we’ve been hurt by it once. With Nowitzki, his bravery is in full effect right now.

I get scared to face life since my deep fall into depression, and while I suppose I’m making a slow climb out of it right now through ECT and other treatments, it’s not easy to pull my life up by the bootstraps and act like I really want it— because I am easily reminded about where this could all go again. But watching Dirk and his fight to win it all makes me tell myself that it’s okay to make a run for it, even at the risk of possibly losing. After all, a “life unexamined is not worth living.”

It’s half time, and the Mavs are leading by 2. I’ve got to go back and root for Dirk!

GO MAVS!

Let’s Tweet for Mental Health!

It’s Mental Health America’s Mental Health Month, and they posted some sample twitter messages that could be sent out during May. They suggest that you use the hashtag #mentalhealthmonth. The following are some suggested messages:

• Do More for 1 in 4: It’s Mental Health Month http://bit.ly/PzAka  #mentalhealthmonth

• Embrace wellness-May is Mental Health Month. Go to www.LiveYourLifeWell.org. #mentalhealthmonth

• The vast majority of mental health conditions are treatable–people live productive lives. #mentalhealthmonth

• Do More for 1 in 4: It’s Mental Health Month. Don’t be afraid to ask for help. Go to http://bit.ly/hmWGSW #mentalhealthmonth

• Who’s your 1 in 4?  Support from family, friends, peers essential in recovery. Learn how to help at http://bit.ly/fkiy8J  

Well, since we’re talking about twitter, I figured I should do a little shameless plug here and say: follow me on Twitter while you’re at it: @ECTchronicles  :)

 For those who Facebook, they also posted some sample posts:

• Good mental health is much more than must the absence of illness – it’s about being able to handle life’s challenges and even flourish. Celebrate Mental Health Month with us! Learn more at http://www.mentalhealthamerica.net/go/may.

• Embrace wellness this May is Mental Health Month. Find out more at www.LiveYourLifeWell.org.

• Wellness encompasses the notion of balance in one’s life among the mental, physical, and emotional elements of health. Live Well! It’s Essential for Your Potential! Learn more at www.LiveYourLifeWell.org.

• A vast majority of mental health conditions are treatable, we can–no matter how challenging the mental health obstacle we face–always chart a course back to wellness. Live Well! It’s Essential for Your Potential! Learn more at www.LiveYourLifeWell.org.

• Did you know that 60 million Americans are diagnosed with a mental health condition in any given year, that’s 1in4. Learn more at http://www.mentalhealthamerica.net/go/may.

• Who’s your 1in4? Did you know that support from family, friends, and peers remains an essential element in the recovery process? Learn how to help at http://www.mentalhealthamerica.net/files/Support_1in4.pdf.

Using texting 2 care 4 ur depression

There’s a study that’s been e-published in the Journal of General Internal Medicine that looked at a trial of using text messaging to provide aftercare to mental-health patients. After five months, compared to the half of the patients randomly assigned to receive usual care, the half who had three online care management contacts with a trained psychiatric nurse were significantly more likely to feel less depressed, take their antidepressant medication as prescribed, and be “very satisfied” with their treatment for depression. (Read the entire article on Medical News Today).

I think it makes a lot of sense to use text messaging to keep in contact with patients who really could use any sort of human contact, like a text message. As the lead author mentions in the new article, texting doesn’t have a hassle of having to play phone tag when a call is being placed to the patient.

the resolve of the Japanese people

My friend had texted me asking if my family was okay. I hadn’t checked the news that morning yet, so I immediately turned on the television. I stood frozen. Despite my little knowledge of Japanese geography, I did realize almost immediately that the area that was hit was not close to where my parents live. But I hadn’t heard from them, so I called. The busy signal rang for next several calls I placed. My parents finally got through, what was probably a barrage of calls trying to get through to/from Japan, a few hours later. While they are not anywhere near the epicenter, they still felt the aftershock for minutes.

My parents love the United States, even though they’ve moved back to Japan. And I love America, too. I mean, I grew up most of my life in this country. But yesterday, I saw that my father posted something on his blog about the earthquake. In the words that he used, it was clear how much love he had for Japan, and I realized, too, the love I hold for the land where I hold my citizenship. Here, we use the phrase, “the resolve of the American people” as if it is unique to this country, but my father talked about “the resolve of the Japanese people.” I sensed a feeling of call for solidarity in my father’s words that reminded me of the words I heard after our 9/11. And I thought about how patriotism is not simply an American concept. Japanese people may not be wearing their country’s colors to show their patriotism, but as I sit and watch the news of the faces of my countrymen, I think that their quiet expressions capture their immense resolve.

 

 

The Psycho-meter: is it offensive?

Huffington Post has an article titled “This Week in Crazy,” featuring a “psycho-meter.” What do you think? Is this just funny, or is it offensive?

Mocking others’ mental stability

Mike Huckabee was on a radio show today and decided to respond to some of his critics.  As for a response to MSNBC “Hardball” host Chris Matthews, Huckabee offered this prescription: “Chris, see a doctor. Do it quickly. You’re out of control. You’re off your meds. You absolutely must get help, and do it today.” (See the article and hear the actual interview)

I doubt that people are going to make a big deal (or any deal) about what Huckabee said just because people make this kind of joke all the time, at least I’ve heard others around me make the same type of comments about people they have issues with. But I believe this is the kind of “humor” that’s often tolerated in society that probably should get pointed out by mental health advocates.

I’ve personally liked Mike Huckabee as a person for some time now. In fact, on last night’s “Colbert Report,” he was pretty funny. But I wish he would understand that the “off your meds” comment is really just making fun of people who take psychotropic medication as some kind of deviants. I realize this was just a casual comment, but really, we wouldn’t poke ‘casual’ fun at other types of  illnesses.

news: do the “crazy” dance

This picture really is worth, well, maybe a, “WTF?”

The linked photo is of the varsity dance team from Waunakee High School, in Waunakee, Wisconsin. Their “We Get Crazy” routine features the 18 dancers in straitjacket costumes with the words “Psych Ward” written on the front. (Read the local story)

Apparently, it took until this February for anyone to get a little disturbed over this routine. Even now, there’s only been mostly local media coverage…..except from Rick Chandler, a columnist on “Off the Bench” blog on NBCSports.com. Here’s what Chandler had to say, though not about the dance team routine, but about the (delayed) reaction from “mental health advocates.”

Thought I’d get this out for now. My own comments to come a little later.

 

FDA Panel: More testing needed for ECT Machines

FDA panel advises more testing of ‘shock-therapy’ devices
by David Brown/Washington Post/1.28.2011

An expert panel advising the Food and Drug Administration decided Friday that electroconvulsive therapy (ECT) machines should undergo the same rigorous testing as new medical devices coming onto the market – a decision that could drastically affect the future of psychiatry’s most controversial treatment.

The majority of the 18-member committee said not enough is known about ECT, also known as “electroshock” or simply “shock” therapy, to allow the devices to be used without more research into its usefulness and hazards.

If the agency follows the panel’s advice, which it usually does, the two companies whose machines are used in the United States will have to provide evidence of the therapy’s safety and effectiveness either from existing research or new studies. If the FDA isn’t convinced, the devices could be removed from use.

The panel’s opinion is the latest chapter in ECT’s seven-decade history, during which the treatment has been lauded as a lifesaver, villified as a form of legally sanctioned torture, and has seen its popularity rise in recent years after a long decline.

ECT machines deliver an electrical current to the brain, inducing a generalized seizure in which the patient briefly loses consciousness. How that may be therapeutic or cause permanent memory loss – the side effect most frequently mentioned by patients – isn’t known. Read More

everyday voice of PTSD

Lately, the news focus for post-traumatic stress disorder has been mostly about veterans coming back from the war. But the recent NYTimes article points out that anyone can have PTSD. In “Behind the facade, post-traumatic stress” by Karen Barrow, the story is about a 25-year-old woman named Robin who was sexually assaulted.

Friends didn’t understand why she never wanted to go out. They would play down her anxiety and say, “Oh, you’re just going to laugh at this in a couple days.” It took years of sleepless nights and paralyzing anxiety over tasks as simple as grocery shopping before she began to look for help.

She sought out psychologists, but some dismissed her. “They’d say, ‘What does a pretty girl like you have to worry about?’ ” she said. Others were simply too expensive. Finally, during an initial consultation, a psychologist heard her full story and said the simple phrase that changed everything: “You have P.T.S.D.”

 

A personal note: I hesitate to say that I had PTSD, but I dealt with issues stemming from my first suicide attempt and things related to the incident, e.g. month of the occurrence. What helped me mostly resolve those issues was when my psychiatrist finally decided to refer me to a psychologist to have EMDR done just about a year ago (it’s been seven years since the attempt). Sometimes, an issue needs to be dealt with in a focused manner, even if you are getting treatment in general.