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A QUESTION OF TRUST In Nov 10, 1999, JAMA ran an article and editorial concerning several drug company-sponsored studies that used various techniques to rig their results, including republication of the same data under different author names (thereby creating the misleading impression of lots of studies covering larger populations), placing treatment nonresponders in the group taking the rival company's hope we still trust our psychiatrists by then.

WHY I HATE BILL GATES

My new version of FrontPage won't let me do links in the usual way and refuses to allow me to enter them as HTML the old fashioned way, so until I can figure out the new system, this issue has no links. Going the alternative route of listing the full URL is not workable, either. Those wishing for the URL for any of my sources in this issue are encouraged to contact me at jmcmanamy@snet.net  Hopefully, I will have the problem resolved by next week.

rTMS

A University of Illinois at Chicago study of 25 patients with bipolar depression or unipolar depression has found rTMS (where electromagnets are passed over a patients left prefrontal cortex behind the forehead) reduced depression scores by 55 percent vs a 64 percent reduction for ECT. According to the study's lead author, Dr Philip Janicak: "rTMS is a promising alternative, particularly for the many severely depressed patients who do not benefit from or tolerate current established treatments."

PROZAC DROOP

Has Viagra let you down? Help is on the way. Eli Lilly will be launching Cialis later this year, and Bayer's Upima, which is placed under the tongue was withdrawn by the manufacturer after several people passed out taking it, but a safer nasal version is in development

No mention was made of a Viagra for women.

EASY DOES IT

Those of you considering crash diets might want to take heed the following:

A UK study of 16 amateur boxers on weight-reduction programs (including exercise and diet) found that "rapid weight loss among boxers was associated with poor performance, increased anger, fatigue, and tension, and reduced vigor."

NONRESPONDERS

A University of Washington study of 300 depressed adults being treated with either Paxil, talking therapy, or a placebo found at the end of 11 weeks that 52 percent had responded to treatment. The nonresponders tended to be elderly women, individuals with low education, those with severe medical illnesses or those with high neuroticism scores. More than 70 percent of the younger women recovered compared with 37 percent of the older women. Women had significantly higher responses to a placebo compared to males.

ADVERSE DRUG REACTIONS

A Georgetown survey of 105 directors of third-year internal medicine clerkships and the directors of 420 internal medicine residency programs has found that 53 percent of the medical schools did not offer training in clinical pharmacology or adverse drug reactions. Sixty percent of residency programs offered lectures on adverse drug reactions, but a quarter of residency program directors had never reported one. Eighteen percent did not review drug reactions during their mortality and morbidity conferences.

Adverse drug reactions are believed to be responsible for more than 100,000 deaths a year in the US.

EARLY WARNING SIGNS

A Dutch study polled parents of 1,578 children and adolescents in 1983, then 14 years later assessed the same population with a standard DSM-IV interview. Among the findings: High levels of childhood problems predicted a two to six-fold increased risk for adult DSM-IV diagnoses. Social problems in girls predicted later disorders while rule-breaking behavior in boys predicted both mood disorders and disruptive behaviors in adulthood. According to the study's authors: "The strongest predictor of disorders in adulthood was childhood rule-breaking behavior."

GENDER GAP

A three-nation study of data from Canada, the UK, and the US has found the gender gap in depression (ie the higher numbers in women) "consistently emerges by age 14 across all three national samples, irrespective of the measure used ... "

A BETTER WAY TO BUY GROCERIES

A Johns Hopkins study has found a Minnesota health plan where employers pooled their buying power to purchase health services to be more efficient than HMOs, with no loss in quality. Employees received the option of choosing which services they wanted, eliminating the insurance company middle man. Overall, the plan spent an average of $120 per month for each member vs $152 per month more member for the average Minnesota HMO. Treatment for depression and other illnesses remained stable or improved over the three-year study period.

GOING AFTER HMOs

In a decision with major precedent-setting potential, the Third US Circuit Court of Appeals by two-one has ruled that the Pennsylvania Psychiatric Society may have the legal standing to sue HMOs on behalf of its member psychiatrists and their patients over unfair refusals to pay for psychiatric services. The PPS claimed that the HMOs "impaired the quality of health care provided by psychiatrists to their patients by refusing to authorize necessary psychiatric treatment, excessively burdening the reimbursement process and impeding other vital care."

The case goes back to a lower court.

MENTAL HEALTH FUNDING CRISIS

Two accounts of the deteriorating state of mental health services in the US, the first from the Washington Post:

A Maryland ER elected not to admit Benjamin Hawkes. The next day, in the words of the Washington Post, Benjamin "entered his mother's home wearing only a bathrobe and an American flag draped around his neck and began attacking her and a houseguest. He sliced their necks with kitchen knives, then bashed their faces with a sledgehammer. Police found the 25-year-old Hawkes in the family room, naked, stained with blood and spattered with brain matter, listening to instrumental music at full volume."

The Post continued: "The slayings stand today as a gruesome reminder of all that is unwell with Maryland's mental health system." In 1997, the state changed the way it reimburses clinics and hospitals for the care they give the uninsured and Medicare patients. This year, the system faces a $20 million budget deficit, exacerbated by the state's budget calls for axing $10 million from a promised catch-up increase in mental health funds.

WEWE'RE NUMBER ONE

According to the University of Maryland Counseling Center, depression and anxiety are the top two concerns for students seeking help. Fifty-four percent of students experienced depression and 47 percent experienced anxiety. More than 1,440 undergraduate and graduate students use the counseling service each year. Since 1999, visits to the university's Mental Health Services has increased 18 percent to 6,399.

TROUBLE IN PARADISE

The Pacific island nation of Fiji has established a suicide prevention task force. In 1999, there were 88 suicides, surpassing the 62 road deaths and 64 drownings.

MISSION EARTH

The Church of Scientology is spending $1.1 million on billboards in major US cities as part of its post-Sept 11 campaign to reach "a nation still troubled by the ... attacks." The advertisements promote the free services of Scientology-trained volunteer ministers, with a 1-800 number to call. Since the attacks, the number of volunteer ministers has grown from 5,000 to 14,000. A Scientology spokesperson claims there will be 6,000 more.

The Scientology campaign however, has others concerned. "We have seen the Scientologists present themselves in other settings as mental health counselors when in fact they're not qualified to provide those services," according to Cynthia Folcarelli, executive vice president of the National Mental Health Association.

The Church of Scientology consistently takes a hard line against psychology and psychiatry.

DUELING DEPRESSIONS

An article on Medscape concerns itself with the now dated distinction between "endogenous" and "exogenous" depression. Endogenous depression was thought to relate to the patients biology while the exogenous type was believed to be precipitated by life events. Those with endogenous depression were thought to respond to meds while those with exogenous depression were believed to require talking therapy.

According to Thomas Kramer MD, author of the article: "In retrospect, this rather dualist approach to depression seemed to imply that only some behaviors had anything to do with the chemistry of the brain, but other behaviors were somehow exempt."

LETTERS

We have a very full mailbag this week, so without further ado:

BELONGING

Donna writes:

I feel compelled to expand upon Dr Heuveline's statement regarding the reason for the increased rate of teen accidents, homicides and suicides by seventeen percent. He said, "People are freer here, but to some extent are also freer to hurt themselves."

I am worried that people will dismiss that statement far too easily. Social psychologist Eric Fromm made a powerful point about man's increasing freedom with the rise of capitalism. Its darker side is the movement toward individuation and therefore too much isolation and loneliness without a sense of belonging.

If this is true, adolescents, who crave a sense of belonging, could be in grave danger, for we as Americans sometimes hail individualism to the extreme. Perhaps the events of Sept 11 and our instinctual cohesiveness can serve to remind us all of the importance of belonging. Our eye must be toward balance. The welfare of our youth depends upon it.

WHATWHAT'S IN A NAME?

Daniel writes:

It occurred to me that the name of the disease, "depression", is part of the reason for some of the misunderstanding about the issue. So many times, a person's favorite soda flavor is not available, and they lament, "I'm so depressed!" Then, a real case of depression comes up, and people say " I don't know what he/she has to be depressed about." The two are not the same, but lumped together, and stereotyped, because of the use (misuse) of the word "depressed." Do you, through your energetic work and great website, have any mechanism for petitioning the medical world to give this ailment a new name. I mean "Mongoloid" kids now have Down Syndrome, and "nervous breakdowns" now are more accurately described. Other diseases have more sophisticated names. When I say my son is depressed, I literally get the "what is he depressed about" and then I say, "No, he is "CLINICALLY DEPRESSED" there seems to be some understanding of his plight.

Just a quick note on an opinion, but if this horrible disease was none as "Smith's disease " or "Mike Wallace Disease" we might be able to focus some more attention, and funding, on the issue.

[McMan's disease run a very distant second and third to bipolar disorder.]

WHOWHO'S ON FIRST?

Last week's lead story quoted Mary, who thought people who are manic should be responsible for their actions. Joanne writes:

This philosophy is a little hard line for me. The times I've been manic (twice), I was not able to make any judgements clearly and appropriately. I was psychotic. I was not responsible for my actions. I had a brain disease, not a moral disease.

Now when you talk about responsibility, that's where the meds come in. I have only had two manic episodes (BP1) because after the second time I started taking lithium and I haven't missed a dose since. That was 18 years ago. I don't ever want to experience being psychotic again. The same goes for those who are BP2 and may not experience psychosis; it is there responsibility to those around them to take their meds.

STEPPING OUT

Last week, Sarah, in anticipation of a high school reunion and wondering if some good would result, asked if she should "come out". Charlene writes:

I think "coming out" is a very brave decision and one which I wish more of us would do, particularly in light of all the people who have committed horrible crimes and then try to use this illness as an excuse. I have always been honest about my illness and never had any negative consequences because of it, but I realize I have been lucky to have enlightened friends and family. Good Luck!

Bonnie writes:

Please, share your story with your former classmates. I know that I try to share the story of my son with others, open their eyes to the possibilities that they may know someone similar to him, and be more receptive to the options available. My son, who was once so functional, ambitious, athletic, charming, talented - has all those things on hold. At present he just sits in a house and waits - I don't know exactly for what, but at least he is still in this world. And, I tell these people about my son because I want to open their eyes to the possibility that the illness is right here in our little corner of the world. Folks just can't believe he's where he is at these days. Maybe they could help someone out that needs it if they open their eyes that it could happen in their lives too.

Gayle writes:

My "coming out" was not wrapped around a school reunion but I did, in fact, come out after hiding it for over 20 years. I wrote a book on bipolar and it was accepted and published. Of course all those folks that I had so successfully hid from for 26 years at my place of employment now know and so do all the people that I interact with at church. So there is nowhere to hide now.

Much to my amazement, nobody, at least to my face, has treated me with any disrespect or rejection. In fact, many where I work have approached me with true admiration in their eyes. They seemed to be united in at least one area, they never knew that I struggled with anything so potentially debilitating and yet I was able to not only work around them but they never saw a difference in me. Many have promoted my book to family members and come to speak to me privately regarding issues they have never been able to talk to anybody about. They see me as level, stable and successful at living life with a sense of challenge each day. So it was a risk, but it has turned out very well. No more secrets, no more pretending and there is such a freedom in that!

Would I recommend that for everybody? Probably not. Some people will never receive the support that I have but in your situation you have everything to gain and nothing to lose. It is a win/win situation. Go for it.

[Gayle Darhower's book, "Seek His Face He Will Provide", a message of hope and peace through God, can be purchased from Publish America at http://www.publishamerica.com/ An extract, "Mania - A Christian Perspective", appears on my website at http://www.mcmanweb.com/article-162.htm]

Andrea writes:

If you truly believe that your self-absorbed and mercenary efforts will constructively enlighten the uninformed masses then my reply to you is this, "You're not just nuts, your stupid, too!!!!"

Bob writes:

In 1990, while in a severe state of clinical depression, I shot myself through the heart with a .38 pistol and miraculously lived. I have suffered with depression for years. I am presently taking Wellbutrin.

For a period of about a year after the attempted suicide I hid from the world. I rarely went anywhere except to the bookstore and back home. I was a total mess and was not in any mood to deal with anyone - so I didn't. I stayed real sick too!

Then I began reading anything and everything I could find on the subjects of depression, LSE, and human motivation. In my studies I came across a tape that suggested hiding in shame was self-defeating. To cut to the chase, I began getting out and talking openly and honestly about my condition to anyone who wished to discuss it. I still do. I do not hide, and I am not ashamed of anything I did. I learned not to let the crud from yesterday louse up a perfectly good today!

One of the biggest boosts to my recovery was my ability to be open and honest about who I was and what I had done. You see, Sarah, when you have nothing to hide - you have nothing to fear!

In 2000, I attended my (double gulp) 40th high school class reunion. I had a blast! I talked openly with anyone who asked about what I had done. While in high school I was one of the class leaders and was in the top 1 % academically. I went on to law school and practiced law for 34 years.

Sarah, there are many people running around out there hiding their depression or trying to pretend it doesn't exist, or even not knowing exactly what it is that makes them feel so rotten so much of the time. My honesty and openness about these things has led many I have come in contact with to seek help for themselves as a result of my talking with them. I have been astounded over the past 12 years at the number of people who have told me what a help I was to them by being so honest about my condition.

My advice is quite simple. Hold your head up high and go and do anything you wish without fear of anyone's thoughts about you. Those that would "throw off" on you about what you have been through aren't worth a grain of salt anyway. Phooey on them! :-)

Have a ball, Sarah! It's your life ... live it out in the open and live it "wide open". The only person who is hurt by hiding is the "hider".

Carlton writes:

I forwarded your comments to my Anti Stigma coalition members and this reply came back immediately so I wanted to pass it on with my compliments on your idea.

"I can't think of a more effective or courageous or convincing way to remove the stigma from mental health. Your success in coping, your accomplishments and counsel to others are instructive and inspirational. It is very much a personal decision. Easy for others to comment on. But I think you will do much good for others who struggle as well as our shared general effort to remove stigma if you follow your instinct. With admiration and best wishes ..."

MCMAN'S WEB

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