McMAN’S DEPRESSION AND BIPOLAR WEEKLY
May 8, 2002 Vol 4 No 17
Note: This
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WHEN HE TALKS ...
"I think if the public understood the misuse of
federal funds in the National Institutes of Mental Health, they’d probably close
it down altogether. And, in fact, if you closed it down altogether, not very
many people would notice, because it’s not doing very much that’s important."
Remember those old TV commercials, "When
EF Hutton talks, everyone listens"? EF Hutton in this case is E Fuller Torrey
MD, who cut his teeth by taking on the psychiatric establishment of his day,
then dominated by Freudians. These days, Dr Torrey is part of the establishment,
the executive director the prestigious Stanley Foundation, which is conducting
critical research into bipolar and schizophrenia, and author of numerous books,
including the just-released "Surviving Manic Depression: A Manual on Bipolar
Disorder for Patients, Families, and Providers".
But Dr Torrey still succeeds in coming
across as a tilter of establishment windmills. "I have accused [the NIMH] of
becoming birdbrains," he recently told Morely Safer on 60 Minutes. "They are
funding a great deal of research on birds. How pigeons think, for example. This
year they are funding 14 separate projects on how pigeons think."
Researching pigeons sounds goofy only if
you are unaware of Eric Kandel MD of
Columbia University, whose work with snails led
to breakthrough insights into how we learn and remember. In 2000, Dr Kandel was
awarded the Nobel Prize in Medicine, the first psychiatrist to achieve this
honor.
Similarly, Dr Torrey’s comments about the NIMH "not doing very much that’s
important" is only true if you choose to disregard the largest clinical trials
ever into medications treatment for depression (STAR*D) and bipolar (STEP-BD),
currently underway, or the establishment of a Mood and Anxiety Disorders
Program, which has a very full agenda of brain imaging studies, clinical trials,
and lab work. An NIMH study on rats into the neuroprotective properties of
lithium has enormous implications for both those who have mood disorders and the
population at large, who one day may find themselves taking this common salt in
low doses as prevention against the ravages of age.
Earlier, in an article in April’s The Washington Monthly, Dr Torrey took aim at
another government mental health body, the Center for Mental Health Services (CMHS),
whose "policy wonks and grant-makers seem to be nostalgic for the days when
mental health policy was inspired by Ken Kesey's book One Flew Over the Cuckoo's
Nest ..."
This drew cries of outrage from various mental
health consumer groups, which took on serious dimensions when - while the
magazine was still on the stands - the Bush Administration nearly cut off CMHS
funding to five major mental health consumers’ groups, including the National
Mental Health Consumers' Self-HelpClearinghouse, which has helped start 1,000
self-help and support groups. Only a last-minute reprieve spared the Self-Help
Clearing House and its sister organizations for another year.
In the meantime, you are sure to
encounter the ubiquitous Dr Torrey on the op-ed pages of your local paper, if
you haven’t already, very soon after there has been a terrible homicide in your
neighborhood committed by someone with mental illness. You only have to sample a
few words to realize he enjoys the best of both worlds - the passion and
persuasiveness of an outsider combined with the credibility of an insider. Be
assured: When EF Torrey talks, people do listen, but what do they hear?
MORE
In fairness to Dr Torrey, here are a few
telling points he makes in an article in May’s The Washington Monthly, entitled,
"While 2.3 Million Americans Suffer From Bipolar Disorder, the National
Institute of Mental Health is Studying How Pigeons Think":
* A 1999 study by NAMI of NIMH’s 1997
research grants reported only eight percent of its total grant funds were
allocated for research on clinical or treatment aspects of schizophrenia,
bipolar, major depression, OCD, and panic disorder combined. A follow-up study
by Dr Torrey’s Treatment Advocacy
Center reported no improvement for 1999.
*
In 1997, the NIMH spent more money on AIDS research - which is the primary
responsibility of the National Institute of Allergy and Infectious Diseases -
than it did on schizophrenia research.
*
House and Senate hearings leading to the birth of the NIMH focused on
overcrowding of psychiatric hospitals and the large number of men who were not
able to serve in World War II because of severe psychiatric illness, indicating
its real mission.
You can check out the full article at:
http://www.washingtonmonthly.com/features/2001/0105.torrey.html
DR KANDEL’S CATHOLIC EXPERIENCE
Eric Kandel MD, the Nobel Laureate
mentioned briefly in the lead article, was born in Vienna of Jewish parents. He
was an impressionable youngster when Hitler and his armies entered
Austria in 1938. Immediately following, the
population en masse, not just Nazis, turned against Jews with a viciousness that
surprised even Germans, and he and his family endured a year of living
dangerously before finding refuge in Brooklyn in 1939. In light of the Catholic
Church’s current scandals, this paragraph from Dr Kandel’s Nobel autobiography
is particularly revealing:
"In a shocking move, even Theodor Cardinal Innitzer, the influential Archbischop
of Vienna, welcomed Hitler and ordered all the Catholic churches in the city to
fly the Nazi flag and to ring the church bells in honor of Hitler's arrival in
Vienna. As the Cardinal personally
greeted Hitler, he assured him of his own loyalty and that of all Austrian
Catholics - which was most of the population of Austria. The Cardinal promised
Hitler that Austria's Catholics would become ‘the truest sons of the great
Reich into whose arms they had been brought back on this momentous day,’
provided that the liberties of the Church were respected and its role in the
education of the young guaranteed."
You can read more about Dr Kandel at:
http://www.nobel.se/medicine/laureates/2000/kandel-autobio.html
QUIZ
Can you name the leading cause of death
in the US? (Answer several articles
down.)
THE PLACEBO EFFECT
A
University of Texas/NIMH study using brainscans of 17 depressed patients found
that either Prozac or a placebo resulted in metabolic increases in the cortex
and corresponding decreases in the limbic regions, but Prozac responders also
experienced changes in the brainstem, striatum, and hippocampus, thought to
confer a longer-term effect. According to the study’s lead researcher, Helen
Mayberg MD, "Our findings do not support the notion that antidepressants work
merely via a placebo effect."
http://www.eurekalert.org/bysubject.php?kw=185
EFFEXOR
A multi-center meta-analysis of 32 drug
trials involving 5,562 patients comparing Effexor to other antidepressants
suggests Effexor has greater efficacy than SSRIs and performs a little better
than tricyclics. The drug was also found to be as well-tolerated as the SSRIs.
None of the studies compared Effexor to non-SSRIs or non-tricyclics such as
Remeron or Wellbutrin. Effexor blocks both norepinephrine and serotonin reputake.
The meta-analysis was funded by Wyeth-Ayerst, makers of Effexor.
http://bjp.rcpsych.org/current.shtml
<a href="http://bjp.rcpsych.org/current.shtml
">click here</a>
PROVIGIL
Please don’t interpret this as a drug
promo:
An article in Stanford University’s
Daily reports on Provigil (from "promotes vigilance") that keeps one awake, but
without perking up the entire nervous system, increasing dopamine levels
orcausing jitters and similar effects, and without the need for "rebound sleep"
to balance sleep debt. A Canadian study found subjects were able to perform well
on cognitive tests after remaining awake for 60 hours, and US Army helicopter
pilots performed well on a flight simulator after being awake for 40 hours
(while those not on the drug became fatigued and made errors).
Provigil is currently FDA-approved only
for treatment of narcolepsy, but is used off-label for sleep problems associated
with depression.
WOMEN AND DEPRESSION
The American Psychological Association
has issued a 59-page report on women and depression stemming from a summit of
experts it convened in Oct 2000. Among its findings:
* Hormonal disturbances are associated
with depressive symptoms.
* Stress and trauma "are clearly
implicated" in the onset of depression, with 80 percent of depression cases
preceded by a major life event such as sexual assault or male partner violence.
* Other stressors include poverty,
inequality, and discrimination.
* "Ruminative thinking" and "unmitigated
communication" are examples of behaviors in women that can lead to depression.
* Women respond preferentially to SSRIs
and men to tricyclics. Women in menopause respond less well to SSRIs, but
hormone therapy may restore this preferential response.
* Estrogen has potential as a mood
modulator, along with progesterone, DHEA, and DHEA-S.
* SSRIs need only be taken in the luteal
phase of the menstrual cycle for women with PMDD.
Surprisingly, the Report had no
recommendations on taking antidepressants during pregnancy or while
breastfeeding.
You can check out a copy of the Report
at:
http://www.apa.org/pi/wpo/women&depression.pdf
DEPRESSED MOMS
A University of Colorado study has found
that four-month-old infants of women without depression associated the sound of
their mother’s voice with the image of a smiling face while those of depressed
mothers did not. An earlier study by the same authors found that mothers with
depression spoke to their babies in flatter tones, which, combined with the new
findings, suggests "the first demonstration of how a specific infant-learning
process can be affected by maternal depression."
http://www.reutershealth.com/archive/2002/05/01/eline/links/20020501elin001.html
AN UPSIDE TO DOWN
A Duke University study of 3670 patients
elderly patients has found those women with subthreshold depression tend to live
longer than those without. According to the study’s authors, low subclinical
depression in women "may lead to adaptive activities that are in some ways
protective of health."
http://www.medscape.com/viewarticle/432933
CRUEL BUT USUAL
According to an Albany Times Union
article, 1,000 mentally ill prisoners in New York state are locked down 23 hours
a day in disciplinary housing known as "The Box," where the rate of suicide is
14 times the prison norm. Disciplinary lockdown is a hazard faced by 6,500
mentally ill inmates in the state’s prisons, who find it difficult to adapt to
prison life.
http://www.timesunion.com/AspStories/story.asp?storyKey=81695&category=O
THE VALUE OF CELEBRITY
Why we need a Today Show host to
complete a depression screening on TV:In the 40-week period after Katie Couric
had her on-air colonoscopy on national TV in March 2000, there was an increase
by 19 percent in the number of diagnostic procedures performed in the US,
according to a University of Michigan study.
http://www.eurekalert.org/bysubject.php?kw=185
YOUTH MENTAL ILLNESS
Ross Szabo is a 23-year-old senior
majoring in political science at American University in Washington DC. At age
16, he was diagnosed with bipolar, and a year later attempted suicide. According
to an article in the campus paper, The Eagle, his defining moment came when a
psychologist who spoke to his class on mental illness began playing to the
laughter in the crowd. This infuriated Ross, who called the speaker a disgrace,
and which resulted in his speaking in front of the class, his first speaking
engagement.
His illness resulted in dropping out of
AU, but soon after returning he became the first student ever to be featured by
the university’s speaker’s bureau to talk on campus. Ross is founder of the
Youth Mental Health Awareness Movement, and in March this year became director
of the National Youth Mental Health Awareness Campaign. Last Sunday, Parade
Magazine’s cover story on youth depression featured Ross.
HIV AND DEPRESSION
A study of 93 HIV-infected women and 62
uninfected women reported in the AJP has found those with HIV suffered four
times the rate of depression (19.4 percent) vs those with no HIV (4.8 percent).
There was no significance between rates of anxiety disorders.
FROM THE BJP
* A University of Dundee (UK) has found
55 percent of older people doing ten weeks of exercise experienced a 30 percent
reduction in depression scores vs 33 percent for those who did not exercise.
* An Oxford/University of
Edinburgh study of brain scans comparing 20
people with treatment-resistant depression to 20 recovered patients and 20
healthy controls found only the treatment-resistant patients exhibited right
frontal-striatal atrophy and subtle changes in the left hippocampus.
http://bjp.rcpsych.org/current.shtml
ANSWER TO QUIZ
According to an article in JAMA, adverse
drug reactions (ADRs) are believed to be the leading cause of death in the
US. Despite testing and trials, new
drugs are often marketed before the full range of ADRs is known, and less than
10 percent of all ADRs are estimated to be reported to the FDA’s MedWatch.
Nearly 20 million patients in the US took at least one of the five drugs that
were withdrawn from the market in the year between Sept 1997 and 1998.
More figures: 548 new drugs were approved from 1975 to 1999. Of these, 56
acquired a new black box warning or were withdrawn from market. Forty-five drugs
acquired one or more black box warnings that were not present when the drug was
approved. Only half of newly-discovered serious ADRs are detected and documented
in the PDR within seven years of drug approval.
According to the authors: "Given the frequent introduction of drugs for which
new serious adverse events are discovered, the FDA should consider raising its
threshold for approving new drugs when safe, effective therapies already exist,
or when the new drug treats a benign condition. Postmarketing surveillance
should be completed, analyzed, and disseminated to physicians."
The authors also recommend that clinicians
avoid using newer drugs when older, similarly efficacious agents are available.
http://jama.ama-assn.org/issues/v287n17/rfull/joc11497.html
ONE MORE FOR KJ
Psychology Today has announced the
recipients of its third annual Mental Health Awards, covering six different
categories, to: Kay Jamison PhD (Survivor - "Her candid account has helped
countless others who have suffered like she has."), Rachel Yehuda PhD (Clinician
- PTSD expert working with children of Holocaust survivors and 9/11 victims),
Ron Howard (Media - Director of "A Beautiful Mind"), Donald Norman PhD (Business
- For making humanizing technology his life’s work), Sen Hillary Clinton
(Government - Co-sponsor of the Mental Health Equitable Treatment Act and other
achievements), and O Ivar Lovas PhD (Research - Revolutionized treatment of
autism).
TOO ELITIST?
Ariel writes:
My concern is with regard to the number
of psychiatrists being trained in medical schools. In the state of
California, approximately 110 are trained every
year. Given that we are one of the most populous states in the nation, and there
is a ever widening gap and crisis in mental health care, is 110 enough?
In Modesto, California with a
population of approximately 220,000, you have to wait 60 to 90 days for just a
20-minute med check. They just do meds. The treatment teams take care of the
real work. In the Behavioral Center intake areas, there is never a psychiatrist
that comes to see you right away like a surgeon or a internist.
Why aren't the rules tightened and laws passed that if a patient is admitted to
an acute psych unit, then the psychiatrist needs to come in and make an
evaluation just like any other real doctor? I think they get away with too much.
They seem very elitist and haughty.
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