Jan
16, 2002 Vol 4 No 3
GENE
QUEST
Humans are not fruit flies and the brain is not a simple organ, so mood
disorders are hardly going to yield their genetic secrets easily. The
quest for the genetic cause or causes of depression and bipolar represents
a virtual scientific Boulevard of Broken Dreams thus far, but the prospect
of hitting paydirt always lies around the corner. A commentary by
different Johns Hopkins authors on the website of the NIH National
Center for Biology Information provides a good overview of what we
know and don't know yet what those combinations
are, how they are transmitted, which ones are dominant or recessive, their
interaction with the environment, and on and on. And three, propositions
one and two - not to mention the science behind it - may be completely
wrong. Putting a man on the moon was a snap compared to this.
A
BEAUTIFUL MIND
Due to the high volume of emails I received from people who have seen the
movie, I will be putting out a special supplement Newsletter in the next
day or two. Please feel free to keep sending your reviews to jmcmanamy@snet.net.
PROZAC
GENERATION
A Columbia University study
of 67,000 patients' records has found that antidepressant use doubled from
1987 to 1997, from 37 percent to nearly 75 percent of patients. The rate
of outpatient treatment rose from 0.73 per 100 people to 2.33 per 100
people. Over the same period, however, the share of patients receiving
psychotherapy fell from 71 percent to 61 percent (in absolute terms,
though the numbers rose).
The proportion of patients who saw physicians or psychiatrists rose from
69 percent in 1987 to more than 87 percent in 1997. Health plans paid for
39 percent of depression visits in 1987 and 55 percent in 1997.
MEANWHILE
A Harvard survey has found
that only 15 percent of mentally ill patients appear to be getting
minimally adequate treatment. As many as 8 million Americans with a
serious mental illness fail to receive decent treatment. Forty percent of
seriously mental ill patients receive treatment, but only 39 percent of
these receive adequate treatment. Teenagers are less likely than older
adults to get adequate care. Only one in 20 people with psychosis get
adequate treatment.
DEPRESSION
AND STROKE
A British study of
2,124 men over a 14-year period has found that those who were depressed
and anxious were three times more likely to die from a stroke. The worse
the depression and anxiety, the greater risk of fatal stroke. Stroke is
the number three cause of death in the US. Each year about 600,000 people
suffer from stroke.
PATHWAY
TO REMISSION
Newsletter 4#1 reported on a study that found increased activity in the
prefrontal cortexes of depressed patients who responded to placebos, in
contrast to those who responded to medication. An item in Scientific
American highlights the significance of this finding. According to one
of the researchers, Andrew Leuchter: These results "show us that
there are different pathways to improvement for people suffering from
depression ... If we can identify what some of the mechanisms are that
help people get better with placebo, we may be able to make treatments
more effective."
ADA
The US Supreme Court last week ruled that an impairment must have a
substantial effect on a person'Connor:
"If Congress intended everyone with a physical impairment that
precluded the performance of some isolated, unimportant or particularly
difficult manual task to qualify as disabled, the number of disabled
Americans would surely have been much higher."
ALSO
The US Supreme Court has rejected without comment Eli Lilly's
petition to appeal a federal court ruling that resulted in the loss of its
Prozac monopoly last summer.
THE
MARK OF OPPRESSION
Two months after the collapse of the Taliban regime, according to an
account in the Sunday Gazette Mail, women are still wearing burqas. Says
one former teacher: "Men did not see women in public without the
burqa. So when you take it off, they are constantly looking at you. You
feel like an exotic creature." Says an activist: "Five years of
the Taliban affected us. Their bad behavior toward women left us
psychologically depressed."
AND
ON ANOTHER FRONT
An AP account reports that after 100 days at sea, more sailors aboard the
USS Theodore Roosevelt in the Arabian Gulf are seeking psychological
treatment. Usual deployments last for about 20 days before a carrier calls
into port. The 5,500-strong crew of the Theodore Roosevelt, however, have
been at sea since Sept 19. The ship's psychologist has been seeing
about seven sailors a day. Psychologists were only stationed on aircraft
carriers three or four years ago. Before then, several dozen sailors would
be sent home for psychological reasons. So far, this has not occurred.
IN
THE PIPELINE
According to an article in Medscape,
the dual serotonin and norepinephrine reuptake inhibitor antidepressant
duloxetine shows more potent and evenly balanced action at both these
reuptake sites than the other dual serotonin/norepinephrine drug, Effexor.
Data from phase III trials show a statistically significant superiority to
Paxil.
CLOSE
CALL
In his new book, My Stroke of Luck, actor Kirk Douglas recounts how his
spirits sunk so low following a stroke that he put a loaded gun in his
mouth. "I stuck the long barrel of the pistol in my mouth," he
writes, "and it bumped my teeth. `Ow!' It sent shivers through my
teeth and I pulled the gun out. I began to laugh. A toothache delayed my
death. I laughed hysterically."
The actor counsels stroke victims and their families. "I think almost
everybody with a stroke has thoughts of suicide," he told USA Today.
"It seemed hopeless with me at that age. At that time I was thinking
I would never be able to talk and act."
ATTITUDES
A University of London study has
found Protestants in the UK, particularly men, drink more than Jews, have
more favorable attitudes toward alcohol, and are more tolerant of
alcoholics. Jewish men, on the other hand, are reluctant to use alcohol as
an escape from depression. According to the study's co-author,
Professor Kate Loewenthal: "The study may help explain the higher
prevalence of depression among Jewish men, because they are more willing
to recognize and report it."
Jews were also marginally less accepting of suicide than Protestants.
ACUPUNCTURE
A University of Vermont study
of 60 acupuncture clients found manipulation of the acupuncture needles -
either by rotation or by piston motions - resulted in greater force needed
to pull out the needles, thus establishing a bio association in the
tissue, potentially of long-lasting cellular and extracellular effect.
Acupuncture typically involves needle manipulation after insertion.
ACCUTANE
Past Newsletters have reported on the possibility of a link between the
acne medication Accutane and major depression or suicide. The discovery of
an Accutane prescription in the home of Charles Bishop, the teenager who
crashed a small plane into a Florida office building, has reopened the
issue. Toxicology tests that could reveal the presence of the drug in
Charles'
s warning to include:
"... Accutane may cause depression, psychosis, and, rarely, suicidal
ideation, suicide attempts and suicide."
CAREFUL
According to an article in WebMD,
researchers at Massachusetts General Hospital reported on three people who
developed sudden very severe headache and brain changes after taking two
or more drugs that affect serotonin levels. These include SSRIs, migraine
medicines such as Amerge, diet pills, amphetamines, St John's
wort,
and illicit drugs including ecstasy, cocaine, and amphetamine.
The article did not say which of the drugs the patients were taking.
The researchers also cautioned about the affect of combining these
substances with meds that can cause narrowing of blood vessels, such as
pseudoephedrine found in many over-the-counter cold and allergy remedies.
EYE-OPENER
According to a Falkland War veteran's group, more veterans of that
conflict have taken their lives in the 20 years that followed than the 255
killed in the fighting itself. An exact suicide count is unknown.
STIGMATA
A London woman was turned away from the US at Pearson
International Airport in Toronto due to a little-known law. When asked
where she worked, she told immigration officials she was on disability
because she might have bipolar. She missed spending the holidays with
family in Wisconsin as a result. She later drove across the border.
The law states immigration authorities may deny access to any person
deemed to have a physical or mental disorder that may, or has, posed a
threat to the property, safety or welfare of themselves or others.
"They made me feel dirty," the woman told the London (Ontario)
Free Press. "They made me feel this is something I should be ashamed
of."
PMDD
AND DEPRESSION
A Rush-Presbyterian-St. Luke's Medical Center pilot study
of eight women with premenstrual dysphoric disorder found seven of the
eight women developed major depression within two years, including all
those who never had depression before. According to the study's
authors: "The odds that a woman with PMDD developed [major
depression] were 14 times the odds that a woman without PMDD developed
[major depression]."
BIPOLAR
KIDS
An Italian study
of 43 bipolar kids aged seven to 18 has found only 11.6 percent did not
have any other psychiatric disorder, and only 23.5 did not have
co-occurring anxiety.
FROM
THE AJP
Twenty-three percent of a sample of mothers in Goa, India were depressed
six to eight weeks after giving birth. Seventy-eight percent had
"clinically substantial psychological morbidity during the antenatal
period," leading the study's authors to conclude:
"Economic deprivation and poor marital relationships were important
risk factors for the occurrence and chronicity of depression."
An Italian genetic study suggests that bipolar with co-occurring panic
disorder may be a genetic subtype of bipolar.
Clozapine and Zyprexa produced a high risk of EEG abnormality (47.1
percent and 38.5 percent) compared to Risperdal (28 percent), older
generation antipsychotics (14.5 percent) and Seroquel (no risk).BENZODIAZEPINES
AND PREGNANCY
A review published in Psychiatric
Services of previous studies suggests it is safe to take Valium
(diazepam) during pregnancy but not during lactation because it can cause
lethargy, sedation, and weight loss in infants. The use of Librium (chlordiazepoxide)
during pregnancy and lactation seems safe. Avoidance of Xanax (alprazolam)
during pregnancy and lactation "would be prudent."
The author advises minimizing risk by using benzodiazepines with
established safety records at the lowest dosage for the shortest possible
duration, avoiding use during the first trimester, and avoiding multidrug
regimens.
ALGORITHMS
Ariel writes:
The idea of treatment algorithms for the medical model of depression and
bipolar disease frighten me. I see it as a way for managed care facilities
to allow nonspecialists to treat mental illness. For example, just call a
1-800 number and get your automatic three month refill.
Mental illness is far too complex and individual in its manifestation,
presentation, and treatment. At this time, we still need mental health
professionals who are familiar with the nuances of their drug therapy. As
far as I know, not every unipolar depression responds across the board to
fluoxetine. It can be a trial and error approach over many years.
Therefore, I weep for the future when some expert comes out with a
treatment algorithm that can be used for non MDs for treating my illness.
DISPATCH
FROM THE ABYSS
"I want to drink tonight. I want to take a bottle of vodka and take a
long hot bath in my pajamas. Drink the bottle in the bath tub. Toast the
new years. And when the bottle is empty, crash it against the bathtub,
shattering it. And taking the shards and slitting my wrists, my ankles, my
throat. Watching the blood ebb out. I want the pain to stop. I want the
loneliness to stop. I feel all alone. I feel empty. I feel worthless. I
feel like I should have been born dead. I don's chilling "Dispatch From the
Abyss" at: http://www.mcmanweb.com/article-167.htm
While there, you can click on the links to read her other articles as well
as check out the rest of this online anthology.
MCMAN'S
WEB
Check out more than 170 articles on all aspects of depression and bipolar,
plus a bookstore, readers' forum, message boards, chat room and other
features at: http://www.mcmanweb.com
SUBSCRIBE
If someone has passed this on to you:
You are invited to subscribe for US $29 a year for 48 issues. You can pay
by credit card online at: http://mcmanweb.com/newsletter1.htm
Or you can mail your check to:
McMan's Weekly
PO Box 331
Southington, CT 06489
USA
Please be sure to include your email address on your check or money order.
For those of you who wish to write larger checks, the surplus will be
applied toward subsidizing subscriptions to those in need. For those
in need, subscriptions are $10 contingent on the generosity of other
readers.
You can also pay by credit card via PayPal
and credit to the account of jmcmanamy@snet.net
For change of address, email jmcmanamy@snet.net
with your new email address.
For three free sample issues, email jmcmanamy@snet.net
and put "Sample" in the heading and your email address in the
body.
John McManamy
"Knowledge is necessity."
|
