Antidepressants: No Diagnosis, No Problem

“Forty-three percent of those who had been prescribed antidepressants, had no psychiatric diagnosis or mental health care beyond the prescription of the drug.”

This comes from The Medicated Americans: Antidepressants Prescriptions on the Rise in the February issue of Scientific American.

The statement is mind-boggling. Most of these prescriptions are written by the family doctor for a drug that can have serious, even fatal side effects.

Reasons

I can see four reasons for this.

• Extensive advertising by pharmaceutical companies create such consumer demand that when many people visit their doctor they ask for an antidepressant and the doctor simply complies.
• The insurance companies steer people towards antidepressants because a pill is cheaper and simpler than paying for therapy or encouraging people to live a healthier life style.
• Many people are under tremendous stress.
• Old habits die hard; most people want a magic bullet. Take a pill, no fuss, no muss.

Results

People are taking antidepressants with no valid medical; others are not getting the thorough medical care they need. This results in some people:

• Becoming even more ill because they are receiving only partial treatment;
• Running to their family physician to take a pill for no medical reason instead of dealing with the root cause of a problem or making simple lifestyle changes.

It also results in a huge waste of money.

The pharmaceutical and insurance companies get richer, lots of money is wasted and people get sicker.

Should Your Child Take Prozac? Ask the Grocer

An article in the The Australian highlights the ambivalence of modern societies towards psychotropic drugs. Particularly the use of those drugs to treat children.

Consider the difference between label warnings in Australia and the US.

• United States – “On the packet of one leading brand, the following warning is displayed in bold type: ‘Anti-depressants increase the risk of suicidal thinking and behaviour (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders.’”
• Australia – “They all say SSRIs are not recommended for use in children and adolescents for depression, but few reveal the increased risk of thoughts of suicide or self-harm in this group.”

The piece exposes a policy contradiction within the governments of both countries.

Although some drug labels in the US warn of suicide in children while Australia uses a “dis-recommendation”, government funded health insurance programs help people buy these drugs.

A quote from the paper attempts to explain the Australian government’s contradiction.

• “The health department said the decision to pay rebates but withhold marketing approval for the use of SSRIs in children for treatment of depression was a “sensible balance” between the risk of inappropriate prescription and the risk of leaving the illness untreated.”

We are talking about children here. Both governments are passing the buck.

As Australia’s Pharmaceutical Benefits Advisory Committee puts it “These treating doctors will, of course, have to carefully consider the options, risks and benefits of prescribing these medicines.”

Here in the US, Food Drug Administration makes its non-decision about the safety of antidepressants based on information provided by the drug companies; and with a child’s life in the balance, lets the psychiatrist roll the dice.

This is like saying “There’s a tomato salmonella outbreak across the country but we’ll let your grocer decide whether or not the tomatoes you buy are safe.”

Our Conversation with Author Sonja Lyubomirsky: On Happiness and Depression

First, I would like to thank Sonja for talking with us. Before we get started, I would like to give our readers some background.

Our guest is Sonja Lyubomirsky a professor of psychology at University of California, Riverside; she’s written a best selling book The How of Happiness A Scientific Approach To Getting The Life You Want. She also has a blog by the same name at “Psychology Today”.

Sonja received her B.A. from Harvard University and her Ph.D. in social psychology from Stanford University. Her research has won her honors such as the 2002 Templeton Positive Psychology Prize and a multiyear grant from the National Institute of Mental Health.

There has a lot of great work being done in the fields of psychology and neuroscience which demonstrate that positive feelings, thoughts and experiences can help with depression and these things can help to bring about positive physiological changes in the brain (See OCD Patients Rewire Their Brains)

The purpose of our talk today is to discuss how the work she’s doing might help people who have problems with depression. So lets get started.

Q: Would you give us an overview of your book The How of Happiness?

Sonja: Yes, the book is basically about the way that people can become happier. All of it is based on scientific research.

My book highlights 12 proven happiness strategies that people can use to improve their sense of wellbeing such as expressing gratitude; avoiding over-thinking and social comparison; and taking care of your body. There are sets of activities you can do to implement each strategy.

One of the unique things about the book is that the reader can take a personality-activity fit test to determine what strategies are right for them so that they can tailor their own program.

Q: Are there strategies that are more effective than others for people with depression?

Sonja: It’s likely that some are more effective but there hasn’t been enough research

For one person, cultivating optimism and gratitude might be good ones and performing acts of kindness may not. It would be difficult for a person to focus on acts of kindness if they are unable to leave the house.

The best strategies for an individual are based on their circumstances, needs and goals.

Q: The How of Happiness talks about the trauma challenge. What does this mean for people struggling with depression?

Sonja: Sometimes when people have a traumatic experience such as sexual abuse or the death of a loved one or some other loss, they become very depressed. Their level of functioning declines and they can’t do the things they used to do.

After such a tragedy happens, there are three paths: surviving; recovering back to where you were; or actually thriving.

Perhaps a person whose has suffered trauma can discover strengths and support they never knew they had or develop some positive interpretation about what happened.

It’s important for me say though, that I don’t want the idea of the trauma challenge to set somebody up for failure. No matter where a person is they shouldn’t think badly about themselves by thinking “It’s been awhile since the trauma and I’m supposed to start thriving. What’s the matter with me?”.

Happiness activities can help move a person along what ever the path they are on.

Q: Is there anything particularly promising on the behavioral research horizon for people with depression.

Sonja: We’ve identified lots of strategies and activities that can make people happier. The research focus now is on trying to really understand how and why they work. This will help us to better tailor programs to each person.

Q: Thanks for talking with us today.

Sonja: Happy to do it. You’re welcome.

How to Avoid a Stroke? Don’t Get Depressed

If you are elderly and depressed, you have a 3 times greater chance of having a stroke.

A Swedish study tracked a group of depressed 85 year-olds including some who had dementia over a 3 year period; and found that the chances of them having their first stroke were triple that of people who weren’t depressed.

The researchers also found an association between high blood pressure and first stroke. However “analysis …of depression revealed that depressed mood was the only predictor of first-time stroke.”

Once again, these results demonstrate how devastating depression can be to your overall health; and the urgency with which this chronic and sometimes progress illness needs to be addressed.

For more see Depression One of the Planet’s Most Devastating Diseases.

The Happiness Curve Allows You to Feel 20 Again

If your a man around 40 or a women about 50 and in the doldrums, cheer up happiness may be right around the corner.

A study of nations around the world has identified that after men and women pass their special age they become happier. Once happiness turns up it keeps on going.

In fact happiness is “U” shaped, you start out in happy and vigorous in your 20’s and then buffeted by experience it starts downhill. Finally the sense of wellbeing or lack of it levels off and then starts back again only to continue through your later years. Two scientists in the article explores some theories about why this phenomena takes place.

Mental Illness: The Courts, Doctor’s Office and Coffee Shop

A June ruling by the Supreme Court is the latest example of our institutions wrestling with the mentally ill’s place in society. Different perceptions about what is right are sometimes based along political and philosophical lines but on the street it’s a different story.

Both the Supreme Court and psychiatric community are struggling with the competence of the severely mentally ill to make their own choices.

The issues at the center of the conflict are the:

• individual rights of the severely mentally ill to make their own choices
• government’s right to protect its citizens
• obligations of health care to serve their patients.

In a split decision, the Supreme ruled that a severely mentally ill person may be competent enough to stand trial with the aid of a lawyer but not competent enough to defend himself.

Majority votes were cast by liberal and moderate judges while dissenting votes were cased by conservative jurists.

This issue is discussed by Dr Peter Kramer on his blog “In Practice”; the title of the post is Degrees of Competence: Do Liberals and Conservative Understand Mental Illness Differently?

The liberal majority indicated that they felt a judge could finely grade the competence of a severely mental ill person; and their ability to participate in their own defense. The underlying assumption is that participating in the trial with the aid of a lawyer is less demanding than defending one’s self.

On the other hand, the dissenting votes of conservative Court members seemed to give the absolute concepts of autonomy, liberty and individual rights greater standing. In the case before him, Judge Scalia also cited the coherence presented by the man who was on trial.

Some people who are psychotic can be artful about how they communicate but yet be suffering from severe delusion. Perhaps Judge Scalia was more worried about the protection of the public at large or the courts being co-opted to send people to the gulag than the nuances of justice for the mentally ill.

The psychiatric community also struggles with the patient’s ability to act in his own self interest.

Does it take less competence on the part of a psychotic patient to accept a doctor’s recommendation than to refuse it. Some ethicists says “yes”. Refusing a doctor’s recommendation is a more complex decision because it would require evaluating other options.

A more specific example of this dilemma is whether or not the government can force a person to take their medications

In some states if the People determine that the person is a danger to himself or others, they entitled to force them to take their meds. As a practical matter states don’t have the resources to monitor compliance.

IMO, judges should exercise the ability to understand the level of competence of a person with severe mental illness so they can participate in their own trial to the maximum extent possible; and states should be able to force a patient to take medication for the protection of the public and patient.

As for the competence of a severely ill person to make his own health decisions, the person has every right to make choices as long as he is not dangerous.

In these extreme circumstances, society’s burden to respect the rights of the mentally ill falls upon the psychiatrist and the judge. As for the every life, affirmation and respect for people with mental illness severe or not, can lift the rest of us whether at work, a sporting event, or the neighborhood coffee shop.

Psychotropic Drugs and Children, Buyer Beware

When Ana Bailey was diagnosed with anxeroia at the age of 12, her psychiatrist prescribed an antipsychotic medication which had weight gain as a side effort. Three years later, Risperdal a drug used to treat schizophrenia, has caused another side effect; dystonia, a painful nerve condition in Ana’s back which requires her to awkwardly twist her neck for relief.

Risperdal is not approved for the treatment of eating disorders.

A doctor can prescribe any drug for any condition. This practice is called using a drug “off-label”. The Federal Drug Administration takes a lassiez faire approach; the regulatory agency neither approves nor promotes “off label” use.

The government requires a pharmaceutical company to get approval for the drug’s initial purpose but after that its buyer beware. Drug companies seldom seek approval of a drug’s new “off label” use because of the time and expense.

So a psychiatrist can prescribe a drug for a child even though it’s only approved for adults.

The post Harvard Professors Flunk Appearance of Propriety documents the pervasive influence of drug company money upon the psychiatric promotion and prescription practices. In the end, corporate marketing influences the type of care a patient receives.

Nevertheless, the profession maintains that it’s independent even though they accept payments from drug companies. When questioned about the appearance of impropriety, psychiatrist Dr Susan Albrecht offered this tone deaf response to the NYT “If someone takes the point of view that your doctor can be bought, why would you go to an E.R. with a sick child and say ‘Can you help me.’”

Because your desperate and there’s no alternative?

Dr. Sharfstein, past president of the American Psychiatric Association, comments in the same article about how patent-protected expensive Lexapro is the top selling antidepressant in the country over the generic Prozac,

“Prozac is just as good if not better, and yet we are migrating to the expensive drugs instead of the generics. I think it’s the marketing.”

Marketing by pharmaceuticals and psychiatrists also seems to have had a huge influence on the increased diagnosis of bipolar disorder in children and the rise of “off-label” prescriptions of antipsychotics and antidepressants to them.

The number of kids diagnosed with bipolar has increased 40 times in a 9 year period and evidence is scarce that the antipsychotics and antidepressants even work.

The story of Ana’s anxeroia, lexapro over prozac and the treatment of children for bipolar are like canaries in a coal mine; all suggest that something is terribly wrong with the drug companies, academics, researchers and psychiatrists that makeup the pharama medical complex.

If Ana’s mother can’t trust her daughter’s doctor for the full story, she is forced to do a lot of homework and make decisions about a complex topic for which she has neither the training nor the experience. There has to be a better way.

So You Think You Know What Will Make You Happy

According to Daniel Gilbert who wrote Stumbling on Happiness, our imaginations can be very misleading when it comes to predicting what will make us happy.

There are 3 mistakes we often make when we are contemplating our future.

Error 1. What Is Will Be.

For instance being depressed and unable to conceive of anything that would bring you happiness.

Error 2. Tricked By the Good Old Days

When our recollection of something in the past is incomplete, we let our imagination fill in the blanks. If we make a choice for the future based on a more imagined than real memory, we may be setting ourselves up for disappointment or avoid examining a better option.

Error 3. Imagination Runs Wild

After about a year lottery winners are no happier than the average person. ”Nough said.

Here are 3 tips to help you decide what will really make you happy.

Tip 1. When Intuition Tells You to Trust Your Gut, Don’t.

Test your gut feelings by getting a second opinion from somebody who knows you. “I see myself moving to the Maine coast in a couple of years. What do you think?” Ask yourself why did I come with this now?

Tip 2. Stop Mulling and Start researching

If you have never been to the Maine coast, vacation there for a week or two before even thinking about moving.

Tip 3. Talk to Somebody Who Has Been There

It’s helpful to talk with somebody who has been there and done that. If you are thinking of switching careers from accounting to driving for NASCAR, interview somebody who has been on the circuit for awhile.

Our imagination has built-in blind spots. Our present circumstances, faulty memory and the excitement of contemplating a future without facts can steer us in the wrong direction. We need to counter our own biases with a dose of reality; by testing your intuition, doing some research and talking with people who’ve been there.

Depressed Women Say Viva Viagra

A study funded by Pzifer, maker of Viagra, indicates that the drug can be used by women to counter the sexual side effects of antidepressants; which for some, causes a lack of libido or the inability to achieve organism.

The number of women who participated in the trial was extremely small and the results of this research contradicts all previous studies.

The study which compared the results for women using Viagra with those who were given a placebo may have been compromised by the fact that the women in the antidepressant group may have known they were taking the drug used for sexual dysfunction.

Dr. Irwin Goldstein, director of sexual medicine at Alvarado Hospital in San Diego, says he already prescribes Viagra to some of his female patients, “[Y]ou think about men and women, there are a lot of similarities.”

Dr. Glenn D. Braunstein, an endocrinologist and chairman of the department of medicine at Cedars-Sinai Medical Center in Los Angeles talked about the research and its impact on sales,

“This is a provocative study, but I would love to see it confirmed in a larger group of women,” he said.

“If I had to predict, use of Viagra will go up,” he said. “A woman might not even ask her gynecologist for it — she might just ask her significant other to give her some.”

It will be interesting to follow this story and see if larger clinical trials confirm the results of this widely published study.

Media Discrimates Against Mentally Ill More Than Blacks

The prime time media uses negative stereotypes to depict mental illness almost 4 times more than it does blacks.

The numbers are from a study, Liz Sayce cites in her book From Psychiatric Patient to Citizen: Overcoming Discrimination and Social Exclusion

The research found that films and tv shows run during prime time depicted the mentally ill characters as villians 73% of the time, blacks 20% of the time and the disabled 12% of the time.

This means the media discriminates against the mentally ill almost 4 times more than blacks and 6 times more than the disabled.

The book also noted a second study published in the The British Journal of Psychiatry found programming for children under 10, showed the mentally ill as “crazy” , out of control and without positive qualities.

No one is suggesting that changes in content be imposed on the media however the studies show that the popular media exploits and perpetuates the stigma of the mental ill.