I’m comfortable saying that if I were going to crash and burn and wind up back at square one, it likely would’ve happened by now. Things haven’t been perfect–there was a bout of depression/seasonal affective disorder a few months back, and my metabolism went haywire after I got off Lamictal and I put on 20 pounds–but I did come through an extremely cold, gray winter (one of the worst ever in Seattle), have been under loads of professional and life stresses and so on. And, yet, things are pretty good.

This isn’t supposed to be happening, not by the standards of medicine and psychiatry. Bipolar disorder is a lifetime diagnosis and you take medications pretty much forever. If you don’t follow through, you are dangerous, a person best kept at arm’s length by one and all.

I know I am lucky, but luck only accounts for so much. The rest is all questions: Did I ever have bipolar disorder? Was my initial diagnosis wrong? Am I a false positive? Did I cure myself? Am I simply a bipolar who does well without meds? Am I in a lengthy remission that will crumple on me someday? Is the diagnosis of bipolar disorder bullshit to begin with? Does the disorder ebb with time? Or am I just a medical freak show, the lone exception that proves the rule?

In his followup post, he describes what led to his decision to try his psychiatrist’s advice to get off of medications altogether, after trying a number of combinations of medications that didn’t seem to be helping him all that much.

I don’t think bipolar disorder has to be a “lifetime diagnosis” — people can and do get better with it over time. And while I don’t think going off of meds for bipolar is for anyone to try on their own (Philip did it with his psychiatrist’s help), it may be something to discuss with your doctor if you feel like you’ve hit a treatment wall. The problem with medication compliance in bipolar disorder is primarily when a person is in a manic phase and feels like they no longer need the medication, and discontinue it on their own, without consulting their psychiatrist or doctor.

The conventional wisdom is that for someone to be successfully treated with bipolar disorder, they must be on medication for a very long time. Sometimes the conventional wisdom is wrong.

Congratulations, Philip! We hope you have many more fruitful years to come.

Read the first post: Losing my religion
Read the followup post: How I got off meds

You’re probably saying to yourselves “This is NOT Dr. John Grohol. I detect a Southern accent.” Very intuitive.

My name is Katherine Stone and I write Postpartum Progress, the most widely-read blog in the U.S. on perinatal mood disorders, including postpartum depression, antepartum depression, postpartum OCD and postpartum psychosis. For some reason, Dr. Grohol has seen fit to give me the keys to his blog. Before he changes his mind, I thought I’d sneak in and talk to you while I had the chance …

The timing of my post is very important. Later this week, the United States Senate may be voting on the Advancing America’s Priorities Act. This package of bills, introduced by Senator Harry Reid this morning, includes the Melanie Blocker Stokes MOTHERS Act, which would fund increased research into the causes of perinatal mood disorders, better training of healthcare providers and more public awareness. I can’t tell you how important this is.

Of the 800,000 women in the U.S. who get postpartum depression each year, only 10% of them are ever diagnosed and treated. As I wrote on my blog today, we know from research that untreated perinatal mood disorders are a serious public health threat –they can lead to chronic depression in the mother, behavioral problems in the child and stress-related health problems in both. This is an enormous financial cost to our health system and even bigger social cost to our families and communities now and into the future. It will continue on perpetually until we break the cycle and take the lead to proactively educate pregnant mothers, conduct more research and train our doctors. I know this because I am the child of a mother who went through PPD. Her mother, my grandmother, had it as well, and I suffered postpartum OCD myself. I also know because I hear from hundreds of women across the country who read Postpartum Progress and send me emails about their terrible experiences and the lack of knowledge shown by many in the healthcare community.

If you’d like to help, please visit the Depression & Bipolar Support Alliance’s Advocacy in Action Alert and send a letter right now to tell the U.S. Senate to pass this bill. Along with DBSA, it is supported by Postpartum Support International, the Association of Women’s Health, Obstetric & Neonatal Nurses, the March of Dimes, Mental Health America, the Suicide Prevent Action Network, the Children’s Defense Fund, the American College of Obstetricians & Gynecologists, the American Psychiatric Association, the National Alliance on Mental Illness and many others.

Not every mother gets PPD. But the ones who do need and deserve effective help. And just so you know, the bill does not advocate any specific treatment for perinatal mood disorders and neither do I. What I care about is mothers recovering as quickly as possible so they can have healthy relationships with their children, regardless of whether it’s via therapy, meds, a combination of both or some other method.

I hope you will support those of us who go through this and speak up. Thanks for listening.

When crossing international boundaries, one has to understand different cultures’ takes on taboo topics. Suicide is one such topic, and one where culture has a significant impact on how it’s viewed. For instance, in Japan suicide has practically been raised to a virtue, where committing suicide is seen as the honorable thing to do when one’s life seems to be going wrong:

A suicide fad is sweeping Japan: Hundreds of Japanese have killed themselves this year by mixing ordinary household chemicals into a lethal cloud of poison gas that often injures others and forces the evacuation of entire apartment blocks.

The 517 self-inflicted deaths by hydrogen sulfide poisoning this year are part of a bigger, grimmer story: Nearly 34,000 Japanese killed themselves last year, according to the Japanese national police. That’s the second-highest toll ever in a country where the suicide rate is ninth highest in the world and more than double that of the USA, the World Health Organization says.

Honor or not, suicide is not the answer. An economic downturn takes your job? Guess what? An economic upswing is just around the corner and virtually everyone finds another job in time. Girlfriend or wife leaves you? That’s no reason to end your life when a million other women are out there waiting for you. Suicide is an immediate reaction to a momentary life question that will haunt your friends and family for a lifetime.

But the problem isn’t just in Japan. It plagues many Asian cultures, including the South Korean one, where things are far worse. South Korea has the unlucky distinction of having the highest suicide rate amongst developed countries: 24.7 deaths per 100,000 people.

The solution? Make people better appreciate the life they have now by sending them on a “fake funeral” of their own. The Financial Times has the story:

“Korea has ranked number one in many bad things such as suicide and divorce and cancer rates, so I wanted to run a programme for people to experience death,” says Ko Min-su, a 40-year-old former insurance agent who founded Korea Life Consulting, which offers fake funerals as a way to make people value life.

Korean corporations — from Samsung Electronics and Hyundai Motor to Kyobo Life Insurance and Mirae Asset Management — send their employees on Mr Ko’s courses regularly, partly to encourage them to question their priorities in life and partly as a suicide prevention measure.

People who experience the course first-hand find the experience terrifying and eye opening at the same time:

Yoon Soo-yung, a manager at the Cheonnam Educational Training Institute, who was considering sending her staff on the course, said the experience was terrifying. “I felt like I was suffocating. I cried a lot inside my coffin,” she told the FT. “I regretted so many things that I had done in my life and mistakes that I had made.”

While some experts are skeptical:

Some medical experts are less convinced of the value of such programmes as a suicide prevention measure. “I think treating the fundamental causes like depression and impulsive behaviour is more important and should come before such programmes,” says Chung Hong-jin, professor of neuropsychiatry at the Samsung Medical Centre in Seoul.

My take? The suicide issue is very different in these cultures and the rate is so high, creative techniques like this may hold some potential. The real test is conducting a simple study on the course, assessing participants’ thoughts and attitudes toward suicide before and after, with a random sample of people (those who work in high stress, competitive jobs, and those who do not). It would be a simple study to conduct and one that would show whether there’s more than anecdotal evidence to support the course’s use.

Sadly, the president of the company marketing the course appears to be more interested in expanding into additional markets rather than examining whether his course actually works.

I think such interventions, possibly categorized under the treatment techniques of “psychodrama” (an established field here in the U.S. and Europe, though not well understood or popularized), have potential. Death holds a terrifying mystery to many people. By experiencing first-hand the ceremonial rites associated with death, it may be enough to reach people on an emotional, irrational level as a response to irrational feelings of killing oneself.

It’s an intriguing concept and one I’d like to see the research done on. Because anything that helps change people’s minds about taking their own lives is something that should be more widely understood and disseminated.

Read the full USA Today article about Japanese suicide: Suicide epidemic grips Japan
Read the full Financial Times article: When death is a reminder to live or view the photo gallery, which takes you on an eery step-by-step tour of the fake funeral process

Our new blog, Bipolar Beat has a great entry about lithium that’s worth a read: Bipolar Medication Spotlight: Lithium.

It’s a great informational piece about this medication and how it’s regaining some renewed interest and prescribing popularity as the downsides to the newer atypical anti-psychotics are becoming better highlighted and understood.

Daniel Carlat, M.D. is a psychiatrist in private practice in Newburyport, Massachusetts. He graduated from a psychiatric residency at Massachusetts General Hospital in 1995, and is the founder and editor of The Carlat Psychiatry Report, a monthly CME newsletter. Dr. Carlat reports the following conflict of interest: He publishes an industry-free CME newsletter, so he would stand to benefit financially if drug companies were not allowed to fund his competitors. In 2007, Dr. Carlat started a blog entitled The Carlat Psychiatry Blog after having an influential op-ed piece published in The New York Times about industry-funded continuing medical education (CME).

John M. Grohol, Psy.D.: You started your blog just over a year ago after having an op ed piece published in the New York Times about the conflict of interest in industry funded, continuing medical education.

How has the continuing education industry changed since then in response to efforts such as yours?

Daniel Carlat, M.D.: The op ed did garner a fair amount of response, both positive and negative; negative response being mostly from medical education companies that stand to profit, from the CME business.

A number of things happened after that op ed was published. One of them was the Josiah Macy Foundation organized a meeting of prominent figures in medicine, and this group issued a report recommending that medical education no longer be funded by industry.

Soon afterwards, the American Medical Association came out with a report through its main Ethics Committee (CEJA, the council for ethical and judicial affairs). This report on medical education was about two years in the making and they also recommended that continuing medical education no longer be funded by the pharmaceutical industry, basically saying that the marketing aims of drug companies have become overly intertwined with continuing medical education.

These physician groups were both saying that have lost control of the content of their accredited medical education, and that we need to take that control back. I’m not talking about promotional talks here—I’m talking about accredited, Category One CME, which is the credit doctors need in order to maintain their medical licenses in most states. So this type of education is really is a big deal, and has implications for the wellbeing of out patients.

Aside from these two reports other things happened. The Senate Finance Committee, under the leadership of, Senator Charles Grassley, came out with a report, saying that after interviews with different stake holders, they felt that many of the CME programs had become promotion activities for pharmaceutical companies.

They sent a letter to that effect to the ACCME, (which is the overall regulatory body for all CME). And then that set in motion a number of activities in the ACCME

It seems that every couple of months now if you go onto the ACCME website they have come up with another set of proposed guidelines to make more impenetrable the firewall between medical education programs and industry sponsorship.

For example, they have redefined what a commercial entity is in order to limit the involvement of advertising companies in CME. In the past pharmaceutical marketing companies could actually also create CMEs.The ACCME looked at that and said, “No, guys. If you as a promotional marketing company want to create CMEs you will have to be very careful. From now on, you have to spin off the CME part of your business into a separate corporation. You can still be sister companies, but it has to be separated in some reasonable way.”

Most recently, ACCME has proposed that when any CME company comes up with a proposed topic for a course they have to do their needs assessment and their topic choice based on independent information sources. They listed a bunch of potential information sources, like medical organizations, and government-funded organizations that can suggest unbiased topic areas. The idea is that this would theoretically prevent a company from just deciding, for example, to create a course about injectable antipsychotics just because Janssen is funding that program (Janssen markets Risperdal Consta, an injectible antipsychotic)

So now, if they do decide to come up with a program on injectable antipsychotics and Janssen is funding it, they are going to have to demonstrate to the ACCME that they came up with that topic and they generated that topic in an independent way without any influence of the promotional needs of the company.

The most recent development is that Pfizer, one of the largest drug companies in the world, announced that they would no longer directly fund CME that was produced by independent medical education companies. That has caused an uproar in the medical education community, which is about a 1.2 billion dollar business,. However, one has to wonder, even with all these new developments, if there are ways for those companies to make end runs around the new regulations.

And I think in the case of Pfizer, it’s pretty clear that Pfizer is saying that, while they won’t directly fund medical ed companies anymore, they will fund education programs that are sponsored by medical societies or academic medical centers, even if those programs are run and produced by private med ed companies. So the money will now go to the medical society, and then from the medical society it will still go into the same coffers as before–the med ed companies!

Will there be a little bit more adequate oversight of the content? Hopefully there will be. But I think that ultimately the same education companies that are one hundred percent dependent on grants from pharmaceutical companies for their business, those companies will still be very much involved in producing the content of these educational activities.

Dr. Grohol: So it sounds like it almost becomes an increasing shell game of how many filters can we put the money through before it actually gets to the same people. And it begs the question, will we ever see real reform in the CME industry?

Dr. Carlat: Well, we will. But it is a very, very slow incremental process. This reminds me of, when the campaign manager for President McKinley was asked what were the most important things in politics. And he said, “There are two important things in politics. The first one is money, and I forget what the other one is.” It works very similarly in the pharmaceutical marketing industry, and it really is all about the money.

So if there is reform, the way that the reform will come about is that the drug companies themselves will realize that their profits and their bottom line are threatened by their continuing involvement in sham educational activities. And once they realize that their bottom line is affected, then they’ll pull out very, very quickly.

Right now it’s difficult because if a particularly ethical company, decides, “This really is very embarrassing and demeaning for us and doctors to be putting on these sham educational programs. We don’t really need to do it anymore, we have plenty of other outlets for advertising that are legitimate. Let’s just stop doing it.” Well, then their shareholders are going to be complaining that they’re taking away a valuable marketing tactic from their business and putting them at a competitive disadvantage to all the other companies that have not been so ethical. Companies are always looking behind their backs at what their competition is doing to make money.

Dr. Grohol: Sure.

Dr. Carlat: So, somebody is going to have to take a stand at some point, or regulatory bodies will do it for them. If companies, both the drug companies and the med ed companies don’t materially change their ways, aside from these shell games and these smoke and mirrors operations, then the Senate Finance Committee will begin to, not simply write letters asking questions and expressing displeasure, but they’ll start to ask Congress to change the laws so that this kind of thing can’t happen anymore.

Dr. Grohol: Recently you’ve had some pretty strong words for George Lundberg and Medscape on your blog about their CME efforts. In an ideal world what could Medscape and other companies like them do to reform their CME in the short term?

Dr. Carlat: Well, I think both George Lundberg and myself are very blunt and frank people. And it’s true that in a recent video editorial broadcast on Medscape, Dr. Lundberg really lashed out. In my opinion he lashed out at everybody who’s trying to bring more honesty into medical education.

Dr. Lundberg certainly isn’t a bad or unethical person, but he is a person who has cast his lot with a private, very profitable medical education company, Medscape, which is, again, almost one hundred percent dependent on pharmaceutical company funding for the production of their medical education. So, anything that threatens that spigot of money is going to threaten everybody that works in that company, and will certainly personally threaten Dr. Lundberg’s position as editor of their medical site.

One of the things that he said was that Medscape is “good, clean, and transparent.” And that bothered me because the real issue, and where the rubber meets the road in this entire debate, is when you look at the actual educational courses, are they biased, are they promotional, or aren’t they? I can give you a lot of rationales for why these things might become promotional, but if you look at them and they are just perfectly good unbiased education, then it really doesn’t matter who’s paying for it.

But when I looked at the psychiatry offerings after Dr. Lundberg published that editorial, I was astounded at how transparently and blatantly commercial and promotional all of the psychiatry CME courses that I reviewed were. It wasn’t as though the bias was even difficult. It was like shooting fish in a barrel.

You just look at anything on their site. I looked at one event, one course for ADHD medications, and the first 10 slides in the online program were essentially commercials for the latest Shire products in ADHD. In another example there was a course on a new antipsychotic called Invega, which is produced by Janssen. And this antipsychotic has only one little niche advantage in the very, very crowded and competitive field of antipsychotics, which is that it doesn’t get metabolized through the liver, and so it’s a good medication to prescribe for someone with liver disease

So, in the Janssen funded antipsychotic program the entire program is based around the case study of, wouldn’t you know it, a patient who had liver failure. The program took the audience by the hand and said, “Let’s look at this important case example of a patient with liver failure. Let’s look at what would be the best medication to treat this person with if he’s psychotic. Guess what? The best medication is Invega.”

And you keep going through the website, and it is so obvious that the money and commercial influence are infiltrating the CME programs, which is really why I ended up lambasting Dr. Lundberg in a couple of blog entries. I received a fair amount of flack from various people who felt I was a bit nasty. But there’s no question that passions do run high in this debate..

Dr. Grohol: So how do they change their business, though? If their business is dependent 100% on pharmaceutical companies to fund them, I mean Medscape would be out of business tomorrow.

Dr. Carlat: That’s ture, Medscape would be out of business, if they felt they needed to continue to produce accredited CME. However, the amount of money companies spend on accredited CME is 1.2 or so billion dollars a year. The amount of money companies spend on non accredited medical education, i.e., various forms of advertising, promotion, dinner talks, dinner programs, web based non CME programs is in the tens of billions of dollars. There’s plenty of money out there for a company like Medscape if they decide that they want to continue to depend on pharmaceutical money. They simply could no longer call their offering “accredited” CME.

It’s funny, but once you start thinking you’re an expert on a new disorder (that you either created from your imagination — or your patients’ imaginations, or helped to do so), suddenly people start flocking to you for help. I call it the “moth to the light” phenomenon. Then you think it’s a “real” diagnosis, because suddenly of all the people who come to see you. Can you say “self-fulfilling prophecy?”

Meet Joel and Ian Gold — brothers and psychiatrists — who believe in something they call the Truman Show Delusion:

While traditionalists insist that this delusion offers nothing new — it is no different from, say, a deranged man who believes that the CIA has planted a microchip in his tooth — the Gold brothers argue otherwise. […]

He also says that The Truman Show had an impact on patients that other films did not, no matter how powerful they were. “I never heard people say, ‘ The Godfather, that’s my life.’ ”

Sure. And if we start diagnosing people based upon how much they identify with a particular movie, wow, we’ll have tens of thousands of new diagnoses tomorrow! In fact, I see so many teenage and young adult men who think they’re Batman and really identify with that character, I’m officially coining the “Batman Delusion.” (You heard it here first.)

I mean, who cares — from a diagnostic standpoint — what the delusion is? The specific delusion helps inform psychotherapy treatment, but it doesn’t tell a professional, “Oh, he thinks he’s the King of the World, that means 20 mg of Prozac.” And in terms of psychotherapy techniques or specific treatments for a particular delusion, well, our level of science and data isn’t anywhere near that level.

So while intellectually, this may be a fun and interesting exercise to suggest the Truman Show Delusion is something new and diagnosable, it’s really nothing more — in my mind — than professional grandstanding.

Excuse me, but there’s a couple of emails from people now in my inbox wanting to get treatment for my new Batman Delusion. I have some replies to get working on.

Read the full article over at the National Post: Reality bites: Patients believe their lives are on TV: MDs

Psychiatrist James Gordon is the subject of the ire, because he’s promoting his new book over in a Newsweek interview suggesting that alternative treatment methods are the preferred treatment approach for mild to moderate (e.g., most people’s) depression. And that antidepressants should only used as a last resort — “There are better ways to do that than taking drugs, which have side effects and don’t address the underlying message that depression is bringing—that our lives are out of balance and significant change is necessary.”

Uh-huh. Yeah, right…

One would assume that before one suggests changing all of the best-evidence clinical guidelines for treatment of the most common mental illness, one might have a couple of meta-analyses or some large-scale clinical trials conducted with adults that show the effectiveness of the treatment program one is recommending.

Alas, Gordon’s research relies on a single published study on 139 war-ravaged teens, and another study “coming out soon.” And while I agree that many of the individual techniques might, individually, have research backing for specific areas, one might be a little more conservative in one’s opinion before suggesting medications are over-prescribed and everyone should just try his New and Improved treatment program. But you can see Gordon is more of a marketer than a researcher by this statement alone:

Individually, these techniques work at least as well as antidepressants for people with mild to moderate depression. Together they are likely to be far more effective.

Sorry, that’s not how research works. You can’t just throw together five of your favorite techniques and assume they will have some sort of magical power of multiplication to become ever more effective just by being combined.

Well, you can, of course, but you shouldn’t then make such pronouncements in national publications without actually having any relevant research data to back you up.

And what’s this misinformation still being regurgitated, and apparently, agreed with by a psychiatrist (who should know better)?

Newsweek: But people with depression do have imbalances in levels of neurotransmitters.

James Gordon: Some people do, I wouldn’t deny that. What I’m saying is that there are many ways to address those changes that do less harm and may be more productive in the long run because they give people the sense of control that comes from helping themselves.

Well, I would deny it only because science has already shown this theory to be incorrect and a useless simplification of brain processes. That Gordon doesn’t know this is telling.

But anyways, back to the point. There is no single method or single magical approach that is going to work for everyone. Cognitive behavioral therapy is not some cure-all panacea, and neither is Zoloft. And while Gordon’s approach may very well effective for some, it probably will not work for a significant portion of people. Why? Because no treatment in the history of depression treatments has ever found to be effective for everyone. None.

Depression is complicated and complex, just like the humans who experience it. It, like us, does not live in a world of black and white dichotomies. It is messy, it often has no reason, and it doesn’t always like to wake up in the morning. If not caused by some underlying biological condition, it definitely has a measurable effect on our brains. And what works for one person’s depression may have no effect on another’s. This is the nature of depression, like most mental illnesses, and has always been.

Dichotomies might be nice to sell a book or one’s new treatment approach, but it has little basis in reality — the data from the research and the front-line clinicians and people who experience these concerns.

We agree with Borchard — depression is very real and not only do drugs help many with depression, they have proven to be a lifeline for some. And while not an ideal treatment, they are one of the tools we have in our treatment arsenal and should not be demonized (or idealized).

Read the full entry: Don’t Get Stuck on “Unstuck”: Depression Is Real, and Drugs Help Me

And while the number of people committing suicide over the past two decades has remained consistent (around 30,000 people a year commit suicide in the U.S.), the suicide rate has enjoyed a steady decline of approximately 0.7% per year (a 13% drop from 1985 to 2004)(Barber, 2004). The decline hasn’t been brought about by superior public health policy, government action, or even the Internet. It’s largely been brought about by the decline in firearm suicides, the leading method of suicide (followed by suffocation and then poison). Men are 3 1/2 times more likely to commit suicide than women.

Guns are a huge risk factor for a successful suicide, because they are one of the most lethal methods available. 90% of those who survive a nonfatal attempt do not go on to die by suicide, meaning that the impulsive, irrational act of a suicidal attempt is what we must try and stop. Hence the reason for the fences and suicide hotlines. If we can get most people past the crisis point, the vast majority of them will live.

But what about those people who are suicidal and make it to the emergency room after a failed attempt? Could we do something more to help the 10% of people who do end up successfully committing suicide?

A column in today’s Boston Globe Magazine today presents the poignant story of the writer, Peter Bebergal, who lost his brother to suicide, and how a group of researchers at Harvard are working to better identify people who are still suicidal when in a hospital:

What clinicians need is some other measure beyond external evidence that could assess whether someone like Eric is capable of suicide in the near future. Four years after my brother’s death, Harvard researchers at MGH are experimenting with a test they think could help clinicians determine just that. It focuses on a patient’s subconscious thoughts, and if it can be perfected, these researchers say it could give hospitals more of a legal basis for admitting suicidal patients.

Of course, I can’t help thinking about whether such a test could have saved my brother. But I also wonder: Would it have been ethically right - or even possible - to save him even if he didn’t want to save himself?

This missing piece in the suicidal puzzle is what prompted the innovative research study now in its final phase at MGH. The study, led by Dr. Matthew Nock, an associate professor in the psychology department at Harvard University, is called the Suicide Implicit Association Test. It’s a variation of the Implicit Association Test, or IAT, which was invented by Anthony Greenwald at the University of Washington and “co-developed” by Dr. Mahzarin Banaji, now a psychology professor at Harvard who works a few floors above Nock on campus. The premise is that test takers, by associating positive and negative words with certain images (or words) - for example, connecting the word “wonderful” with a grouping that contains the word “good” and a picture of a EuropeanAmerican - reveal their unconscious, or implicit, thoughts. The critical factor in the test is not the associations themselves, but the relative speed at which those connections are made.

The research is still ongoing, so we don’t know whether this type of psychological testing will actually work or not. But it’s intriguing to imagine that our unconscious minds might give away our “true” thoughts when it comes to something like suicide. It could become as valuable a test as the ones we use to assess whether someone had a stroke and is at greater risk for a future stroke.

The next step, Nock realized, was to use the test to determine, from a person’s implicit thoughts, whether someone who had prior suicidal behavior was likely to continue to be suicidal. It would give doctors a third component, along with self-reporting and clinician reporting, and result in a more complete picture of a patient. Nock doesn’t assume that a test like the IAT would be 100 percent accurate, but he believes it would have predictive ability.

I believe any tool that can be used to better predict future behavior is a potentially valuable one. Especially when that future behavior might be the taking of one’s own life.

Read the full article: On the Edge

Reference:

Barber, C. (2004). Trends in rates and methods of suicide: United States, 1985-2004 (PowerPoint presentation). Harvard Injury Control Research Center.

It’s hard to say for certain whether teen over-scheduling is an increasing trend, since there are very few lifestyle surveys of teens across decades (the only data that could reliably answer such a question). However, one study mentioned near the end of the article (that’s always the place they put the dissenting data that calls into question the value of the entire article!), does provide some context:

In 2006, around the time that the pediatrics group issued its warning, psychologist Joseph L. Mahoney, then an associate professor at Yale, and two colleagues published a study debunking what they called “the over-scheduling myth.”

Based on an analysis of previous research, Mahoney’s team concluded that fewer than one in 10 youths could be described as over-scheduled and that 40 percent did not participate in any organized activities. Teenagers who did participate averaged fewer than 10 hours per week, Mahoney reported, while fewer than 6 percent devoted 20 hours or more to extracurricular activities. The researchers also challenged the notions that parental pressure was to blame for over-scheduling and that a lack of free time caused undue stress.

Anecdotally, we can all remember our own teenage years, and how some of our friends or people we knew seemed always to be doing something.

I fell somewhere in-between. I wasn’t a complete slacker, but I also didn’t join every club or after-school activity I could. I ensured I kept some time free, but even then, there were definitely times I felt overwhelmed by all the commitments I had made.

In the article, the writer notes how some teens drive themselves right into therapy with their packed schedules, and they do so to please their parents:

The toxic combination of perfectionism and over-scheduling can lead to excesses such as those seen by University of Pennsylvania adolescent medicine specialist Kenneth Ginsburg, author of the AAP recommendations. Ginsburg said his patients have included a teenager who had started studying for the SATs at age 11 and high school students whose parents told them they “didn’t need to bother to go to college” if they didn’t get into either Harvard or Yale, schools that last year reported record-low acceptance rates hovering around 8 percent.

Sometimes, he noted, teenagers who say they can’t imagine life without a packed schedule and profess to “love” hours of extracurricular activities are really afraid of disappointing their parents by opting out or scaling back.

The irony of this, however, is that most parents don’t really have a set agenda for their kids’ lives. (Some do, and those parents should stop trying to live their lives through their kids.) They just want their children to be happy. But somewhat mistakenly, some parents believe that they need — i.e., it is their responsibility as a parent — to try and expose their child to as many “opportunities” as possible. “Let’s sign up little Johnny for softball! Let’s sign him up for soccer! Oh, he enjoyed going to the show, maybe he wants to sing, and dance, and…” You get the picture.

There is a balance there that needs to be found. Sure, giving your children the opportunity to experience a wide range of activities is potentially beneficial. But don’t take it too far, because kids need to be kids first and foremost. They can always learn or discover a talent later on in life too — childhood isn’t the only time we learn activities.

Because what happens in many cases is that a child learns their parent always wants them to not just “do well,” but “exceed expectations,” to “excel” in everything they do. And as they become a teenager, that work ethic turns into a nightmare in trying to balance 3 or 4 social activites and hobbies with clubs and academic pressures, and sports, and friends, and still have time to enjoy life. Teens don’t need to excel. They need to find a place in life that feels right, to explore who they are, what they like, and what relationships are all about. A few activities helps a teen explore and enjoy the things they like to do, but too many and it can quickly feel like pressure they don’t need nor want.

So over-scheduling may be a problem for some youths, but by and large, most teens understand the need for some balance in their lives, even if they don’t always succeed in finding it.

Teens, know your limitations and learn to prioritize what’s most important to you (versus something you might be doing that you no longer enjoy or care for). Parents, don’t pressure your teens into doing stuff that you think they enjoy (but that they really don’t). Listen to them if they say to you, “Hey, I don’t think I’m going to go out this year for the team.” It doesn’t make them a quitter, it makes them a wise pragmatist who is beginning to find their way in the world.

Read the full article: Too-Busy Teens Feel Health Toll

Well, that’s more than enough to scare away the anxiety-disordered job-seeker, isn’t it?

Finding a job is tough. Finding a job that’s a good fit for someone who has an anxiety disorder is even more difficult. How is it possible? It’s not like you can openly profess your panic disorder or anxious tendencies to the hiring manager and hope for an understanding nod. So, how can you realistically navigate the job-search process and find a job that works for you?

I’ve spent the past five years trying to hold my anxiety and panic tendencies at bay. I’m doing well these days, and I owe a wide round of thanks to cognitive behavioral therapy, biofeedback, and lifestyle changes. I eat well, (try to) exercise regularly, and I do one thing at a time.

Yes, just one….thing. At. A. Time.

I’d never fully realized how much of a serial multi-tasker I was until I began practicing mindfulness meditation in graduate school. I would sit on a chair in my quiet living room in an attempt to “tune in” to the moment and stop thinking about what needed to be done, but a constant stream of to-do lists would cloud my mind. Finish my persuasion paper by seven o’clock. Don’t forget to do the dishes tonight. Call my boss back before the end of the day. Call maintenance about the leak in my ceiling. What smells funny in here? Find the source. Speaking of sources, I need more references for my persuasion paper. Figure out how to reset my office voicemail. Oh no, I have an exam next week! What time am I supposed to meet with that prospective student?

With practice, I was able to ditch the habit of thinking about (and doing!) twenty things at once. I learned to do the dishes while thinking exclusively about the dishes. I discovered that banging out the rough draft of a ten-page paper in one sitting was, surprisingly, less stressful than writing a tiny bit at a time and leaving Microsoft Word open on my desktop for the (few) moments during which I felt inspired. I found out that I study better for exams if I’ve already completed reading my weekly dose of peer-reviewed journal articles. I began doing one thing at a time. I became focused. My mental clarity improved and my stress level receded below the levee.

And now, I’m a proud graduate. Like the rest of my classmates, I’m looking for a job. And yes, they all seem to require a love of multitasking as a prerequisite! If you’re anything like me, the thought scares you. But, the phrase is everywhere, and most jobs require multitasking to some degree. These lines are taken directly from the last three job listings I’ve viewed on major career-search Web sites:

“Candidates should enjoy multitasking and possess a strong desire to succeed.”

“Candidate needs to multi-task between handling email, telephone, and projects as assigned.”

Yikes.

Tips for Handling Job Search Anxiety

It’s a bit intimidating, but I’m determined to push on and find a job that isn’t going to stress me to pieces. Here’s some tips for handling the job search process if you, like me, are hoping to keep your anxiety and stress levels in check:

1. Don’t outright ignore the job listings that include words and phrases such as “multi-tasking”, “meeting tight deadlines”, and “stressful environment.”

You can never be sure if the company representative who wrote the job listing is writing about what the position is like on the absolute worst day or on a standard day at the office. Send in an application if the job meets your needs and skills; worry about the semantics later.

2. If you’re contacted for an interview, prepare yourself with a list of questions to ask your potential employer.

Many employers like to see a candidate ask questions about the position, so throw in a few neutrally-worded questions about the office culture, deadline structure or project timelines, or the position’s daily goals. However, be careful to avoid direct questions about job pressures. Some commonly recommended questions include the following:

• What would a typical first assignment be?
• How much travel is normally expected?
• What are some examples of the short and long-term goals of the project or position?
• What qualities are you looking for in the ideal candidate?

Asking questions can help you to feel out if the position truly is too stressful for you to handle, and it demonstrates to your potential employer that you have an interest in the position.

3. If you are presented with a job offer, weigh the pros and cons carefully.

Consider the following questions: What will the job do for your anxiety and stress level? Will the job produce positive or negative stress for you? What types of coping skills can you use (or must you develop) in order to handle the pressures of the job? Would refusing the job offer be a step toward unhealthy avoidance of an anxiety trigger or would it be a healthy way of managing your lifestyle?

4. If you choose to accept the job, keep your physical and mental stress levels in check.

Making small changes in the way you organize your desk, computer files, or office can have a profound difference on your sense of well-being. If you are required to multi-task, do your best to complete one activity before starting another. For example, if you are responsible for checking email and answering phones at the same time, don’t look at your inbox while you’re on a phone call. If you’re assigned two projects to be completed by the end of the business day, try dedicating your morning to one and your afternoon to the other (instead of hastily trying to complete both at one time!) When you turn your attention to one task at a time, your quality of work will likely increase as well.

Finally, utilize all breaks that are given to you to get out of your workspace and into a more relaxing environment (the break room or the outdoors, for example). Only use your break time for errands if you absolutely must. Breaks are meant for relaxation and rejuvenation!

But not in Oregon.

One Flew Over the Cuckoo’s Nest is the infamous 1975 film that led to a movement to close most of these kinds of public facilities. It was filmed at the sprawling campus of the Oregon State Hospital, a testament to the kinds of facilities government used to build and fund in the belief that such places were good and helpful to the people treated there. But problems at such facilities existed nearly from the start, as it takes special types of people to staff and take care of the emotionally vulnerable souls found in such hospitals. Sadly, most hospitals paid little attention to the quality of staff they hired, resulting in serious abuses and problems:

Although mean Nurse Ratched [from the movie] was pure fiction, the Oregon State Hospital has struggled with some very real troubles over the years, including overcrowding, crumbling floors and ceilings, outbreaks of scabies and stomach flu, sexual abuse of children by staff members, and patient-on-patient assaults.

These problems are not unique to Oregon State — you can find them at practically any state-run hospital for people with mental health issues. That’s because such facilities, often started off with a lot of fanfare and funding, quickly fade into the background and struggle to keep their funding in times of government hardship.

It usually takes some sort of gruesome discovery or horrible abuse to bring about change in government. In Oregon, it took finding some cremated remains not returned to family members (apparently sexual abuse of children by adult staff members wasn’t sufficient):

Politicians had been talking for years about the need to replace the hospital, but didn’t get serious about it until a group of legislators made a grim discovery during a 2004 tour: the cremated remains of 3,600 mental patients in corroding copper canisters in a storage room. The lawmakers were stunned.

So the old building that has mostly been abandoned, the J Building, will be torn down to make way for the new:

Milos Forman, the director, lived for six weeks at the institution and had his actors study real patients, according to a 1975 account in Rolling Stone magazine. Nicholson became depressed because of what he saw, including electroshock being administered to a patient.

State leaders decided in 2006 to build a new, $300 million, 620-bed hospital at the site of the oldest and most dilapidated part of the complex, the J Building, a yellow-painted brick structure with brown trim, a towering cupola, and iron gratings on the windows. […]

It is not just a bricks-and-mortar exercise Oregon is undertaking to improve care for the mentally ill. State leaders have pledged beefed-up staffing levels, new treatment programs and better living conditions.

We’ve heard it before. We only hope Oregon state leaders live up to their pledge and provide not only a shiny new building to their charges, but also appropriate staffing levels and care from those staff to actually provide a therapeutic environment. A government running an inpatient mental hospital seems like something from another time…

Read the full article: `Cuckoo’s Nest’ hospital to be torn down

• The different categories and potential causes of bipolar disorder
• How to select the right mental health specialist
• Managing employment-related issues brought on because of the disorder
• How bipolar disorder affects children
• Advocating for yourself or a loved one
• Planning ahead for manic and depressive episodes
• Selecting the best medications for you—including alternative “natural” treatments
• How to survive an immediate crisis situation
• Identifying triggers and mapping your moods

The new blog will help people learn about new developments in bipolar (also known as manic depression), but also provide tips and techniques that can help you deal with this concern.

We hope you enjoy the blog. Don’t have bipolar? We plan on launching additional topical blogs in the weeks to come, including blogs on depression and ADHD.

Check it out: Bipolar Beat

At first, it was widely assumed that the misleading results in manufacturer-sponsored studies of the efficacy and safety of pharmaceutical products came from shoddy studies done by researchers who manipulated methods and data. Such scientific malpractice does happen, but close examination of the manufacturers’ studies showed that their quality was usually at least as good as, and often better than, studies that were not funded by drug companies.

This discovery puzzled the editors of the medical journals, who generally have strong scientific backgrounds.

Richard Smith, the recently retired editor of BMJ (formerly the British Medical Journal), has written that he required “almost a quarter of a century editing . . . to wake up to what was happening.” Noting that it would be far too crude, and possibly detectable, for companies to fiddle directly with results, he suggested that it was far more important to ask the “right” question.

What Smith and other researchers, such as Lisa Bero of the University of California at San Francisco, have found is that industry researchers design studies in ways that make the products of their sponsor appear to be superior to those of their competitors.

This bias effect even has a name — the “funding effect.” And now it’s becoming more well-known and public knowledge as researchers are being questioned about the industry funding of their past research. Hiding behind a university research policy isn’t going to be sufficient to answer questions related to this effect. And why researchers, fully aware of this effect, continue to do research funded in this manner.

Indeed, one of the first things I look at when evaluating research is what specific questions or hypotheses are the researchers testing. If the questions look skewed or framed to detect statistical significance (but ignores clinical significance or patient report), then I already know the study may be suspect. Furthermore, I look at the measures used — are they only clinician-based or esoteric assessments, or are they a broad mix of such measures along with patient measures and even third-party measures (such as family members’ report).

There is an answer:

It has become clear to medical editors that the problem is in the funding itself. As long as sponsors of a study have a stake in the conclusions, these conclusions are inevitably suspect, no matter how distinguished the scientist.

The answer is de-linking sponsorship and research. One model is the Health Effects Institute, a research group set up by the Environmental Protection Agency and manufacturers. HEI has an independent governing structure; its first director was Archibald Cox, who famously refused to participate in President Richard Nixon’s “Saturday Night Massacre” meant to help cover up the Watergate scandal. HEI conducts studies paid for by corporations, but its researchers are sufficiently insulated from the sponsors that their results are credible.

Sounds like a model that the entire pharmaceutical industry should pursue. Before the decision is made for them.

Read the full article: It’s Not the Answers That Are Biased, It’s the Questions

Some estimates suggest it may affect as many as 1 in 100 of the population globally. There is no widely accepted explanation for the disease and patients are currently offered a variety of different treatments.

Chronic fatigue syndrome (CFS) is defined by a person having severe chronic fatigue of six months or longer duration with other known medical conditions excluded by clinical diagnosis; and having four or more of the following symptoms: substantial impairment in short-term memory or concentration; sore throat; tender lymph nodes; muscle pain; multi-joint pain without swelling or redness; headaches of a new type, pattern or severity; unrefreshing sleep; and post-exertional malaise lasting more than 24 hours. The symptoms must have persisted or recurred during six or more consecutive months of illness and must not have predated the fatigue.

Cognitive behavior therapy is effective in treating the symptoms of chronic fatigue syndrome, according to a recent systematic review carried out by Cochrane Researchers.

Cognitive behavior therapy (CBT) uses psychological techniques to balance negative thoughts that may impair recovery with more realistic alternatives. In treating CFS, these techniques are combined with a gradual increase in activity levels.

The researchers looked at data from 15 studies involving a total of 1,043 patients with CFS. The studies compared the effects of CBT with those of usual care and other psychological therapies and suggest that in both cases CBT is more effective at reducing the severity of symptoms, provided patients persist with treatment.

Further research is required to determine whether CBT is more beneficial than other forms of treatment, such as exercise and relaxation therapies. The researchers also suggest that CBT could be more effective if used as part of a combination treatment approach.

“CFS is a challenging illness for patients, and there is ongoing controversy about its causes. There remain unanswered questions, but the available evidence is clear – CBT can help many people with CFS”, says lead researcher Jonathan Price, who works at the University of Oxford in the UK.

Reference:

Price JR, Mitchell E, Tidy E, Hunot V. (2008). Cognitive behaviour therapy for chronic fatigue syndrome in adults. Cochrane Database of Systematic Reviews 2008, Issue 3. Art. No.: CD001027. DOI: 10.1002/14651858.CD001027.pub2.

Confidential mental-health services are available in some Indianapolis schools. Midtown, part of Wishard Health Services, provides services at about 20 Indianapolis Public Schools.

“All children who we treat have to have parental consent. We want the family’s input on what it is they want their children to achieve or accomplish in school and in their counseling. So we get everybody involved and then try to build on the students’ strengths so that they can be successful,” Augenbergs said.

While well-intentioned, such requirements means that seeking treatment for their concern is not a possibility. For many legitimate reasons, teens don’t always want their parents knowing what’s going on with them. And while parents believe they have a right to such information, the reality is that they will only get whatever information their kid chooses to tell them.

We have to keep in mind that age 18 is an arbitrary legal line, but it doesn’t mean a teenager is a “kid” at 17, and an “adult” one year later. Becoming an adult is a process, and it starts at 13 or 14 for a lot of teens nowadays. Teens deserve the same rights to privacy and confidentiality as adults do when discussing their emotional or mental health issues. And while some of their concerns may be related to family issues, many are not. It should be the teen’s decision and choice whether to share their mental health issues with their parents, not a forced decision made for them.

Mental health services should be available to teens (but perhaps not pre-teens or children) without parental consent. If one were rich enough and old enough looking, one might be able to seek out psychotherapy on one’s own in private and pay cash. But most teens aren’t rich, don’t have that kind of money, and don’t look old enough.

If one in 5 or 10 teens has a mental health concern (the article is a little confusing in its description of how many teens suffer from such concerns), this is a pretty serious trend. And I suspect one that isn’t being well-addressed by the current treatment options available to most teens.

Read the full article: Kids must speak up about mental health