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IT'S ABOUT TIME: L.I. MOM
Tue Mar 23, 5:05 AM ET Add Op/Ed - New York
By DOUGLAS MONTERO

Joanne Schillinger didn't get any warnings about the antidepressant drug prescribed to her then-12-year-old daughter - except that she might gain a few pounds.


It wasn't until her daughter's suicide attempt a year ago that the Long Island mother began blaming the drug Paxil for the girl's violent and irrational behavior.

Yesterday, the 44-year-old mother said the Food and Drug Administration (news - web sites)'s decision to ask the makers of 10 antidepressants to put a stronger warning about suicide on its labels is a little too late.

"I don't know why it took them so long," Schillinger said.

"If I had known [about the risk], I would've never let my daughter take the drug . . . I didn't have a [medical] degree. I took the word of the doctors because they know better."

Weaned off the drug nearly a year ago, Jaime, now 15, is still suffering from flashbacks.

She does not remember mutilating herself with scissors, knives and paper clips, or the tantrums, or the day she jumped out of her father's moving car.

" 'I can't believe I did that,' " Schillinger recalled her daughter saying as memories begin to enter her life.

"We used to walk around on eggshells because we never knew what was going to trigger her."

Every time Schillinger complained about her daughter's behavior the Paxil dose was increased from 10 milligrams to 20, and eventually to 30.

By March 11, 2003, Schillinger wanted Jaime off Paxil but the doctor persuaded her otherwise - and upped the dosage to 40 milligrams.

Sixteen days later, Jaime used black lipstick to write obscenities all over her bedroom wall, swallowed a fistful of Tylenol and slit her wrist, the mother said.

"I should've followed by motherly instinct and taken her off the drug - that's what makes me so mad," said Schillinger, who learned through the Internet that for years many other families across the nation have complained about possible links between antidepressants and their loved ones' suicides.

"The FDA should've made [its] decision years ago."

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I absolutely believe that pharmaceutical therapy works for people who are treated correctly, but Paxil scares me.

Discuss.
 

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Posted by mr_porteiro_head (Member # 4644) on :
 
This kind of stuff pisses me off. This is why I don't like doctors.

But then, I'd probably be a sucky doctor.

I don't have any solutions. This stuff scares the crap out of me.
 

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Posted by skrika03 (Member # 5930) on :
 
Yeah, I had a neighbor who shot his toddler, his infant, and himself. I'm not sure what he was taking, but sometimes it's better for a person to be depressed and ineffectual than depressed and enabled.

I've never taken reuptake inhibitors for precisely this reason.
P.S. I've not heard of folks being unable to remember things they do on the meds, though...

[ March 23, 2004, 07:01 PM: Message edited by: skrika03 ]
 

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Posted by Theca (Member # 1629) on :
 
Articles written like this scare me.

[ March 23, 2004, 07:02 PM: Message edited by: Theca ]
 

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Posted by Starla* (Member # 5835) on :
 
They put my friend on Paxil---it's a long story which invovles me wanted to throw things at the school counselor.

One day in lunch, she turned white (she's of mixed decent, so this was odd) and her veins popped out of her arms like a weightlifter's and she started shaking all over. I thought she was going to have a seizure.

That week, her boyfriend made her stop taking it because a woman in central Jersey who was taking it tried to kill her husband and herself.

I hate stuff like that. It does more harm than good.
 

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Posted by skrika03 (Member # 5930) on :
 
I think the main problem is the idea that drugs are a less expensive alternative to therapy. Folks should be closely monitored by a professional while they are tapering up on psych meds and periodically monitored while they are on it.

Trouble is, right now you can get a prescription from your General Practicioner (sp?) and never see anyone with mental health experience.

And I really think it's wrong for kids to be put on it at school without parental informed consent. I don't know how common that is, but I am definitely against it.

I think both of these scenarios are made worse by social bias against the mentally ill.
 

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Posted by Raia (Member # 4700) on :
 
This type of thing really really saddens me. That's awful.
 

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Posted by mackillian (Member # 586) on :
 

 

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Posted by Pixie (Member # 4043) on :
 
Drugs are scary even in environments under the control of medical professionals.

When I was about 9 I broke my right arm rollerblading on a hill after a particularly nasty winter (lots of gravel and sand does NOT mix well with wheels). It had to be set 4 times since they botched it up so much at first but anyway...

About the third time I went in, they couldn't give me any more anesthesia or I would have died so, instead, they put me on a hallucinogen. I had to be watched by two whole teams of both doctors and nurses - one in the room and the other watching outside on monitors. I'll tell you one thing, those things are scary. Yeah, you get the nice hallucinations but the scary or bad ones are REALLY bad. And they don't make any sense either. For instance, when I came out my mum asked me why the poptarts were so scary. It turns out I'd screamed out the word "poptarts!!!" in absolute terror. Why were they frightening? I don't know and THAT is a scary thought.

Anyway, my point is that drugs are NEVER cool, whether perscribed or not. I told my mum right afterwards that I would NEVER take drugs and I've kept my word - once was frightening enough: as in, imagine being utterly helpless with no distinction between reality and the hallucinations whatsoever.

...I know this is a bit of a derailing so I hope you'll pardon that. Just wanted to share.
 

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Posted by Valentine014 (Member # 5981) on :
 
OH CT (and other Hatrack docs)! Please tell these people that not all SSRIs are evil!! These drugs have helped so many people, including myself. Yes, I had to go through a few, but I finally found one that helped me through some very tough times in my life.

That article, and many more just like it, are going to scare sooooo many people away, people that maybe could've been helped by them.
 

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Posted by mackillian (Member # 586) on :
 
I know. But I just don't know how to explain it so that people will hear what I have to say. Hence banging my head against the wall.
 

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Posted by Valentine014 (Member # 5981) on :
 
I figured that was why you were doing that. Maybe we should try and find some articles from a couple of journals for them.
 

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Posted by mackillian (Member # 586) on :
 
I've tried that many times--it goes ignored. Sensationalized reports and hearsay seem to have more effect.



I mean, I study this stuff. Brain chemistry and such.

People who doubt or discount these medications...do they really look to see how they work? Percentages of side effects? Patient rights? Patient advocacy? Checking other articles and resources that advocate for patients, such as the National Alliance for the Mentally Ill?
 

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Posted by jexx (Member # 3450) on :
 
I apologize for posting this without giving more of my opinion on the article. I should have realized that it would make persons who need Paxil (and other pharmaceuticals) and professionals who prescribe them have to explain that not all drugs are bad. It wasn't really my intention to do this, but rather to induce a dialogue about misprescribed/overly prescribed drugs and their effects. Especially if the follow up care misses signs of ineffectiveness/bad side effects.

So I officially apologize to mack, Theca and CT; and to the others who might be adversely effected by this article. But I'm not going to stop this discussion.

One thing I did want to discuss about this article, that is fairly tangential, is the bias inherent in reporting. Granted, this is The New York Post we're talking here, but it is clear that the drug is being demonized. There's no quote from the doctor or the medical establishment, either.

And I'm thinking about the use of drugs with juveniles, too. There've been some news stories about the uncertainty of dosage for youths and the different chemical make-up they have.

All my thoughts are unravelling. I'm grumpy and tired tonight. Maybe someone else will be able to address these incoherent issues for me.

Blah.
 

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Posted by ClaudiaTherese (Member # 923) on :
 
jexx, no, I think it's a good question to raise.

Unfortunately, the sensationalist bias of many such stories leaves out the more accurate assessment of the numbers.

A very small number may have bad side effects (and even then, whether these are attributable to the medication is a big question, because you don't really have a control group of non-mood-disordered persons to compare to). But there can be a vastly greater group of people who are enormously helped. The ratio of these groups is very important.

It's like anti-seizure medications, all of which have causing seizures as a known potential side effect. Weird, huh? And if you just listened to one bad account, you may not have an accurate and helpful picture of whether to use these medications for your child. But thorough and accurate information helps make sense of this apparent paradox of "why would these evil doctors give my child with epilepsy a medicine that could make him seize more? Arrrrgh!"

I should write more, but I am currently watching the expanding scotoma of an oncoming migraine. (I'm not saying it was triggered by seeing mack's head banging against a wall, but I'm not ruling it out, either. ) My trusty Imitrex awaits. By the way, the known side effects of this medication includes headache. Oddly enough, for me and millions of other people, this is not a problem.

[PS: But there have been important other topics raised here, too: informed consent, overmedication of kids, reliance solely on medication without appropriate non-pharmaceutical therapy, and the like, are all well worth discussing. So is the main issue, but I'm out for now. I loves me Imitrex. ]
 

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Posted by Valentine014 (Member # 5981) on :
 
Re: Anti-seizure meds

Correct me if I'm wrong, but didn't Abbott's Depakote get a black box warning on it due to a patient death. If I remember right, a trial subject died in a car accident while he was on the drug and because of that fact, it had to be listed in the PDR as a possible "side effect".

Edit: At least I think that was what the rep told me...

[ March 23, 2004, 10:00 PM: Message edited by: Valentine014 ]
 

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Posted by mackillian (Member # 586) on :
 
The hard part about dosing for the pediatric population is how fast they are growing and developing. Neurons and neurotransmitters are continuously being refined and organized up through adolescence. In fact, the most major mental illnesses (schizophrenia and bipolar disorder) form in early adulthood--after this biochemical organization is finished.

But...kids can become depressed. Drug therapy alone IS effective--as is talk therapy alone. However, the greatest effective treatment is both together.

Any psychiatric medication must be administered with care.

Different medications work in different ways.

SSRIs: Selective Serotonin Reuptake Inhibitors (zoloft, paxil, prozac, celexa, lexapro) create higher levels of serotonin in the body by inhibiting the reuptake of serotonin into the synapse.

Serotonin is formed by the neuron and sent out across the synapse into a receptor, where it transmits its information. It's released by the receptor and then taken back up into the neuron. SSRIs inhibit this action--so the serotonin stays in the synapse longer and can create better functioning (if the level was low).

But serotonin isn't the only neurotransmitter. There's dopamine, ephinephrine, norepinephrine...and many, many others.

Atypical antipsychotics (risperdal, geodon, abilify, seroquel, zyprexa) work in many different ways. Many act as agonists or antagonists for neurotransmitter receptors, either creating more of less available neurotransmitters. But that's a very simplified explanation.

See, the thing is..while these medications DO act on receptors and synapses and such on a selective level...they also have low or high levels of affectation on OTHER receptors--which is what causes side effects.

Which sucks.

But, there's a cost of living analysis. Is it better to suffer with the illness? Or suffer the side effects of the medication?

Tough call.

But in treatment of mental illnesses, it's a responsibility to treat the biochemical aspect as well as the behavioral cognitive aspect.
 

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Posted by Valentine014 (Member # 5981) on :
 
MSN Health

quote:

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But the FDA stopped short of recommending people discontinue taking their antidepressants.

"We specifically decided not to tell people not to use these drugs," said Katz. "We don't think that is necessary at this point."

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Hear that? I know what some of you might be thinking: DO NOT stop taking your meds without first discussing it with your doctor!
 

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Posted by jexx (Member # 3450) on :
 
Yes, this is exactly what I wanted to know (mack)! And a little of what I was trying to say, as far as the growth of brainy bits in younger persons. Thank you, mack.

It's incredibly complicated, drug therapy. But important, I realize that. And I can't imagine that drug therapy alone can be very effective, unless the patient is regularly (like monthly) seeing a doctor to keep tabs on the meds. Wouldn't that constitute *some* kind of therapy, anyway? Hurumph. I need to read more about this.

CT, I hope the Imitrex works like a dream (so to speak) for you. I have several friends with migraine problems, and Imitrex works for a couple of them, and one takes Midrin with good result. Thank goodness for pharmaceuticals, yes. Thank you for making me feel less guilty about posting this article, and for bringing up more questions to ponder.
 

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Posted by mackillian (Member # 586) on :
 
Going off meds straight cold can do a serious amount of harm.
 

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Posted by Tiger Eye (Member # 6353) on :
 
there was an article somewhere a while ago, that listed ten drugs for treating anti depressants that were being perscribed legally to children in the US. only one of those ten is allowed to be given to children in the UK.

[ March 23, 2004, 10:13 PM: Message edited by: Tiger Eye ]
 

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Posted by jexx (Member # 3450) on :
 
Oh, I would nevernevernevernever want to imply that I recommend persons get off of their meds without a physician's help or recommendation.

I just want to make that clear.

Sorry if I gave that impression.
 

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Posted by rivka (Member # 4859) on :
 

quote:

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This kind of stuff pisses me off. This is why I don't like doctors.

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quote:

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I'm not sure what he was taking, but sometimes it's better for a person to be depressed and ineffectual than depressed and enabled.

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quote:

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I hate stuff like that. It does more harm than good.

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Blatantly false. These medications SAVE LIVES. And even more often, make life worth living.



Repeat after me: The plural of anecdote is NOT data! Do some people have bad side effects? Yes, sometimes very bad. Should there be warnings about them, and should doctors and patients be on the lookout. Definitely.

Are these side effects common? No. Should they stop people who need these drugs from taking them? Not in my opinion!

quote:

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I think the main problem is the idea that drugs are a less expensive alternative to therapy. Folks should be closely monitored by a professional while they are tapering up on psych meds and periodically monitored while they are on it.

Trouble is, right now you can get a prescription from your General Practitioner and never see anyone with mental health experience.

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quote:

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And I really think it's wrong for kids to be put on it at school without parental informed consent. I don't know how common that is, but I am definitely against it.

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Is that legal??




I have never (yet, anyway) been on SSRIs. However, I have been on narcotics (post appendectomy and while in labor). While I cannot understand the appeal of taking them for non-medical reasons -- I really didn't like not making sense and the wooziness -- they sure as heck beat post-surgical pain!
 

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Posted by Valentine014 (Member # 5981) on :
 
Tiger Eye: This one?

Jexx: Not at all! I just am trying to make sure that everyone knows
 

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Posted by mackillian (Member # 586) on :
 
Hell. I'm the poster child for tried/failed meds.

Celexa: no effect
Depakote: malaise, constant hunger
Zyprexa: slept for 32 hours straight
Topamax: malaise, severe loss of appetite
Trileptal: dizziness, headache, loss of coordination
Seroquel: slept for 20 hours straight
Risperdal: slept for 16 hours straight
Geodone: slept for 14 hours straight
Lithium: severe nausea, malaise
Abilify: fainting, heart palpitation

...this was over the course of about a year and a half.

Successes:

Lamictal: completely alleviated atypical major depressive episodes. have not had one since starting it last June. side effects--severe headache for the first month. worth it now? absolutely.

Lexapro: alleviated abdominal pain. side effect--headache for first week. worth it? yes. no pain.

Ritalin LA: controls symptoms of ADHD and allows me to focus, relax, concentrate. side effects--appetite supression, tiredness when dose runs out. worth it? absoeffinglutely.

Better living through chemistry.
 

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Posted by mackillian (Member # 586) on :
 

quote:

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I'm not sure what he was taking, but sometimes it's better for a person to be depressed and ineffectual than depressed and enabled.

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Well, in mental health, that IS a concern, but in a different way.

When a person is SO deeply depressed that they have no energy or will to do anything, they're fairly safe, because they just won't DO it..they'll just contemplate it.

The most dangerous part of recovering from depression is that lift from listless, deep depression to the active irritable depression. That's where action can occur from a mind not in its right place.

But to not treat because of this possibility is unethical. But you have to be well educated and well versed and MONITORING it.
 

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Posted by Valentine014 (Member # 5981) on :
 
Wow, mack, that is quite a list. Some heavy duty ones there.

Diagnosis #1: Depression

1. Paxil: nothing. Did NOTHING!
2. Zoloft: Sex? What's that?
3. Celexa: first 20, 40, then, yes, 60mg. Serious side effect: my short term memory is GONE. It is really sad, actually, I can barely remember the details of yesterday...(I'm serious)

Diagnosis #2: Anxiety

1. Risperdal: Sleepy time
2. Paxil XR: (gimme a break)
3. Effexor XR: 37.5, 75, 150mg....getting closer

Diagnosis #3: Sleep Disorder

1. Seroquel: DEAR GOD! WTF are you trying to do to me!!
2. Sonata: Nada
3. Ambien 10-20mg: Works like a dream....
 

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Posted by mackillian (Member # 586) on :
 

quote:

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Zoloft: Sex? What's that?

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Val, if you're on 60mg of celexa with side effects, have you talked to your prescriber about switching to lexapro? It's a more potent form of the active ingredient of celexa, so has less side effects and you take less OF it.

quote:

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Seroquel: DEAR GOD! WTF are you trying to do to me!!

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Posted by pH (Member # 1350) on :
 
About people forgetting things they do while on pills: I don't remember most of high school.

But I don't think they're all bad. I think they're overused, but honestly...they have helped me a lot, when I haven't been able to handle things on my own. I think they need to be studied more carefully, though.

EDIT: Lexapro?! I remember that stuff. I took it last year; I spent most of the week curled up in bed wishing for death from the sheer physical discomfort of it.

[ March 23, 2004, 10:40 PM: Message edited by: pH ]
 

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Posted by Valentine014 (Member # 5981) on :
 
You know what, mack, come to think of it, I probably tried Lexapro too. See, it's kind of hard to REMEMBER!
 

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Posted by mackillian (Member # 586) on :
 
Lexapro came AFTER celexa though...
 

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Posted by Valentine014 (Member # 5981) on :
 
No one made the connection between my memory loss and Celexa until much later...so, yes, I do realize Lexapro just came out not that long ago.
 

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Posted by mackillian (Member # 586) on :
 
Bleah. That sucks.
 

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Posted by karen.elizabeth (Member # 6345) on :
 
I wasn't allowed to be on Ritalin due to drug abuse and alcoholism in my family (almost everysinglepersoni'mrelatedto). I'm on Stratterra right now, and it's AMAZING.

I'm on the beginning dose (or...whatever it's called), so I'm only on 25mg, but I'm supposed to have it upped within the next couple of days. It's so wonderful being able to lay down and not have to wait three or four hours for my mind to unwind; to sit and now start shaking because I need to MOVE ... so much more. I can recognized and stop being obnoxious when it happens ... well, most of the time; sometimes, I can only recognize, and I get this insane feel that "Hey, I should stop!" but I can't.

Stratterra has done so much for my family. My brother Christopher, just now 16, who lives with my mother, is on it, and he's doing so much better than he's ever done before. He now reminds my mother to refill his prescription! This is the child that smoked pot on a school bus when he KNEW that there was a video camera on it! His teachers say that there has been a huge improvement.

Tony, 9, is on 50mg, and he's doing so well in school! He was never the problem child that Chris was, but he's even better now. His reading level has gone up from sixth grade to seventh in just a few months. This from a fourth grader! I'm so pleased for him.

So, yes, I luff Stratterra.
 

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Posted by jexx (Member # 3450) on :
 
I can definitely see a difference in mack (and anyone who has had a passing acquaintanceship with her can, too, I bet) once she and her doctor figured out which med was most effective.

When I first 'met' mack online, I was often afraid to sign off of AIM with her because she was ideating (imagining suicide), sometimes actively (planning suicide). Once, I called her so she could hear the sound of someone's voice.
What scared me most about this was primarily my ignorance. Secondly, mack knew exactly what the terms were for her suicidal thoughts, and why suicide was wrong (technically), and could explain to me what was going on, but felt powerless to stop it. That was/is totally alien to me.
Through different drug therapies and whaddyacallit "talk" therapies, mack gradually made it out of her fog. When she visited me this past weekend, I was astounded by how fully *alive* she is now.

So yes, there IS better living through chemistry. Of course. I just hope that there are people working on how to do effective drug trials and development and yaddayadda.

Also: I have never heard of drugs being administered in schools (by school nurses, presumably) without parental consent. Would anyone have a link?
 

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Posted by pH (Member # 1350) on :
 
I've been thinking about trying adderall....apparently, in some rare cases, it'll fix ocd right up. And SSRI-type medications definitely do not agree with me, as evidenced by my happy Lexapro time, among other adventures.
 

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Posted by Valentine014 (Member # 5981) on :
 
I have been hearing such wonderful things about Strattera. People have been raving about it. Sure is nice to not have to have a written script for every time to the pharmacy too, like it is for Ritalin, Adderall, and Concerta.
 

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Posted by Eljin (Member # 6354) on :
 
I have very little knowledge of this subject, so feel free to laugh at me.

I feel that everyone wants the "quick fix", so they come up with these personality disorders, then prescribe behavior changing drugs. Now, in extreme cases, this could definitely be the right course. However, I believe that way too often, someone says "I have a problem, someone else should make it go away." Taking these medications seems very similar to drinking or taking narcotics in order to get rid of problems, which really doesn't work. I also thought it was hilarious when I saw an ad for one of these drugs that claims "people can finally get to know the real you." Well that's just wonderful, but if you're hopped up on behavior changing drugs, then how are they getting to know the real you?
 

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Posted by mackillian (Member # 586) on :
 
Okay...ADHD is the result of dopamine and norepinephrine imbalances.

Ritalin works on just dopamine receptors.

Concerta and Adderall work on both dopamine and norepinephrine receptors.

Strattera works on just norepinephrine receptors.

Neuropsychology is very interesting.
 

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Posted by pH (Member # 1350) on :
 
What do you think? Adderall or Strattera? I mean, have they even _tried_ Strattera on ocd?
 

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Posted by jexx (Member # 3450) on :
 
Okay, Eljin, think of it this way: if you had a vitamin deficiency, you would change your diet. If you had diabetes (a deficit of insulin, right? A naturally occurring element in your body) you would take insulin shots. Similar thing.
 

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Posted by rivka (Member # 4859) on :
 
Eljin, except you're missing one rather important fact. These drugs work by fixing something that is wrong. Would you tell someone who had an infected appendix not to have surgery, because that would not be the "real them"?

Being on psychoactive drugs is NOT like being on narcotics or alcohol -- they don't mask the problem. They adjust the brain chemistry back to normal.
 

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Posted by Valentine014 (Member # 5981) on :
 
According to the website for Strattera, trials have only been done on Child and Adult ADHD. But that doesn't mean a doctor can't prescribe it for you for that diagnosis if they think it is right for you.

[ March 23, 2004, 11:12 PM: Message edited by: Valentine014 ]
 

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Posted by Shigosei (Member # 3831) on :
 
I think that the real me was finally allowed to emerge when I started taking antidepressants. I have days where I'm still pretty down, so I doubt my mood is being artificially elevated.

I am taking drugs to get rid of my problem, yes. The problem being a neurochemical imbalance which I can't fix on my own.

Anyhow, welcome to Hatrack, Eljin!
 

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Posted by mackillian (Member # 586) on :
 

quote:

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I feel that everyone wants the "quick fix", so they come up with these personality disorders, then prescribe behavior changing drugs

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quote:

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someone says "I have a problem, someone else should make it go away

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quote:

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Taking these medications seems very similar to drinking or taking narcotics in order to get rid of problems, which really doesn't work.

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*scratches head*

I'm just going to have to disagree with that. Yup.

I'm not even sure how to address that.

And yeah. If the real you is suffering from a mental illness and all your friends see are SYMPTOMS...they aren't seeing the real you. A person is NOT their illness.
 

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Posted by ClaudiaTherese (Member # 923) on :
 
Welcome, Eljin.

quote:

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I feel that everyone wants the "quick fix", so they come up with these personality disorders, then prescribe behavior changing drugs.

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quote:

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Well that's just wonderful, but if you're hopped up on behavior changing drugs, then how are they getting to know the real you?

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This reflects a bias that is behind much mental-illness discrimination and also pharmaceutical non-compliance. As soon as some folks start feeling good they want to stop taking their meds. They think they aren't authentic if they have to take a pill. Strangely folks don't feel this way about nitro-glycerin or viagra.

Then there's exercise\ . Of course no one should try to replace meds with exercise on their own.
 

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Posted by mackillian (Member # 586) on :
 
...and ended up in a bathroom with their kidneys missing
 

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Posted by Valentine014 (Member # 5981) on :
 
Well, except for Canada, Toretha.
 

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Posted by Bob the Lawyer (Member # 3278) on :
 
"According to the website for Strattera, trials have only been done on Child and Adult ADHD. But that doesn't mean a doctor can't prescribe it for you for that diagnosis if they think it is right for you."

While it's late and I don't desperately want to get into this, you have know idea how annoying this is from the perspective of big pharma. You know that what you're designing the drug to do isn't necessarily how it will be used. Doctors aren't pharmacists, sometimes I think they forget that.
 

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Posted by mackillian (Member # 586) on :
 
Exercise is wonderful for mental health

As well as a good diet and good sleep.
 

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Posted by rivka (Member # 4859) on :
 
mack, that happened to you, too?!
 

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Posted by mackillian (Member # 586) on :
 
mmm. using strattera like that would bug me...but I haven't even looked at the biochemistry of how typical OCD medications help and how strattera differs.

But to test it--you need to do controlled clinical trials.

But some medications for mood stabilizers ARE used off-label.

Lamictal was just approved last July for use as a mood stabilizer in bipolar disorders--and I'd started taking it in June.

This is most common with anti-seizure meds. Depakote is one that is approved as well.

But the others...trileptal, tegretol, topamax, gabitril...still off-label.
 

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Posted by Eljin (Member # 6354) on :
 
quote:
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I feel that everyone wants the "quick fix", so they come up with these personality disorders, then prescribe behavior changing drugs.
--------------------------------------------------------------------------------

I understand that you feel this way, but I'm curious as to the thought process which lead you there. Why do you believe this? Specifially, what are your reasons for believing this to be more than just a possibility, but rather an established fact?

(Thanks. Honest questions, I promise -- I'm interested. )

I think the main reason I feel this way is the family and community I live in and have lived in my entire life are very big on taking personal responsibility. I come from a very conservative and religious background, and I've always been taught that one should do the best with what they have. There are also quite a few students at my school who use ADD as an excuse for any bad behavior, as if it were a crippling disease, and they were completely unable to make any choices for themselves. Before very recently, there was no medication for ADD, and people still survived. My HB teacher this year, who has been teaching at the school for at least 20 years, very obviously has ADD. This is not to say that all cases are made up; I do realize that there are many identifiable imbalances in the brain. It's just been my experience that human beings in general want that "quick fix", which usually doesn't fix the problem, just the symptoms (I'm not talking medically here, I'm talking universally)

Not sure how much sense that made, but you said you wanted my thought process, so I gave it as best I could. My logic usually makes some fairly random seeming jumps that I don't always understand completely, so I hope that all hangs together well enough.
 

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Posted by mackillian (Member # 586) on :
 
rivka--which?

(GET ON AIM)
 

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Posted by ClaudiaTherese (Member # 923) on :
 
Eljin, I'd definitely agree with you that it is possible both to have a treatable mental illness and to be a real jerk. They are certainly not mutually exclusive!

Thanks for your honesty. I have a different take on this, but I was mainly curious to learn where you were coming from, and I appreciate the explanation.
 

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Posted by mackillian (Member # 586) on :
 
Eljin--that's what I do for my work, in part.

I work with kids with mental illnesses in terms of managing their symptoms and resulting behaviors in the community. That while they do have a mental illness, be it ADHD, depression, bipolar, what have you, that is no excuse for misbehavior. But it takes a different type of behavioral management system and some damn good accountability for behavior for those kids.

Mental illness isn't an excuse for bad behavior. But it doesn't discount the actual illness's existence, either.
 

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Posted by ClaudiaTherese (Member # 923) on :
 
Yeah. What mack said.

[I love it when she does that.]
 

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Posted by pH (Member # 1350) on :
 
mack: Well, my psych at home...the one I refuse to speak to anymore....once mentioned adderall for ocd. But he never got around to trying it with me; apparently, it has worked in the past, as I said, on rare occasions.
 

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Posted by rivka (Member # 4859) on :
 
mack, the kidney/bathtub thing.

Can't -- am trying to help a child with homework he doesn't think he can do.
 

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Posted by mackillian (Member # 586) on :
 
pH--hmm. makes me curious, that's for sure.

rivka--tell him he just can't. I'll take care of the rest.

CT: *blush*
 

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Posted by rivka (Member # 4859) on :
 
Tried that, mack. Didn't work. The coaxing is working -- almost done with this page. *phew!*
 

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Posted by mackillian (Member # 586) on :
 
cattle...prod...
 

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Posted by ClaudiaTherese (Member # 923) on :
 
Be strong, rivka.

*sends the good vibes
 

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Posted by rivka (Member # 4859) on :
 
I try to save that for getting him out of bed in the morning.
 

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Posted by mackillian (Member # 586) on :
 

 

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Posted by Jill (Member # 3376) on :
 
I asked my therapist about this today, and she said that one theory is that when people are depressed, they generally lack energy. When they start a new antidepressant medication, they have a lot more energy, and therefore some of them will use that energy to actually DO something about their depression... i.e., commit suicide. Note that most antidepressants don't take effect for a few weeks, so the most dangerous time is right after someone starts one.
 

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Posted by Alucard... (Member # 4924) on :
 
Sorry I entered the fray late. A few points from a pharmacy perspective:

I have been a pharmacist for 8 years, and I have never had a patient commit suicide because of an adverse drug reaction to something like Paxil. I have dispensed SSRIs: like Paxil, Prozac, etc THOUSANDS of times, and I must tell you very honestly that the world is definitely a better place because of modern pharmaceuticals.

I have seen drugs pulled off the market in the United States for fewer than 40 deaths nationwide, Baycol and Rezulin to name a few. Now similarly, Prozac had this type of negative press in its early years, and the sensationalism was hard to fight through for me professionally.

Strangely enough, the Church of Scientology was found to have masterminded a huge anti-Prozac press campaign that evolved into a multi-headed beast that still surfaces its head to this day. I also believe that Eli Lilly, the makers of Evista (osteoporosis drug) at least had an indirect hand in discrediting Premarin as an unsafe drug. Why? Many patients were switched to Evista.

Ask yourself who has the most to gain by some of the sensationalized ads you see concerning pharmaceuticals, then ask someone you trust what they believe to be the crux of the matter. In the case of Paxil, I would cry and console any of my patients' families that suffered a tragedy like the one listed in this article. The pain and suffering you read is obviously real. Also keep in mind that the FDA is not pulling these drugs off the market, but they are recommending that certain SSRIs are not to be prescribed for adolescents under 18. This is a very important distinction. If you are very Darwinian, you might consider 40 deaths compared to MILLIONS of patients who benefit from a drug acceptable. Think in terms of cancer drugs: if you had a 50/50 chance of surviving cancer, but a drug could make that chance of survival 90/10, would you risk it, even though 40 patients died out of thousands because of liver toxicity? I would! However, the FDA does not work under these terms. A drug will be pulled off the market, in many cases VOLUNTARILY by the manufacturer, with the FDA overseeing the process. Paxil and other SSRIs will NOT be pulled from the market. This should alleviate the fear of pharmacueticals for some people.

However, I remember being 18 once and I can attest to the turbulent and emotional time that it was for me personally. I cannot pretend to think that these potent pharmaceuticals have no adverse effects at all, however, for every 1 adverse reaction, there are 99 positive ones. I just hope professionally and personally, that no one is permanently injured or hurt while trying to find the right drug.

Let me also say this: If diabetes medicine seemed frightening to you, would you not take it and let diabetes run its course? Seems foolish doesn't it? If your body NEEDS insulin but you are afraid of needles, will you willingly let your disease progress until it kills you?

I hope not, but I know people like this. As mac and CT and others are illustrating, some psychololgical disorders are a chemical imbalance of neurotransmitters, just like the body not having enough of a hormone like insulin.

However, experts may give the false assumption that they know everything about the brain and how it works. Wrong. As vast as our knowledge has become and the subtle differences between pharmaceuticals, there is still a 3-week period in which doctors tell their patients to "try" a new drug.

This makes NO SENSE in a pharmacokinetic sense. Without going through the boring mathematics of it, dosing of a drug once a day should reach steady-state blood plasma levels in about 5 doses. So on paper, with the purity of mathematics to support it, taking a drug for a week should ellicit some positive or negative response. However, the brain is still a mystery and takes as long as 3 WEEKS to illicit a response to some drugs. What does this mean?

For someone who is suicidal, they may be prescribed and antidepressant, a SSRI, like Paxil. If this is not working, or is causing side-effects, this patient may have to battle suicidal depression another 3 weeks with no benefits from pharmacotherapy.

As eluded to, these 3 weeks can be a dangerous time, and as much supportive therapy as can be given will make all the difference.

Remember, drug therapy is only one facet of therapy. I do not believe by any stretch of the imagination that simply taking a pill will solve all problems. Psychotherapy and counseling also play an integral role in treating suicidal tendencies. Communication also plays a HUGE role. We see this break down where the patient in the above example did not want to continue Paxil, so the doctor doubles it. This is a tough call for the casual observer to make judgement on. In many cases, the prescriber is justified. However as many Jatraqueros have mentioned, they knew when a drug was not working probperly and procedded to discontinue the medication promptly.

What does all this mean in summary? If you believe that your current medication is not working properly, check with your doctor. If you do not want to take the medication, then tell the doctor exactly that and ask what else can be taken to replace the discontinued medication.

HOWEVER!

Please do not stop medication without informing your doctor. Keep your doctor in the loop and let them help you make an informed decision. If you are not satisfied with the decision, get a second opinion.

I must say that working with drugs all around me all day long that drugs are not scary.

People are scary!

Hope this helps!

P.S. I cannot recall Depakote having a black box warning of any kind. The most recent black box warning has been for Serzone. I expect one for Zyprexa soon as well, and as far as Serzone is concerned, it has been pulled off the market in Europe for liver toxicty associted with long-term therapy. This may happen in the US as well, so Serzone should be reserved for last-line therapy.

[ March 24, 2004, 05:42 AM: Message edited by: Alucard... ]
 

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Posted by ClaudiaTherese (Member # 923) on :
 
(Is there any other place like Hatrack? Bravo, Alucard, and thanks. )
 

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Posted by Valentine014 (Member # 5981) on :
 
I can't seem to find any information regarding the reason I stated earlier, but I do know for a fact that it has been black boxed for hepatotoxicity.
 

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Posted by ClaudiaTherese (Member # 923) on :
 
Valentine, I'll try to look around later.

( )

[ March 24, 2004, 09:06 AM: Message edited by: ClaudiaTherese ]
 

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Posted by Tiger Eye (Member # 6353) on :
 

quote:

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These medications SAVE LIVES. And even more often, make life worth living.

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yah. i'm living proof. i'd be in trouble without my meds.
 

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Posted by imogen (Member # 5485) on :
 
On a slight tangent / back to the first pageishness...

Looking back on this thread - something that strikes me is the issue of the amount that antidepressants/ADHD drugs are overprescribed.

Let me qualify here. I do not think that antidepressants or any other drugs to correct disorders are not necessary in many cases. I've seen a lot of first hand cases where those drugs have helped immensely.

Mack, I've read how happy you are this year with your medications working out, and I don't doubt for a second that these medications have been fantastic for you.

But I also have a mother who is a GP, and a couple of friends who got prescribed various drugs that, in hindsight, they didn't need. My mother sees the over-prescription of such drugs as a big problem.

In Australia, at least, it seems some (not all!) doctors are more willing to write out a script then spend some more time with their patient and maybe refer them to other services.

And now we (in Australian primary schools) are starting to see a trend that way with kids as well - it's easier to give them ADHD medication than try more time consuming ways of getting them focussed and interested. Which I think is very worrying.

[ March 24, 2004, 09:29 AM: Message edited by: imogen ]
 

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Posted by UofUlawguy (Member # 5492) on :
 
I have a question for all you super-knowledgeable people. Is there any indication that the kinds of disorders we've been talking about (depression, ADHD, bipolar, others?) are more common now than they were in the past? The fact that they are being diagnosed and treated so much seems to surprise a lot of people, and in some cases make them wonder if the phenomenon is real. Others, who believe the disorders are real and as prevalent as they seem, start to see conspiracies re: chemical/industrial/pollution-related harms related to modern life that former generations didn't have to deal with.

So, were people of the 19th century and before plagued by these disorders as much as we are today?
 

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Posted by pH (Member # 1350) on :
 
Honestly, I think they were just as prevelant...but not as easily recognized. I mean, treatment for mental disorders used to consist of basically taking a chunk out of your brain or shocking the crap out of you.

I think they're _overdiagnosed_ today, but I don't think they're any more common.
 

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Posted by Shigosei (Member # 3831) on :
 
Bit of a tangent here: Has anyone had a medication quit working after a few years? Did you switch to another one or increase the dose?
 

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Posted by MrSquicky (Member # 1802) on :
 
Many people seem to think that a mental illness is either biologically caused or it isn't. Also, they seem to think that the only way to fix a biological-based illness is through biological (usually pharmacological) intervention. Except in rare cases, neither of these are true.

For one thing, most major mental illnesses are most likely a combination of biological predisposition and environmental factors. There are very few places where we've concluded that something is purely biological. When someone gets depressed, it is likely that they have brain chemistry abnormalities that are contributing to this, but there are also usually environmental things that are also fueling this state, and some of these factors are the person's way of thinking about things. Also, it is likely that in some cases, a depresssed person may not have a biological cause for their problems and it's mainly their own way of thinking about things that is the cause.

Here's the thing though. We don't know what the case is. Furthermore, from a therapeutic standpoint, we don't really care. It's not a therapist's job to necessarily determine cause except where it leads to a more effective treatment. It is certainly not a therapist's job to blame someone, to say that it's their fault that they have a mental disorder. That's for ignorant people and talk radio hosts to do. A therapist should be concerned almost exclusively on what's going to make their client function better and remain functioning better.

A person with problems caused by brain chemistry abnormalities doesn't necessarily need to be treated by fixing these abnormalities with drugs. In many cases, talking cures can fix this problem. Likewise, people with non-biomed problems can still have these problems fixed or at least covered by drugs. Just because a problem is caused one way, doesn't mean that it can only be dealt with in that dimension.

The analogy I like to use for mental illness is of someone struggling with a weight. It's bearing them down and you want to help them. Utlimately, you want the person to become strong enough to handle this weaight and other weights that come along, but yelling at them that it's their fault that they are not strong enough to lift this one is not a step along this road. Even if it is true (and what arrogance to assume that you can know that it is), you're not helping them either get over this weight or become stronger. You're just distancing yourself from your own projected weakness. You're job is to try and help them, by lessening the weight or helping them lift or teaching them a better strategy to lift the weight. Also, some weights are going to be too heavy, not matter how hard you try. That's when you just have to try to get rid of it and keep it away.

I think we overproscribe drugs to deal with psychological illnesses and that this is both an indicator and a cause of some big problems in our society. In many cases, drugs are by no means the most effective treatment, neither in the short term or the long term. What they often are, however, is the easiest way of dealing with someone who isn't acting the way you want them to. Also, on the part of the person taking the drugs, they are the easiest way of "dealing" with their problems. However, much of the time, all their doing is blocking the symptoms without doing anything about the problem itself.

pooka brought up the recent findings that exercise is an effective treament for certain types of depression. According to studies I've read, it works even better when treating childhood ADHD. The problem - well besides it not working in all cases - is that it's much more effort to get kids to exercise than it is to have them pop a pill. Also, it's more threatening to acknowledge that kids don't pay attention in school because the school system is extremely poorly set up in terms of getting and keeping kids attention. It's better to blame the children than ourselves, and it's even easier to blame some sort of chemical problem than the kids.

Popping pills, even when this treats the syptoms without many adverse side effects, rarely works in a long term view. As soon as the person stops taking the pills or acclimates to them, the problem is often going to return. Generally, at best, they can clear the ground of threats for the "real" therapy to work. That is, teaching coping strategies and helping with lifestyle changes and psychological growth.

This thinking, however, is not inline with the high value that our culture places on comfort based individualism. People don't want to accept that their thinking is at least partially the cause of their problems. They also don't want to go through the difficult process of reworking the way they think about things. It's much easier to deflect the responsiblity and say that it's because of brain chemicals and there's nothing I can do about it. They don't want to hear that even if it is caused by brain chemicals, that doesn't mean they can't do anything about it other than popping pills.

On the other side of the aisle, people who want to distance themselves from people with mental illnesses put the blame completely on a lock of will. In this thinking, people who have a mental illnesses are just weak, whining individuals who are looking for an easy escape from their problems. That this is in a very mild form true doesn't help this type of thinking. The people who think this way rarely want to recognize that, not only are there psychological illnesses that are pretty much beyond people's control, but that people, themselves included, rarely ever have even a majority of control over their mental state. Not only do they yell at the people trying to lick that bruden, but they're jumping up and down on it to make it heavier.
 

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Posted by MrSquicky (Member # 1802) on :
 
UofU,
Comparing across time periods is a really imprecise thing. We're lacking reliable data and a basis for comparison. There's really no way of knowing.

However, we do have access to comtemporary cross-cultural comparisons of the prevalence of mental disorders. As this as our basis, America compares extremely poorly on many of the neuroses, such as depression, ADHD, and anxiety disorders.

It's important to acknowledge the possible sources for this other than the "weakness in society" one that people immediately jump to. For example, American's have a significantly different diet than other countries. Also, there is in general more and different types of pollution (according to some current thinking this is a possible cause for the ADHD) here than elsewhere.

However, I'm a social/personality guy, so I'm predisposed that it is mainly due to the structure of our society and also because these disorders are masked by the deprivations in the other societies that we're talking about.
 

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Posted by MrSquicky (Member # 1802) on :
 
As I'm in a ranting mood right now, I'd like to point out that the single best thing we can do to improve both the mental and physical health of our country is to strongly encourage exercise. The big problem with this, other than the reluctance of the population to do it, is that it doesn't make anyone any money. It's free and it's the universal magic bullet. This is one of the main reasons why I support nationalized health care in theory, because then we can use interventions that really work rather than ones that are good for the economy or at least drug companies.
 

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Posted by Tiger Eye (Member # 6353) on :
 
UofUlawguy,

i was watching the news and they had a story that talked about the increase in diagnosing children with mental 'problems' (bipolar, ADHD, etc.) over the past few years. however, i dont remember it proving whether it was the children that were changing, or the process of diagnosis.

my guess would be a combination.
 

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Posted by sndrake (Member # 4941) on :
 
I think these things go on a continuum from "difference" to "disorder/disease" and interact heavily with social and environmental factors.

I've dealt with it somewhat on my own. At time in my life (none recently), I've been in situations where I was given a screening test for depression and met borderline conditions for very mild depression. Recently, I've learned that this is no surprise - part of whatever happens with hydrocephalus seems to leave a lot of us predisposed to depression, so it's probably biochemical/structural in origin.

My own education, assertiveness and a cooperative professsional led to a polite decline of a medication offer. (I have a lot of atypical reactions to different meds)

When I feel it's an issue, I know what to do. For the level of depression that I get, a regimen of regular exercise, decent diet, and paying attention to my sleep kicks my own system into gear. What you do does effect your internal chemistry - in my case there was a clear choice to be made.

I also have some features that overlap with ADD, but heck, I have features that overlap with Aspergers, too. For me, I'm not sure what medication would do for or to me. And I'm comfortable enough not to want to mess with it.

But that's the point, I think. If things aren't working - the whole risk/benefit analysis begins to look very different. Like when I have an approaching migraine and reach for the medication with all the grim warnings on it.

Every time.
 

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Posted by Alucard... (Member # 4924) on :
 
I have in my hand the Package Insert for Depakote. It is black-boxed for Hepatotoxicity, Teratogenicity (spina bifida especially), and Pancreatitis. Thanks for making me look it up and I apologize for not knowing this. I SHOULD have known this (flogs self with spatula on the knuckles).

I have done continuing education on ADHD and ADD and I was surprised by the meta-analysis of the population treated with drugs like Ritalin or Strattera.

This news is alarming and very unexpected, but the study found that only 30-50% of patients that could be diagnosed with ADD/ADHD are treated pharmacologically. What this means is that the reasearchers of the study extrapolated, with very scientific methods, how many patients are treated, how many go untreated, and how many go undiagnosed. I am the biggest skeptic in the world and I can't help but do what I do professionally and be shocked by how much pshychotropic medicine I dispense. Numbers don't lie, people do. I just hope that the companies that make drugs for ADD/ADHD are not manipulating the data for further sell their products.

I especially liked the idea to exercise. I miss gym class. I beleive that if more companies and employers offered pre-work calesthenics, that more and more people would want to participate. However, in the real world, this would give employees more opportunuties to gain workers compensation claims and sit at home.

I also liked the comments that there is more than one way to solve a medical condition. Basically, pharmacotherapy is only one facet of total health care. I would also caution strongly the use of common sense. Magnet therapy, reflexology, and other quack sciences are just that. Don't make me quote PT Barnum on this issue...
 

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Posted by Alucard... (Member # 4924) on :
 
I also forgot to mention one other important factoid. For those of you who believe that drugs are overused for psychological disorders in general, you are wrong. Before the advent of benzodiazepines (Valium-like drugs) and antidepressants, many of these patients were institutionalized. The ones left untreated generally became ostracized from "normal"society as insane. What this means is that with the advent of modern pharmaceuticals, studies have shown that as much as 20% of today's society would be intitutionalized if treated under guidelines a hundred years ago. Just where are you going to put all these people? That is why TOTAL therapy is so important when facing a psycholical condition. Drugs are only a small but important part of therapy. I believe that psychoanalysis and pshychology are also big components. Most importantly, I believe that a certain amount of self-discovery and self-analysis have to occur to allow healing. Only then can someone have the courage to fight their condition and find ways to live with it.
 

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Posted by MrSquicky (Member # 1802) on :
 
Alucard,
But it's entirely possible that drugs are both over-prescribed and under-prescribed at the same time. Just because there are a lot of people who aren't getting treated at all doesn't change the fact (well, not a fact as much as an opinion on my part) that there are many people who are being mistreated by either being treated solely pharmocologically or being given drugs when other therapies would be much more effective.

It is possible to both overserve and underserve the same community. In fact, I'd say it's pretty much inevitable.

[ March 25, 2004, 12:58 PM: Message edited by: MrSquicky ]
 

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Posted by Alucard... (Member # 4924) on :
 
I agree wholeheartedly. In fact, I would rather see drugs underused than overused if I had to choose, but I always strive to aid in a patients optimal therapy, finding that happy medium.

Personally, I hate to take my cholesterol medicine, and do take vitamins, although I wish I were not relying on either.

So, essentially, I agree.
 

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