Markham's Behavioral Health

Pharmaceutical companies disease monger to detriment of society

Catherine Arnst had an interesting article published in the May 8, 2006 issue of Business Week entitled "Hey, You Don't Look So Good: As Diagnoses Of Once-Rare Illnesses Soar, Doctors Say Drugmakers Are 'Disease Mongering' To Boost Sales".

Here is a snippet from the article:

Click on article to enlage for easier reading.

 

What do Republicans and Effexor have in common?

According to John Stewart what the Republicans and Effexor have in common is the same slogan - The change you deserve." Video lasts about 2:37 minutes.

Annuale- a new pill for women who only want to have a period once per year

NIH Research Suggests Stimulant Treatment for ADHD Does Not Contribute to Substance Abuse Later in Life

According to a April 1, 2008, press release by the National Institutes of Health, NIH, recent studies indicate that the use of stimulate medication to minimize symptoms of ADHD in youth does not contribute to substance abuse. Here is a brief snippet of the release:

Treating children as early as age six or seven with stimulants for Attention Deficit Hyperactivity Disorder (ADHD) is not likely to increase risk of substance abuse as adults, according to two studies funded by the National Institutes of Health (NIH). However, the studies also showed treatment with stimulants did not prevent substance abuse later in adulthood. The studies, conducted by researchers at New York University School of Medicine (NYU) and the Massachusetts General Hospital/Harvard Medical School (Mass General) are being published in this month’s American Journal of Psychiatry.

Link: NIH Research Suggests Stimulant Treatment for ADHD Does Not Contribute to Substance Abuse Later in Life, April 1, 2008 News Release - National Institutes of Health (NIH).

Feeling like your real self.

I remember reading a story that Peter Kramer tells in his book, Listening To Prozac, when Dr. Kramer said he prescribed Prozac to a young woman who didn't meet the criteria for the diagnosis of depression. When she returned for a follow-up six weeks later, she told Dr. Kramer that Prozac had changed her life. He asked what she meant and she said, "For the first time in my life, I feel like my real self." Dr. Kramer said he pondered her statement for some time. What does it mean to feel like your real self?

We are all expected to play certain roles, to behave in certain ways, to pretend to feel certain ways to please others. After awhile we loose touch with what is genuine, true, real, deep down. Does it take a drug to help us get back in touch with our soul?

It is very difficult to find our real self, the truth, after we have lost our way. I believe that psychotherapy is a better way to do this than by taking drugs but then who am I to judge?

Socrates said that an unexamined life is not worth living. How many  people do you know who are living examined lives? The two places in our society that I have met them are in my psychotherapy office and in twelve step rooms like Alcoholics Anonymous. Once in a while I might meet them at Church or at the University, but that is rare. If we are blessed, we have this opportunity to come to realize our true selves in our marriages, families, or very close friendships.

One of the most important challenges in life is to become aware of and facilitate the development of our true selves.

Only Severely Depressed Benefit From Antidepressants

And while I am writing about antidepressants today and the treatment of depression, let me mention here that antidepressants, while a great revenue enhancer for the pharmaceutical companies, don't seem to work beyond what one would expect from the placebo effect.

Reuters HealthDay reported on March 1, 2008 on a study which appears in the on-line journal, PLoS Medicine, on February 25, 2008 which found that antidepressants only helped in severe depression. They did not seem to have much of an effect beyond the placebo effect for mild and moderate depression.

Again, these are not new findings. Most of us in the mental health field have known this for years. Primary Care Physicians continue to prescribe antidepressants because it is an easy, quick way to respond to patient's complaints, and the pharmaceutical companies have plied Primary Care Phsysicians with plenty of free samples to give the physician and patient the illusion that there is a quick fix in popping a pill. Here's a snippet from the Reuters article:

While popular antidepressants such as Prozac are widely prescribed for people with varying degrees of depression, the drugs are only effective for those with the most severe depression, a new study suggests.

"Although patients get better when they take antidepressants, they also get better when they take a placebo, and the difference in improvement is not very great," lead researcher Irving Kirsch, a professor of psychology at the University of Hull in Great Britain, said in a prepared statement. "This means that depressed people can improve without chemical treatments," he added.

In the study, Kirsch and his colleagues collected data on 35 clinical trials of antidepressant drugs whose results had been submitted to the U.S. Food and Drug Administration. The antidepressants included in the trials were fluoxetine (Prozac), venlafaxine (Effexor), nefazodone (Serzone), and paroxetine (Seroxat/Paxil).

An analysis of the data showed that patients taking antidepressants fared no better than patients receiving a placebo. This appeared to be the case whether the patients were mildly or moderately depressed.

The drugs only seemed to benefit a small group of patients -- those with the severest depression when the study began.

Based on these results, there appears to be little reason to prescribe these antidepressants to anyone but the most severely depressed patients, the study authors concluded.

The findings were published online Feb. 25 in the journal PLoS Medicine.

Brief cognitive behaviorally oriented psychotherapy is treatment of choice for mild to moderate forms of depression, and has been shown to be very helpful with medications and other treatments with severely depressed patients as well.

Link: MedlinePlus: Only Severely Depressed Benefit From Antidepressants: Study.

Psychotherapy helps for Depressed Teens

Reuters HealthDay reported on February 26, 2008 on a study published in the February 27, 2008 issue of JAMA, the Journal of the American Medical Association, that if adolescent depression doesn't lift after treatment with an antidepressant, guess what, psychotherapy helps and/or maybe another antidepressant.

While the Reuters article headline is "New Hope for depressed teens", this is old news and mental health professionals, I hope, have known this for years. Most careful research has found that psychotherapy is the treatment of choice especially for adolescent depression, and sometimes, medication can help. Of course, it is much easier for Primary Care Physicians to write out a prescription or give the teen pharmaceutical samples than it is to actually listen to the kid's troubles.

At any rate, it is validating to see some research which finds what I and most of my collegaues already know and that is, psychotherapy is helpful.

Link: MedlinePlus: New Hope for Depressed Teens.

College students have more psychiatric problems than ever straining college counseling centers

According to an article in Inside Higher Ed on March 18, 2008 more students in college these days have psychiatric problems requiring treatment.

In last year’s annual survey of counseling center directors sponsored by the American College Counseling Association, fully 91.5 percent reported observing the “recent trend toward greater number of students with severe psychological problems” on their campuses, while 87.5 percent said they noticed a growing number of students arriving on campus already on medication. They reported that 23.3 percent of “clients” at counseling centers are on psychiatric medication, up from 20 percent in 2003 and 17 percent in 2000. In 1994, the number was even lower, at 9 percent.

Link: The Mental Health Squeeze :: Inside Higher Ed :: Higher Education's Source for News, and Views and Jobs.

Socially connected people do better after surgery

To us Social Workers the findings in a study published in the February, 2008 issue of the Journal of the American College of Sugeons and reported by Reuters on 02/21/08 comes as no surprise. People with good social support do better in outcomes after surgery than those without good social support. Here's a brief snippet from the Reuter's article:

People who have a strong social network feel less pain and anxiety before having surgery than their more isolated peers, according to a new study in VA patients. This translates to less pain and anxiety after the operation, less use of pain medication, and fewer days spent in the hospital, researchers report.

"Our hope is to try to put a spotlight on this for surgeons," Dr. Daniel B. Hinshaw told Reuters Health. The findings make it clear, he explained, that surgeons should ask patients about their level of social support, and anticipate that people with less support may fare worse.

"The old John Donne reference 'no man is an island' is extremely relevant to our health," he commented.

Link: MedlinePlus: Socially connected people do better after surgery.

Chantix May Raise Suicide Risk but smoking is still the far greater health risk

Reuters HealthDay reported on February 1, 2008 that the FDA has warned that the anti-smoking drug, Chantix, might contribute to suicidal ideas and behavior.

There's increasing evidence that the smoking-cessation drug Chantix is linked to serious "neuropsychiatric" side effects, including agitation, depressed mood and even suicide, U.S. health officials said Friday.

The U.S. Food and Drug Administration has asked Chantix's manufacturer, Pfizer Inc., to make the warning about these potential problems more prominent on prescribing information and on the drug's label. The agency is also working with Pfizer to produce a Medication Guide for patients, officials said.

"We have become increasingly concerned as we have seen a number of compelling cases that truly look as if they are the result of exposure to the drug and not to other causes," Dr. Bob Rappaport, director of the FDA's Division of Anesthesia, Analgesia and Rheumatology Products, said during an afternoon teleconference.

"These cases involve abnormal behaviors, changes in mood, and suicidal ideation and suicide," Rappaport said.

The FDA knows of 491 cases of suicidal behavior associated with Chantix, said Dr. Celia Winchell, a team leader in the FDA's Division of Anesthesia, Analgesia and Rheumatology Products.

"Of these, 420 are from the United States," Winchell said. "There are 39 that involve completed suicides, 34 in the United States."

According to Pfizer, 5 million patients have taken Chantix, whose generic name is varenicline.

Friday's warning follows a Nov. 20 FDA statement that the agency was "evaluating post-marketing adverse event reports on Chantix related to changes in behavior, agitation, depressed mood, suicidal ideation, and actual suicidal behavior."

At that time, Pfizer said there had never been a cause-and-effect relationship shown between Chantix and these symptoms. The company also said that part of the problem may be due to nicotine withdrawal.

Pifzer who manufactures and markets Chantix says that part of the agitation and suicidal ideas might be linked to nicotine withdrawal. One thing seems clear, and cigarettes are a huge risk factor for premature death so stopping smoking, even with the use of Chantix, is well worth any minimal risk.

Link: MedlinePlus: Quit-Smoking Drug May Raise Suicide Risk.