2007 was a busy year for people reporting on mental health and psychology stories, with a heavy emphasis on pharmaceutical news and research. No significant breakthroughs in our understanding of any particular mental disorder occurred in 2007, although new techniques, such as functional magnetic resonance imaging (fMRI) and genetic studies continue to be at the forefront of causative research.
We present to you our highlights that we identified as some of the biggest stories in 2007 in mental health. Sorry it’s such a long post, but it was a busy year!
Highlights from Research
A large, randomized, placebo-controlled study from the STEP-BD folks was published in April in the New England Journal of Medicine by Sachs et al. (2007). It found that in people with bipolar disorder, adding an antidepressant to a mood stabilizer doesn’t help to relieve depressive symptoms. It also doesn’t make things worse (e.g., there is no increased likelihood of a manic or hypomanic episode on an antidepressant). However, another study by Goldberg et. al. (2007) found that antidepressants were associated with significantly higher mania symptom severity at a 3 month follow-up.
The most surprising finding, though, was that the placebo outperformed the antidepressants in the study in helping to relieve depressive symptoms. Twenty-seven percent of patients getting a placebo held off depression for at least 8 weeks during the 26-week study while antidepressants only worked in 23.5 percent of patients.
Multiple follow-ups from the CATIE study of 2006 were published. Stroup, et. al. (2007) found there to a pretty big variation amongst the atypical antipsychotics, Seroquel (quetiapine), Zyprexa (olanzapine) and Risperdal (risperidone) when it comes to a person with schizophrenia discontinuing the medication (e.g., basically a measure of how well-tolerated and of the perceived benefits of a medication). Seroquel came out on top at 9.9 months before discontinuation, followed by Zyprexa at 7.1 months, with Risperdal bringing up the rear at a measly 3.6 months. This was with a group of people with chronic schizophrenia who had just discontinued use of an older antipsychotic medication, so your mileage may vary.
Keefe et. al. (2007) found no significant differences amongst cognitive improvement (e.g., thinking) in people with schizophrenia taking any antipsychotic medication – they all experienced slight improvements. After 18 months of treatment, neurocognitive improvement was greater in people who took the older antipsychotic, perphenazine, than in the people who took the newer antipsychotics, olanzapine and risperidone. In another study Keefe et. al. (2007) published, they found modest cognitive gains on all three newer atypical antipsychotics for people with early psychosis.
Bick et. al. (2007) highlighted one of the CATIE study’s main findings, that psychiatrists don’t always do a good job assessing and treating medical problems in people who presented with schizophrenia in the study:
“Some of the results were expensive confirmations of known prior results; of the commonly prescribed drugs, clozapine was the most effective, and olanzapine and ziprasidone caused the most and fewest metabolic side effects, respectively.
The most stunning finding was that psychiatrists tend to ignore life-threatening, treatable medical conditions in patients presenting for treatment with schizophrenia. Of patients entering the study, 45% had untreated diabetes, 89% had untreated hyperlipidemias and 62% had untreated hypertension. […] Psychiatrists should learn to properly treat diabetes, hyperlipidemia and hypertension when detected.”
(See also Manschreck & Boshes (2007) for another good summary of the CATIE findings.)
So what did the CATIE study data have to say about the cost effectiveness of newer atypical antipsychotics compared to the other treatment conditions? Rosenheck et. al. (2007) examined that question and found some unsurprising results – placebo treatment is the most cost-effective treatment available:
“There were no differences in measures of effectiveness between initiation of active treatments or placebo (which represented watchful waiting) but the placebo group had significantly lower health care costs. [Ed. – emphasis added]”
Maybe doctors should be prescribing more sugar pills?
Black Boxes and Suicide Rates
Did an FDA-mandated “black box” warning on antidepressants result in an increased uptick of suicides, especially in teens? That’s the question of the year, as proposed by Robert Gibbons, who authored a study published in September that said, yes, indeed it did. Other researchers (and us) said, no, it didn’t. Alternative hypotheses weren’t considered by Gibbons as potential explanations for the data. And since his study was published, 2005 data became available showing that deaths by suicide may have decreased. Year to year changes are rarely significant enough to suggest policy changes, however, as trending for such changes need to take at least 3 or more years into consideration in order to draw robust conclusions.
- The Story Behind the Increase in Teen Suicide Rates
- Experts Question Study on Youth Suicide Rates
- Your Suicide Rates Study Deemed Dubious
- Research Attempts to Answer Critics
Prescribing Atypical Antipsychotics for Everything
Even though atypical antipsychotics are not approved by the FDA for treatment of attention deficit disorder, that hasn’t stopped psychiatrists and other doctors from prescribing them wholesale for the disorder. And not just a handful here and there. No, atypical antipsychotics were prescribed to children ages 1-12 in Florida for a completely off-label use – the treatment of attention deficit disorder (ADHD) – in 50% of the prescriptions written under the Florida Medicaid program. And what about antipsychotic prescriptions for dementia? The Wall Street Journal reported on its investigation into such prescriptions and found what it called “abuse” of such prescribing. While I’m fairly certain overmedication occurs in most nursing homes, I doubt this is a problem unique to a particular class of medications.
- Very Young Children Being Prescribed Antipsychotics
- Antipsychotic Abuse in Nursing Homes?
- Prescription Abuse Seen In U.S. Nursing Homes
- Doctors Should Stop Abusing Dementia Patients
Mental Illness, Violence and Prisons
2007 was the year for many stories focusing on the plight and horrible conditions that prison inmates who suffer from a mental illness face. 60 Minutes started the year off in its February broadcast of the case of Timothy Souders, a person with bipolar disorder who unfortunately ended up in prison for shoplifting, and died. It’s a disturbing story.
The Boston Globe conducted an in-depth report on mental illness in Massachusetts’ prisons, and the findings should be surprising to no one… If you’re mentally ill and imprisoned, your very life becomes at risk.
Mary Beth Pfeiffer also published a must-read book on this topic, Crazy in America, which looks to be worth a read.
Other major news organizations also focused on this growing issue of concern:
Virginia Tech became the sad center of a tragedy and unwanted attention when one of its students decided to gun down and murder 32 others and himself at the university’s campus in April. Cho, the murderer, had previously sought treatment for mental health issues in 2005, two years prior to the murders.
Omaha followed in December, when a 19-year-old troubled teen opened fire in a crowded shopping mall and killed eight people, and then himself. He apparently was on antidepressant psychiatric drugs at the time of the murders, and according to a report on Good Morning America, since he was 5 years old.
In February, the powerhouse blog Furious Seasons released the court documents related to Eli Lilly’s ongoing court case regarding its atypical antipsychotic drug Zyprexa. The documents showed the drug has a greater risk of diabetes and weight gain in people who take it, concerns the company downplayed according to the documents. To date, Eli Lilly has spent over $1.2 billion in settlements related to Zyprexa, according to the New York Times. Also, Furious Seasons has been rigorously following the individual state lawsuits filed against Eli Lilly (and other pharmaceuticals) for various reasons, including widespread off-label marketing of atypical antipsychotics (a big no-no in the U.S.):
In January, the BBC reported on GlaxoSmithKline (GSK) “hiding” evidence that showed one of its drugs, paroxetine (Seroxat in the UK, Paxil in the U.S.), was linked to increased suicides amongst teens.
The childhood diagnosis of bipolar disorder, not recognized in the Diagnostic and Statistical Manual-IV as a legitimate diagnosis, received renewed attention as some professionals came out to advocate its treatment with psychiatric medications not approved for such use. And of course Rebecca Riley’s death in February from an overdose of such medications didn’t help. As a reminder, Rebecca was diagnosed at 2 ½ years old with both ADHD and bipolar disorder.
- Very Early Diagnosis Leads to Girl’s Death
- Bipolar Illness Soars as a Diagnosis for the Young
- The Growing Backlash on Bipolar Disorder in Kids
- Is Early Onset Bipolar Disorder Simply Normal Childhood?
Daniel Carlat, M.D., a publisher of a psychiatric newsletter and practicing psychiatrist, began a blog that became an instant hit documenting his view on pharmaceutical-funded continuing medical education and its many biases.
Megan Meier made tragic headlines in November when it was revealed she committed suicide after suffering from online harassment, by none other than allegedly an ex-friend’s mother, Lori Drew. Adding salt to the injury was the fact that the county prosecutor refused to press charges against Lori Drew, despite the serious ramifications of this person’s apparent poor judgment. It was an illustrative case of how pretending to be someone else online has real-world impact. Put in another way, social relationships online have just as much power over us as our traditional face-to-face relationships.
The American Psychological Association (APA) found itself at the center of a growing controversy regarding its wishy-washy policy of allowing psychologists, even indirectly, to be involved in interrogations that may include torture. After much media exposure on the topic, and the resignations of hundreds of APA members, the APA finally clarified their position – psychologists are banned from all torture interrogations, even indirectly.
Newsweek had a good cover story on men and depression in early 2007.
Owen Wilson’s bout with depression captured the headlines in August.
Brain research published in September found that there may be structural differences between liberal and conservative brains. The work grew out of decades of previous research suggesting that political orientation is linked to certain personality traits or styles of thinking. A review of that research published in 2003 found that conservatives tend to be more rigid and closed-minded, less tolerant of ambiguity and less open to new experiences.
In October, we reported that a U.S. government agency released a study that found approximately 7% of the U.S. workforce may suffer from depression.
And not surprisingly, one of the most popular blog entries of 2007 was the list of 237 reasons to have sex, from the University of Texas study published in the August 2007 issue of the Archives of Sexual Behavior:
A completely useless study, but one that talks about the most popular topic online: sex.