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Nuvigil: Not Better Than Placebo for Depression Symptoms in Bipolar

Saturday, August 31st, 2013

Nuvigil: Not Better Than Placebo for Depression Symptoms in BipolarMillions of people around the world rely on antidepressants in the treatment of clinical depression and, to a lesser extent, bipolar disorder. Over a dozen such medications exist, and many are also available in generic form.

But for reasons that scientists can’t yet adequately explain, some people don’t respond to many antidepressant drugs. And the drugs they do respond to may carry unwanted side effects that make taking the drug for any length of time downright challenging.

So drug companies are constantly looking for new drugs, new uses for old drugs, and new formulations of old drugs to help improve their batting average. Sadly for this effort, though, we can cross off another potential drug — Nuvigil (armodafinil).

Are We Medicating Normalcy?

Sunday, August 25th, 2013

Are We Medicating Normalcy?You’ve heard it all at dinner parties, graduations, school fundraisers, and family cookouts… At least, I have, and it goes something like this:

“Psychiatry is a business that is medicating every normal syndrome out there: Too shy to ask a girl to prom? Take Zoloft for Social Anxiety Disorder…. Grieving the loss of a spouse a year after he passed away? Try Prozac for Major Depressive Disorder…. Feeling a little hyper and can’t concentrate? You need Adderall for Attention Deficit Hyperactivity Disorder.

“Doctors are greedy experts that are too lazy to get to the core problem and will medicate any person for any reason. They are essentially poisoning the population with this pill-popping philosophy.”

Now I know that there is a bit of truth to this… So it led to me to wonder, are we medicating normalcy?

Do You Understand the Bipolar Spectrum?

Wednesday, August 21st, 2013

Do You Understand the Bipolar Spectrum?In modern psychiatry, there is more than one type of bipolar disorder, and patients may be told that they are ‘somewhere on the bipolar spectrum.’

This can be confusing to hear; as a newly diagnosed patient, you may wonder, ‘so do I really have bipolar disorder or not?’

According to the current, dominant model, the bipolar spectrum runs from bipolar I at one end, to cyclothymia and ‘not otherwise specified’ at the other.

You may have heard that bipolar disorder (BD) affects only one in a hundred people, but this is untrue — or only a partial truth — according to the spectrum model.

Is a Glut of Antidepressants Really So Bad?

Monday, August 19th, 2013

Is a Glut of Antidepressants Really So Bad?The other week I read in the New York Times about a “glut of antidepressants.” The story was about the loose (and perhaps over-diagnosis) of depression in a community sample of over 5,600 patients.

Most of those patients examined who supposedly had clinical depression turned out to, in fact, not have it — only just over 38 percent met the official criteria after 12 months.

Somehow this got convoluted with the increase in antidepressants over the past two decades. “One in 10 Americans now takes an antidepressant medication; among women in their 40s and 50s, the figure is one in four.”

While we can lament this increase all we want, I also can’t help but say, “So what?”

Life as a Mentally Ill Professional

Tuesday, July 30th, 2013

Life as a Mentally Ill ProfessionalI am a Social Security disability attorney and I just won another bipolar case for the most deserving of clients.

I have a soft spot for her myriad problems: psychotic breaks, commitment to psychiatric hospitals, deep depression, panic attacks… you name it. Today was a glorious day when I feel proud of my profession and lucky that I have found somewhere to do good while living with a mental illness.

Yes, living with a mental illness. I am 37 years old and was diagnosed with bipolar disorder in February 2000.

Biomarkers: Can Blood & Brain Scans Help with Future Depression Treatment?

Thursday, July 25th, 2013

Biomarkers: Can Blood & Brain Scans Help with Future Depression Treatment?Are predictive biomarkers the wave of the future of depression treatment?

Recent research has demonstrated — in small pilot studies — that brain PET scans and, in a separate study, blood proteins, may act as important biomarkers for determining whether an antidepressant or cognitive behavioral therapy might be the best treatment for a person’s clinical depression.

Such an indicator would be a potential boon for those seeking treatment for depression. Currently, depression treatment is characterized by a trial-and-error approach, with most professionals recommending most people get both medications and psychotherapy.

These studies point to the possibility that, in the future, we may have a more reliable way of directing people to the treatment that’s going to be the most effective for them.

Looking for a Doctor? 10 Questions You Should Always Ask

Tuesday, July 9th, 2013

Looking for a Doctor? 10 Questions You Should Always AskThe average patient with bipolar disorder takes approximately 10 years to get a proper diagnosis. About 56 percent are first diagnosed with unipolar depression. I imagine the stats for depression and other diagnoses aren’t pretty either.

Working with a good doctor can save you 15 years of pain and misery. Trust me, I know.

I went through seven doctors before finding the one who saved my life. Not only was I diagnosed incorrectly for more than 10 years of my life, once I did get the right diagnosis, I was treated incorrectly — with about 15 different kinds of medication in the time period of four months.

No wonder I was admitted into the ER to detox.

What are Some of the Physiological Manifestations of PTSD?

Friday, June 28th, 2013

What are Some of the Physiological Manifestations of PTSD?Post-traumatic stress disorder, or PTSD, is a result of severe trauma. The trauma experienced is usually one that has threatened a person’s safety. PTSD is seen in people returning from fighting in a war, or people who have been victims of violence or a natural disaster.

It’s normal to feel traumatized by significant life events such as surviving a severe car accident. It becomes pathological when the feelings of trauma, anxiety, panic, or sadness don’t fade with time. People who experience PTSD may feel like they are forever changed and suffer constant panic attacks, loss of sleep and social isolation.

Trauma and prolonged stress inevitably has a negative impact on overall health. PTSD has been linked to more physician visits in veteran populations.

You Will Gain Weight on these 6 Psychiatric Medications

Friday, June 28th, 2013

You Will Gain Weight on these 6 Psychiatric MedicationsI had been on the drug Zyprexa (olanzapine) for four weeks and had already gained 15 pounds which, you know, didn’t help my depression.

After going to a wedding and catching a side view of myself, I called my doctor and told him that my name was now Violet Beauregarde, you know, the gum chewer in “Charlie and the Chocolate Factory” who becomes a blueberry balloon. Except that when I rose to the top of the room I was crying.

“The two most common questions that patients ask me are, ‘Will I become dependent on the medications?’ and ‘Will I gain weight?’” says Sanjay Gupta, M.D.

What If a Sugar Pill Was Just as Effective As Psychotherapy?

Wednesday, June 26th, 2013

What If a Sugar Pill Was Just as Effective As Psychotherapy?Yum, sugar pills! We talk about them all the time in science, where they have a much more formal and less appetizing name — placebos.

A placebo is simply something used in research to act as a treatment equivalent, so as to not bias either the research subjects or the researchers themselves in how they perceive and react to the experimental treatment. In research on drugs, this often means giving one group of patients pills that look just like the medicine being studied, but lacking any active ingredient.

In recent years, new research has emerged looking solely at the studies that were used to gain FDA approval of antidepressant medications (some of which were never published). When taken together, the studies found that antidepressant medications may not be as effective as previously thought (but what any patient who’s ever tried them could’ve told us decades ago). This recent research found effect sizes of just 0.31.

Which got some researchers to wonder… If antidepressant drug treatment effect sizes might be lower than we had thought, could the same be true for psychotherapy effect sizes too?

Could, in fact, a sugar pill offer as much change in one’s depression as months or years of intensive psychotherapy?

Brain Chemistry Altered by Later Life Experience, Part 2

Sunday, June 16th, 2013

Brain Chemistry Altered by Later Life Experience, Part 2I recently wrote of an informative NBC News article of June 2, 2013 (see part 1 here). Investigative reporter Rebecca Ruiz laid out medical research evidence pointing toward non-genetic alterations in brain chemistry — that is, organic changes in the brain’s chemistry after birth.

Specifically, Ruiz’s article was centered around the behavioral concept of resiliency. She provided medical research and testimony, as well as case study, that early formative experiences may produce structural adaptations to genes

Amazing, that early experiences can have such an impact on the developing physical brain. But what about later in life? Short of the eventual physical decline of aging in the brain structure, are there other experiences which significantly alter the actual organic brain?

Drink and drugs immediately come to mind… But these affect functioning ability, no?

How the DSM-5 Got Grief, Bereavement Right

Friday, May 31st, 2013

How the DSM-5 Got Grief, Bereavement RightOne of the charges leveled against psychiatry’s diagnostic categories is that they are often “politically motivated.” If that were true, the framers of the DSM-5 probably would have retained the so-called “bereavement exclusion” — a DSM-IV rule that instructed clinicians not to diagnose major depressive disorder (MDD) after the recent death of a loved one (bereavement) — even when the patient met the usual MDD criteria. An exception could be made only in certain cases; for example, if the patient were psychotic, suicidal, or severely impaired.

And yet, in the face of fierce criticism from many groups and organizations, the DSM-5 mood disorder experts stuck to the best available science and eliminated this exclusion rule.

The main reason is straightforward: most studies in the past 30 years have shown that depressive syndromes in the context of bereavement aren’t fundamentally different from depressive syndromes after other major losses — or from depression appearing “out of the blue.” (see Zisook et al, 2012, below). At the same time, the DSM-5 takes pains to parse the substantial differences between ordinary grief and major depressive disorder.

Unfortunately, the DSM-5’s decision continues to be misrepresented in the popular media.

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