McMan's
Depression and Bipolar Weekly
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Jan
2, 2001 Vol 4 No 1
A
BEAUTIFUL MIND
As a 20-year-old doctoral candidate in mathematics at Princeton in
1948, John Nash was the odd one out, an outlander from West Virginia who
simultaneously felt superior to and out of sorts with his preppie colleagues.
"There could be a mathematical explanation for how bad your tie is,"
he tells
one classmate. While at Princeton, he came up with a strikingly original
contribution to games theory (which purports to predict seemingly random
human behavior) that would win him the Nobel Prize in Economics nearly fifty
years later, but a full 25 years in between would be lost to schizophrenia.
Ron Howard has produced and directed a film based on John Nash's life,
"A Beautiful Mind," starring Russell Crowe in a tour de force
performance
that makes him a strong candidate for his second Oscar in a row.
Schizophrenia may be vastly different from our own life experience, but we
share enough of the same symptoms and meds - not to mention treatments,
hospitalizations, and stigma - to feel we are watching as insiders.
Accordingly, when John Nash's reality dissolves into madness and he is
bundled into the back seat on his way to involuntary commitment, we relive
all the horror and shame and hurt of our own life stories. There's no point
in trying to suppress a tear. Mother Nature has just delivered one of its
fiercest blows and we more than anyone else on the planet have an inkling of
what that's like.
At the same time, however, comes that feeling of great release. They
GET it! you want to jump up and shout. After all these years, all this time,
someone out there actually gets it. Maybe the people who voted down mental
health parity will see the film, one dares think. Maybe the producers of all
those prime time shows that portray the mentally ill as violent 72 percent of
the time will be inspired to come up with sympathetic characters.
But this is Hollywood, and the movie takes some sharp deviations from
real life. By far the most contentious is when Russell Crowe's character
decides to go off his meds so he can have a clear head to continue with his
work. The hero ethos of Hollywood demands nothing less, but one needs to
check the credits to be assured that psychiatry's antichrist Peter Breggin
was not the movie's technical adviser. In the end, this fictitious John Nash,
now on newer meds, acknowledges that the illness is something he can at best
accommodate, not overcome. This mitigates the antipsychiatry theme of the
movie, somewhat, but now we are left with the wrong impression that
schizophrenia never remits.
Enter the real John Nash. A short burst of creativity coincided with a
brief remission during the late fifties, but the sixties through to the
eighties were lost years. John Nash himself describes this time as "the gap
period of about 25 years of partially deluded thinking [which provided] a
sort of vacation ..." Later, he would resume his work, but not until his
madness showed him who was boss and gave him a reprieve. It was only after
this later remission that John Nash was able to go off his meds, not before.
Paradoxically, Russell Crowe molds this fictitious John Nash into a
character truer than life, as he shuffles about Princeton's campus in a
nuanced choreography of facial and body tics and spirited interactions with
imaginary people. Not since Charlie Chaplin has an actor exhibited such head
to toe mastery, but only Russell Crowe has accomplished this as drama.
Ultimately, reality and Hollywood converge in the form of John Nash's
Nobel Prize. Who can blame Ron Howard for going with the obvious feel-good
ending? It is time to forget what your head may be telling you, at this
stage. Go with your heart and get out your largest hankie. Then tell ten
people to go see this movie.
MORE
Chances are friends and family will ask you for your "expert" opinion
of "A Beautiful Mind." Feel free to share your thoughts here by
emailing
jmcmanamy@s...
Following are the impressions of two of the first in line:
From Richard:
I saw the movie yesterday and have to compliment Ron Howard and Russell
Crowe on a great job bringing such an important topic to the big screen.
And from Sally:
I did and did not see it. I went to a screening two weeks ago in
Princeton, where it was filmed. Now I would have seen this movie anyway, but
the rumor was that Russell Crowe would be attending. So naturally I got
dolled up, bought new clothes and was really excited. So was every other
female in the audience with a pulse. Needless to say I spent half the movie
looking around to see if I could see him. I didn't. The bits and pieces I saw
were awesome. Really awesome. But I missed half the movie because I was
looking for Russell Crowe. I will see it again.
SERZONE
WARNING
The FDA has instructed Bristol-Myers Squibb to issue the following
black box warning on its antidepressant, Serzone:
"Patients should be informed that SERZONE therapy has been associated
with liver abnormalities ranging from asymptomatic reversible serum
transaminase increases to cases of liver failure resulting in transplant
and/or death. At present, there is no way to predict who is likely to develop
liver failure. Ordinarily, patients with active liver disease should not be
treated with SERZONE. Patients should be advised to be alert for signs of
liver dysfunction (jaundice, anorexia, gastrointestinal complaints, malaise,
etc.) and to report them to their doctor immediately if they occur."
Additional information provided by Bristol-Myers Squibb notes that
there is one case of liver failure for every 250,000-300,000 patient years of
Serzone treatment, three to four times higher than normal. Concerned users
are urged to call Bristol-Myers Squibb at 1-800-321-1335.
NO
COST SAVINGS
Next time your health plan tries to put you on Haldol, you might want
to cite this study:
An open study co-authored by Frederick Goodwin MD, former director of
the NIMH, of 17 patients on Risperdal and 15 patients on older antipsychotics
found overall cost per year to be about the same - $2,703 in the Risperdal
group compared to $2,55l in the older antipsychotics group. The increased
cost of Risperdal ($1,631 per patient year vs $357 for older antipsychotics)
was offset by decreased hospitalization rates in the Risperdal group. Use of
outpatient services did not significantly differ.
SAD
An NIMH study of winter and summer melatonin levels in 55 SAD patients
and 55 healthy volunteers found the SAD patients experienced longer nocturnal
periods of active melatonin secretion in winter while there was no change in
the healthy volunteers. The study's authors conclude: "The results show
that
patients with seasonal affective disorder generate a biological signal of
change of season that is absent in healthy volunteers."
BRAIN
DAMAGE
Newsletter 3#43 reported on subtle cognitive brain impairments that may
be permanent for some people with bipolar. A Spanish study of 49 bipolar
patients in remission found a pattern of "cognitive deficits in tests of
executive function" similar to a group of 49 schizophrenic patients without
severe symptoms, but "quantitatively more marked" in the schizophrenia
group.
VPM
FOR BP
A University of Louisville study of 28 bipolar women found most reduced
their symptoms by 50 percent or more after taking the calcium ion blocker
Verapamil. All of those who were manic responded vs 39 percent who were
depressed vs 77 percent in mixed states. Six of eight patients on
continuation therapy remained well. According to the study's authors: "The
response rate for mania compares favorably to that for other mood
stabilizers. After decades of case reports and underpowered clinical trials,
we must definitively study [Verapamil] for efficacy and gender specificity in
bipolar disorder."
rTMS
VS ECT
A study of 25 patients with major depression published in Biological
Psychiatry has found that those who received 10 to 20 treatments of rTMS
showed similar improvement (55 percent reduction in symptoms) to those who
received four to 12 treatments of ECT (64 percent reduction).
PHEN
COMBO
Please don't try this without a doctor's supervision:
According to an ABC News account, some doctors are prescribing a
combination of antidepressants and phentermine to help patients lose weight.
Phentermine is the "Phen" in "Fen-Phen." According to Dr
Richard Atkinson,
professor of medicine at the University of Wisconsin in Madison and the
president of the American Obesity Association who prescribes the combination
to his obese patients: "Obesity is a chronic disease. Pretty much every
other
chronic disease I can think of requires more than one drug."
But says Connie Diekman, director of nutrition at Washington
University: "People want the easy answer when it comes to weight loss, and
unfortunately it just doesn't exist."
NO
LIE
Be careful about using a mental illness defense to a minor charge. A
Virginia State Crime Commission reports that of 250 people in Virginia state
mental institutions for crimes, 63 committed misdemeanors and the average
confinement for those 63 was three years. One man accused of breaking a
window has been confined for 13 years. According to the Commission, it costs
$160,000 a year to maintain a patient in a state health facility.
WE'RE
NUMBER SIX
According to a Council of Public Relations Firms survey, more than a
quarter of Americans believe drug and alcohol abuse is the most urgent health
issue in the US. Mental health and depression was sixth at 10 percent.
ANOTHER
9/11 VICTIM
Joe Flounders, who worked on the 84th floor of the World Trade Center's
south tower, never made it out of the building that fateful Sept 11. His
surviving wife, Pat, had been struggling with depression before Joe's death.
Concerned neighbors took knives and guns from her home, but she kept hidden a
tiny pistol which she used to shoot herself. According to US News, she is the
first known family member of a Sept 11 victim to commit suicide.
DOWNHILL
RACER
When US Olympic gold medal skier Picabo Street is in top form, she is
going downhill. She has also gone downhill several times following the
injuries that are part of the sport. A few years ago, a spectacular
crash-landing in Switzerland shattered her left leg and tore apart her right
knee. Nightmares and depression followed, along with five operations and
arduous rehab. Now she is staging an improbable comeback at age 30. Her goal
is to compete in this year's Winter Olympics, but she has not yet made the
team.
WHO
TREATS YOUR DEPRESSION?
From an article on Medscape:
"Only 30 percent to 40 percent of depressed patients are accurately
diagnosed by primary care physicians, although 50 percent of all depressive
episodes are treated in a primary care setting."
The article goes on to say that only 45 percent of those accurately
diagnosed receive appropriate meds, but the dose or duration of treatment is
often inadequate.
BP
MEDS
An NIMH study of 35 patients with refractory bipolar and 10 with
refractory depression has found that 51 percent responded to Lamictal and 28
percent to Neurontin, not much better than the placebo. Neurontin, however,
appeared more effective in younger patients with lower weight.
GENE
QUEST
A multi-center European study of genetic samples of 75 bipolar families
turned up a suspect on chromosome 8q24, "a region that has not attracted
much
attention in previous linkage studies of [bipolar]." The second best
finding
was seen on chromosome 10q25-q26.
BRAIN
SCAN
The amygdala in the brain has been implicated in mood. A German study
using brain scans on 30 depressed patients and 30 healthy controls found the
depressed patients showed increased amygdala volumes in both hemispheres
compared to the controls. The study's authors speculate that enlarged
amygdala volumes in patients with a first episode of major depression might
be due to enhanced blood flow to the region.
FROM
THE AJP
a.. Co-occurring panic disorder may define a subtype of bipolar. In
one study, DNA samples revealed significantly higher frequencies of COMT
Val158Met, 5-HTTLPR, and TPH IVS7+218C gene mutations in bipolar patients
with panic disorder.
b.. A study of family groups found that risk for panic disorder with
familial bipolar appears to be inherited.
c.. "Nearly three-quarters of patients with bipolar disorder have a
thyroid profile that may be suboptimal for antidepressant response."
d.. EEGs of depressed patients who responded to placebos found a
significant increase in prefrontal activity early in treatment compared to
medication responders (who showed a decline) and nonresponders. The study's
authors concluded: "These findings suggest that 'effective' placebo
treatment induces changes in brain function that are distinct from those
associated with antidepressant medication."
CHILDHOOD RISKS
Two studies:
a.. A Center for Disease Control survey of 17,337 adults has found
that lifetime prevalence of at least one suicide attempt was 3.8 percent, but
adverse childhood experiences in any category (emotional, physical, and
sexual abuse; household substance abuse, mental illness, incarceration,
parental domestic violence, separation, or divorce) increased the risk two to
five-fold.
b.. A Stanley Foundation survey of 631 bipolar outpatients found
those who had a history child/adolescent physical or sexual abuse had an
increased number of co-occurring disorders, including drug and alcohol abuse,
a greater number of medical illnesses, earlier onset of bipolar illness,
faster cycling frequencies, and a higher rate of suicide attempts. According
to the authors: "Greater appreciation of the association of early traumatic
experiences and an adverse course of bipolar illness should lead to
preventive and early intervention approaches that may help lessen the
associated risk of a poor outcome."
MCMAN'S
WEB
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on all aspects of depression and bipolar, plus a bookstore, readers' forum,
and other features.
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