Lead story: A speedy traverse of integrative psychiatry.

Also in this issue: Procovery, Hyperbaric chambers, Toxins, Native American view, Abilify, Double trouble, Omega-3, Vagus nerve stimulation, Antipsychotics and diabetes, Better than Haldol?, Paxil for Hot Flashes, SSRI open season in the UK, Personality types, Jail diversion, Truehope sues Health Canada, Teen sex, Right to refuse meds, Lilly Reintegration Awards, Boston Tea Party, Food for thought, Next issue, McMan's Web, Donation information.

Anything Goes?

Tricia’s adopted son - we’ll call him Andrew - started to unravel at age eight. "It was the scariest thing to happen to a mother," she recalled. Andrew threw things, flew into rages, and jumped out of a van at 50 miles an hour. Andrew was diagnosed with bipolar I and put on meds, but according to his mother he became a vegetable, sleeping all the time and not engaging in the outdoor activities he once loved. Whereas Andrew had once tested four to six years above grade level, he was now testing two years below. As Tricia explained: "They felt they had solved my problem. I felt I lost my child."

In desperation, she weaned her child off his meds and started him on a regimen of vitamins and supplements. This nearly resulted in Andrew getting kicked out of school, but she stayed the course and was happy to report that her son had just been awarded the most joyful kid in his class.

Tricia was speaking at a two-day conference, Non-Pharmaceutical Approaches to Mental Disorders staged in Pasadena May 31-June 1 by a nonprofit organization, Safe Harbor. The need for such a conference can best be underscored by contrasting it to the six-day American Psychiatric Association’s annual meeting which took place two weeks earlier in San Francisco. That conference featured hundreds of workshops and symposia, many underwritten by pharmaceutical companies, with just one session (to this writer’s knowledge) on vitamins and supplements.

Fortunately, mainstream psychiatry and alternative therapies don’t have to be either-or choices. As Lewis Mehl-Madrona MD, PhD of the University of Arizona, a half Cherokee raised in tribal shaman traditions and author of Coyote Medicine and Coyote Healing, told the Safe Harbor conference, "whatever works is good medicine." He has coined the term, integrative psychiatry, to describe the combined medical-alternative approach he is implementing at the University of Arizona.

Many of the leading so-called alternative practitioners are firmly-grounded in western medicine. The patients who find their way to the Pfeiffer clinic in Illinois, for example, are given an extensive battery of tests to determine body toxins and nutrient deficiencies and how the body methylates substances prior to the formulation of a treatment plan based on diet and supplements. And Gunnar Heuser MD, PhD of UCLA is as western as they come, a neurotoxicologist who happened to acquire a hyperbaric chamber. Not only is the treatment hi-tech, but he sends his patients for before and after brain scans.

On the flip side of the coin, simply by prescribing lithium to their bipolar patients, most psychiatrists are already engaged in "natural" treatment. Omega-3 is making headway in many practices, and there is sure to be something growing by the side of the road that will one day be met with equal enthusiasm. In the meantime, shamanism lives. When this writer asked a number of psychiatrists at the APA meeting what they found worked best in treating patients with bipolar, several of them replied establishing a trusting relationship with the patient. Getting the patient to buy into one’s treatment (and by extension healthy lifestyle choices), in other words, dramatically enhances one’s chances of recovery, whether it is medication we are talking about or acupuncture.

Hopefully, the day will come when people like Tricia can turn to their psychiatrists for expert care on natural supplements and diet as well as meds. Fortunately, Tricia’s son turned out fine. What we didn’t hear about at the Safe Harbor conference were the patients who tried the same thing and wound up in the hospital, case studies for what happens when people go off their meds but also an indictment on a profession that knows more about Seroquel than vitamin C. Last month, the APA turned down a proposal for a research task force for unconventional therapy. The good news is that the proposal was entertained in the first place. All in good time ...

Safe Harbor

More on the Safe Harbor conference ...

Procovery

A deep needle biopsy that struck the sciatic nerve was part of Kathleen Crowley’s descent into pain and madness, recounted in her book, The Day Room. The intense chronic pain is still with her and will always be. What changed was when an insightful doctor prompted her into the revelation that she could never go backward - to how she had been before - but that she could move ahead. Hence the title of her latest book, The Power of Procovery.

Kathleen told the Safe Harbor conference that procovery is about attaining a productive and fulfilling life, regardless of the limitations of symptoms. As she explains on her website: "The fundamental focus of procovery is one of moving forward when you can no longer move back, of letting go of what was and rebuilding new dreams."

Part of the process involves the recognition that big problems don’t necessarily require big solutions. "Small changes," she says, "can have big impact." Another important rule is "just start anywhere." Where do we start? is a proposition that tends to immobilize us. "Whether it’s number one or number five or number 30 on the task list," she advises, "whether it’s getting a goldfish or getting a job, just start anywhere."

Air Power

Gunnar Heuser MD, PhD of UCLA, referred to in passing in the lead article, has yet to treat patients with depression or bipolar, but his work using a hyperbaric chamber on those exposed to neurotoxins, including several who manifested ADD, may be the beginning of a trend. Hyperbaric chambers contain compressed air, and are essential for deep-ocean divers to avoid getting the bends. Mountaineers use pump-inflated portable chambers to cope with oxygen-depletion at high altitudes. The high air pressure inside the chamber forces more oxygen into the body’s blood and tissues. Most hyperbaric chambers operate at two or three times normal atmospheric pressure, but Dr Heuser uses a smaller chamber at 1.3 times normal atmospheric pressure, with 24 percent oxygen concentration. Patients are typically given 10 one-hour treatments.

Of 10 patients he treated for toxic encephalopathy (which results in cognitive and memory impairment), eight showed significant improvement and two marginal improvement in TOVA scores. Before and after SPECT imaging showed marked reduction in blue and violet areas -signifying a return of more normal blood flow - in the brain.

Toxins

Nancy Mullan MD, who practices psychiatry in LA, talked about the rain barrel effect that occurs when a person is exposed to one toxin too many, resulting in an overflow that can overwhelm victims. An excerpt from a video she showed, Doris Rapp MD’s Environmentally Sick Schools, documented the various molds, dust, chemicals, pollens, and foods that can turn healthy individuals into physical and mental basket cases.

The small intestine, Dr Mullan told the Safe Harbor conference, is the loci for most food reactions. If the intestinal wall protrusions called the villi are damaged, then we have trouble absorbing food. What contributes to their damage includes non-steroid anti-inflammation drugs, HIV, parasites, alcohol, aging, and ingesting allergic foods.

Dr Mullan often has her patients take food allergy tests, though they are expensive and their reliability has been called into question. A more labored but failsafe means, she says, would be to eliminate a suspect food from one’s diet to see what happens. These would include: dairy, wheat, corn, eggs, citrus, caffeine, alcohol, refined sugar, honey, maple or barley syrup, tap water, or any food one eats more than three times a week.

In the meantime, she advised, read labels carefully, as hidden allergens are frequently found in packaged foods.

A Native American View

Lewis Mehl-Madrona MD, PhD, mentioned in the lead article, referred to the Cree Indian medicine wheel as an example of how native cultures can inform the west:

One first goes to the east, Dr Mehl-Madrona explained, to connect the person with the spirit, followed by the south for feelings, then the west for body and the north for beliefs and values. Three more circuits are made of the wheel to connect the person to his or her surroundings and community, to instill a sense of identity, and finally to become a teacher and advocate.

Dr Mehl-Madrona is working on a study that will randomize patients into the full gamut of alternative therapies on the hypothesis that people will get better regardless of the type of treatment, that their relationship to their healer and their belief in getting better will play key roles. He cited his own study of Reiki on asthma patients whose results were simply too good to be believed. "We didn’t do a study of Reiki," he told the Safe Harbor conference. "We did a study of the culture of Reiki," which began in the waiting room, where people met and were introduced to new friends and new therapies and lifestyle choices.

Even in the psychiatric literature, he stated, we know the drug is not responsible for the total effect.

In the Cherokee view, he related, anything you do changes your chemistry. Watching horror movies, he said, down-regulates cytokines (involved in the immune system) while watching the Marx Brothers up-regulates cytokines within 15 minutes.

"Whatever the ceremony," he concluded, using the term in a therapeutic sense, "I am bigger than I thought I was, I can expect more from myself."

Segue

Much more on the Safe Harbor conference in future issues. Now to several items from last month’s APA meeting ...

Abilify

At May's APA meeting, Bristol-Myers Squibb released a new study on Abilify for acute mania. In two previous trials, one study failed while the other showed 40 percent of patients responding. This time, a 12-week trial involving 347 patients found that 50 percent of them responded and remained on Abilify vs 28 percent who took Haldol. Thirty-six percent of the Haldol patients reported EPS (muscle movement effects) vs nine percent on Abilify.

Double Trouble

A UCLA study released at the APA meeting of 11 bipolar patients who reported drinking 14 days in the previous month found they consumed an average of 11 drinks a day. At a symposium at the APA, one of the study’s co-authors, Mark Frye MD, reported that according to Epidemiological Catchment Area study, 60.7 percent of bipolar patients have a lifetime substance dependency, with 46.2 percent of bipolar I patients and 39.2 percent of bipolar II patients having a lifetime alcohol dependency.

Meanwhile, at the APA meeting, a Case Western reserve study of 73 rapid-cyclers (equally divided between male and female) with a recent history of substance dependence found that 45 percent had been convicted of a serious offense and 62 percent had been charged with misdemeanors. Of the 34 percent who had been jailed, 70 percent were males.

Omega-3

An NIH study unveiled at May’s APA meeting tracking 14,541 women from their eighth week of pregnancy to eight months after giving birth found those who had no seafood - rich in omega-3 - had nearly twice the rate of depression as those who ate 10 ounces of fish daily, leading the authors to conclude: "Omega-3 fatty acids have beneficial health effects with no adverse side effects."

Antipsychotics and Diabetes

Newsletter 5#11 reported on studies by Elizabeth Koller MD, a former FDA official, and P Murali Doraiswamy MD of Duke that suggest a link between Zyprexa, Risperdal, and Clozaril and diabetes. At the APA meeting, the two authors unveiled a study from the FDA database that fingered Seroquel, involving 34 patients with newly-diagnosed hyperglycemia. There were 21 cases of diabetic ketoacidosis resulting in 11 deaths.

Meanwhile, at the same venue, Eli Lilly released an analysis of previous trials that found approximately one-third of the patients had pre-existing high glucose levels and that two-thirds possessed multiple risk factors for diabetes. Weight gain had only minimal impact on diabetes onset.

Segue

And now back to regular programming ...

Vagus Nerve Stimulation

Cyberonics has announced the completion of a 12-month study of treatment-refractory depressed patients involving placing a pacemaker-like device in the chest that delivers pulses through a wire to the vagus nerve and into the brain. Among the completers, the response rate was 31 percent.

Better Than Haldol?

A feature article in the NY Times reports on three studies that suggest atypical antipsychotics may only be marginally more effective than the older generation antipsychotics such as Haldol. A University of Illinois at Chicago analysis of 124 studies released a month ago found Clozaril the most effective, followed by Risperdal and Zyprexa, but the rest conferred no advantage. A 2000 Oxford analysis of 52 studies published in the British Medical Journal found no difference in effectiveness between the newer and older drugs. And a German review published recently in The Lancet (see Newsletter5#14) found only Clozaril had fewer side effects than the older drugs.

Sales of atypical antipsychotics in the US reached $5.4 million in 2002, putting them fourth behind cholesterol drugs, ulcer drugs, and antidepressants. More than 7.4million prescriptions were written for Zyprexa and more than 7.6 million for Risperdal.

Hot Flashes

A Johns Hopkins study of 165 menopausal women found those receiving 12.5 mg of Paxil reduced their daily hot flashes from 7.1 to 3.8 and 6.4 to 3.2 for the 25 mg group vs 6.6 to 4.8 for those on a placebo.

HealthScout reports that Paxil is not as effective as hormone replacement therapy, which can reduce hot flash frequency by up to 90 percent, but may be a safer alternative.

Bad Press

It’s open season on SSRIs in the UK. The Independent reports on a high-profile coroner’s inquest into the death of Wendy Hay, 52, who hanged herself while on Prozac. David Healy MD of the University of Wales, who has testified as an expert witness in cases involving Prozac and Paxil, told the inquest: "This drug can make healthy people who aren’t remotely thinking of suicide suicidal."

Manufacturer Eli Lilly has issued a statement saying: "There is no credible scientific evidence that establishes a causal connection between Prozac and violent or suicidal behavior."

Meanwhile, the BBC news magazine program, Panorama, last month aired a sequel to last October’s piece on the withdrawal effects of Paxil (marketed as Seroxat in the UK). That program resulted in 67,000 phone calls and nearly 1,400 emails. Said one viewer: "It was strange to learn from a TV program rather than your GP what these side effects were."

Personality Types

Newsletter 5#14 reported on a reader poll that found a surprising 83 percent who replied were introverts, leading this writer to speculate on how our illness may isolate us. Since publishing that piece, David Janowsky MD of the University of North Carolina sent me several articles of studies he has published in this area, which drive home the point with considerable force. One of his studies turned up 74 percent introverts among a depressed population and another found 84 percent introverts among those who were suicidal, leading him and his co-authors to observe: 

Your Opinion

Should psychiatrists and therapists use a shortened form of the Myers-Briggs to screen for introverts? Email mcman@mcmanweb.com and feel free to addd your own insights. Confidentiality assured.

Jail Diversion

The Mentally Ill Offender Treatment and Crime Reduction Act of 2003 that would authorize $100 million to create jail diversion programs for the mentally ill, provide treatment to those who are incarcerated, and establish services to those returning to the community is before both houses of the US Congress. NAMI is urging people to contact their legislators and request they co-sponsor either the Senate version (S 1194) or the House version (HR 2387) of the bill.

Border Dispute

Alberta-based Truehope, makers of Empowerplus supplements for treating bipolar and other illnesses, is suing Health Canada for stopping shipments at the border. The manufacturing of the supplement has been contracted to a US company, which means hundreds of Canadians have been cut off. According to David Hardy, cofounder of Truehope: "We're getting calls from desperate people. They can't go back to medication. The conventional meds don't work for many people."

In Dec 2001, a University of Calgary open trial of 14 bipolar patients still on their meds while taking the supplement found that depression scores dropped by 55 percent after 44 weeks and mania scores by 66 percent. That study was published in the Journal of Clinical Psychiatry, which also carried a commentary by Charles Popper MD of Harvard, who reported successfully treating 19 of 22 bipolar patients with the supplement.

Teen Sex

The conservative think tank, the Heritage Foundation, has released a study that found that 25 percent of sexually active teens say they are depressed all or a lot of the time vs eight percent of girls who are not sexually active. About 14 percent of girls who had intercourse have attempted suicide vs five percent of girls who had not. Six percent of sexually active boys attempted suicide vs less than one percent sexually inactive boys.

Pyrrhic Victory

The Canadian Supreme Court has ruled 6-3 that Scott Starson, 47, is entitled to refuse the antipsychotic meds his doctors want to give him. Despite no formal training, Scott has published academic articles on anti-gravity, relativity, and similar topics. Five years ago, he was hospitalized after a court found him not criminally responsible for making death threats. Release back into the community is not foreseeable for Scott, who believes the Pope is in his employ. Said his mother to CBC News: "I'm devastated and I truthfully believe that the Supreme Court did not have sufficient information. It's the end of his life."

Reintegration Awards

Eli Lilly is seeking applications for its Reintegration Awards. The three awards for people living with bipolar or schizophrenia include: The Artistic Achievement Award, the Mentorship Award, and The Inspiration Award. First place winners will receive $5,000 and second place winners $2,500. Deadline July 25. For more information: http://www.reintegration.com

Boston Tea Party

The Boston Globe reports that Massachusetts has scrapped a plan that would have severely restricted more than 50,000 Medicaid patients in their choice of antipsychotic meds. The restrictions would have come into effect last week. "The impact of destabilizing a person on these drugs is going to be far more drastic than taking someone off of their ulcer medication,'' said Dr. David Osser MD, a psychiatrist on a committee set up to study the matter. The state still has restrictions for antidepressants, which went in place in May.

Food for Thought

"Now, when we should be so excited because we can diagnose mental illnesses and treat them effectively, the states are cutting back services. It's really tragic."

Rosalynn Carter on Larry King Live, which devoted an entire program to depression on May 28.

Next Issue

It’s back to mainstream psychiatry and the Fifth International Conference on Bipolar Disorder, which takes place in Pittsburgh later this week. Stay tuned for exclusive reports.

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