First-generation antipsychotics (typical antipsychotics, neuroleptics) have been around since the 1950s, but how safe are first-generation antipsychotics like haloperidol? One doctor, Henry A. Nasrallah, MD, suggests that haloperidol and its likenesses should be retired as first generation antipsychotics are not safe for the brain (he and the literature contend). Are first-generation antipsychotics like haloperidol safe or possibly neurotoxic?
After looking at the future treatment approaches for treatment-resistant depression, I thought I’d share a bit more depression and bipolar research. New options offer hope for everyone who run the gamut of bipolar or depression treatments.
- A new mood stabilizer
- A new, novel antidepressant
- Knowing when depression isn’t depression
Today’s piece is written by Elaine Hirsch of MastersDegree.net. She writes today about the benefits of generic drugs for patients. Note: This is in no way an endorsement of, or advertisement for, olanzapine (Zyprexa).
The Food and Drug Administration (FDA) must approve any medication before it is made available to patients, this includes generic medications. As highlighted in one of Natasha’s earlier articles (Are Brand Name Drugs Better than Generics? – Drugs are not Cornflakes), generic drugs must go through rigorous FDA tests just as their brand-name counterparts do. The approval of generic olanzapine (Zyprexa) for bipolar disorder the FDA has taken a step forward in providing better healthcare to men and women who suffer from mental health issues.
What is olanzapine (Zyprexa)?
The FDA has approved generic olanzapine (Zyprexa), an antipsychotic, for the treatment of bipolar and schizophrenia. This medication is a new and less expensive version of the brand name medications Zyprexa and Zyprexa Zydus. The active ingredient in the medication is the same in the non-brand form.
The purpose of olanzapine is to treat schizophrenia and bipolar symptoms. Such symptoms include disturbed thinking, loss of interest in life, inappropriate emotions and mania.
What are generic drugs?
Generic drugs are the same as brand-name equivalents as far as ingredients, measurements, and effects are concerned. The difference is generic medication is offered as a much lower price than branded medications so patients are more easily able to obtain it.
Benefits of generic drugs
Americans often have a skewed vision when it comes to generic medications. As many as one third of Americans don’t realize generic drugs have the same ingredients as their brand-named counterparts and are just as effective. Fortunately, gradually increasing knowledge about the benefits of generic medications is making the release of generic olanzapine more significant for bipolar patients.
Cost of generic drugs
The main benefit of generic drugs is the lower cost when compared to brand name options. Brand name medications are expensive and insurance companies do not generally cover the full cost of the drug. This means more money is coming out of the pocket of consumers. Generic medications come at steep discounts and many are covered in-full by prescription drug insurance coverage.
Availability of generic drugs
Perhaps one of the greatest advantages of a generic drug is that it’s more readily available to the public. Families and individuals who otherwise are not able to afford the medication from a name-brand company are able to pay for the generic version and receive the same health benefits. This opens up more doors to improving public health by making drugs more widely available among even the poorest patients.
With the approval of generic olanzapine, the FDA has made mental health treatment available to more men and women throughout the country. This generic medication for bipolar disorder and schizophrenia is much less expensive than Zyprexa, but has the same effects. Of course, any form of generic medicine entering a market reduces the overall cost of treating ailments, and olanzapine has certainly done so for people suffering from schizophrenia and bipolar disorder.
Elaine Hirsch is kind of a jack-of-all-interests, from education and history to medicine and videogames. This makes it difficult to choose just one life path, so she is currently working as a writer for various education-related sites and writing about all these things instead.
Last week I didn’t post three new things but don’t take that to mean I wasn’t learning because I certain was, and always am. For this week I have these three new pieces of information to share:
- Repetitive transcranial magnetic stimulation (rTMS) treatment for depression to be free for (some) Canadians
- Brain changes are noted in depressed females
- Why are some doctors anti-benzodiazepine?
1. Free rTMS in Manitoba (Canada)
RTMS stands for repetitive transcranial magnetic stimulation and is a treatment for treatment-resistant depression. RTMS is considered a neurostimulation therapy, like electroconvulsive therapy (ECT), but is non-invasive. RTMS has its pros and its cons.
- Pros – rTMS is drug-free, has few side-effects and can produce remission from depression in some people
- Cons – rTMS is expensive, intensive and its therapeutic effects are generally temporary
Cost of RTMS
Most people don’t get rTMS due to the cost. Repetitive transcranial magnetic stimulation requires 2 sessions per day for 10 days (weekends off) plus and additional possible 5-10 sessions depending on the reaction to treatment. Needless to say, this is one expensive therapy. In Canada that works out to $5000 – $7500 and in the States lord only knows how much.
And Manitoba is taking the very civilized step forward of offering rTMS as part of the public health care system, which is how it should be. The only reason why it isn’t is cost. You can get rTMS in Canada, but this is the first time I’ve heard of it being free.
Congratulations to Manitoba for taking a step forward in helping people with a mental illness. I hope this is the sign of things to come across the country.
2. Brain Changes Noted in Depressed Females
Women are twice as likely to develop depression as men but no one knows why. This study takes a look at female brains to look for biological identifying markers between depressed brains and well brains.
. . . depressed women had a pattern of reduced expression of certain genes, including the one for brain-derived neurotrophic factor (BDNF), and of genes that are typically present in particular subtypes of brain cells, or neurons, that express the neurotransmitter gamma-aminobutyric acid (GABA.) These findings were observed in the amygdala, which is a brain region that is involved in sensing and expressing emotion.
BDNF and GABA in Depressed Brains of Women
BDNF is something I’ve mentioned before as to a biological cause of depression. Yes, just another fact to chalk up for all the people saying depression is just “in your head.”
And work toward identifying the gene that contributes to depression:
. . . researchers tested mice engineered to carry different mutations in the BDNF gene to see its impact on the GABA cells. They found two mutations that led to the same deficit in the GABA subtype and that also mirrored other changes seen in the human depressed brain.
I keep telling people: We’re getting closer to effective treatments and understanding every day.
3. The Religion of Benzodiazepines – Why Some Doctors Don’t Prescribe Benzos
I’ve taken benzodiazepines (benzos) of one type or another for a decade and never once had a problem with them, but many people do develop tolerance, dependence and drug-seeking behavior around this type of medication.
My opinion is that benzodiazepine medications can be used quite safely when properly handled, but that some people have the tendency to get addicted to medications, and for them, these medications may be contraindicated. In other words, it’s down to the individual and prescription of benzos cannot be characterized as “bad” or “good” in a blanket statement.
I plan on writing a whole article about this, but if you’d like a sneak peek about why some doctors are anti-benzodiazepine, check out this article in Psychiatric Times.
Until next week all, when I shall learn more and do better.
I try not to give medical advice here because I am not a doctor. But so many people ask me about this I felt I had to address getting off antidepressants without withdrawal. So many people with bipolar disorder (depression and others) need information about getting off psych meds and they are not getting it from their doctors.
This is the first in a three-part series:
- When to Stop Antidepressants in Bipolar Disorder
- How to Stop Antidepressants in Bipolar Disorder While Minimizing Withdrawal
- How to Stop Taking venlafaxine (Effexor) and Desvenlafaxine (Pristiq) – as they are particularly nasty to get off
This is an informational article only and should not be considered a recommendation. Talk to your doctor before any and all changes to your treatment. I’m not kidding about this.
Bipolars Shouldn’t Take Antidepressants
Some doctors are on the fence about this, but more and more bipolar specialists are recommending people with bipolar disorder not take antidepressants. There are lots of reasons for this, and I have to tell you, they are compelling.
Why Shouldn’t People with Bipolar Disorder Take Antidepressants?
Some reasons people with bipolar shouldn’t take antidepressants:
- Antidepressants may not work in bipolar disorder – believe it or not, the literature is mixed on how well antidepressants even work for bipolar depression.
- Antidepressants can induce mania or hypomania (known as switching) – most of us have seen this and it happens all the time to bipolars who are prescribe antidepressants by non-psychiatrists because they just don’t understand the danger. And it is very dangerous because once switched, this type of mania or hypomania can be treatment resistant.
- Antidepressants can induce rapid-cycling or mixed moods – same as above, this cycling can be treatment-resistant.
- Antidepressants can worsen a bipolar’s illness overall – this is more controversial and I suspect varies case by case.
To be clear some people with bipolar disorder will always need antidepressants temporarily, or long term, for their mood, but more and more, doctors are saying to avoid them whenever possible. (Alternatives will be presented in a future article.)
When to Stop Taking Antidepressants
Here are some guidelines from Dr. Phelps about when to stop taking antidepressants in bipolar disorder:
- If they have been on antidepressants a short time, I stop them.
- Less than a week, stop; two weeks, cut in ½, a week later stop.
- Likewise, if they just increased their antidepressants dose I will do the above, decreasing to their previous dose and get rid of the rest later.
- If manic or severely hypomanic, get rid of antidepressants now. Usually can stop abruptly.
- If cycling or mixed get rid of the antidepressants.
- If they are not getting better after several add-on meds then slowly decrease.
- There are more exceptions to the above rules than there are rules.
When to Stay On an Antidepressant if You’re Bipolar
More guidelines from Dr. Phelps: When a bipolar should stay on an antidepressant:
- If the patient is doing well, no mixed state symptoms or cycling, leave it.
- I usually wait until the patient is doing better to much betterto stop an antidepressant; why:
- Trust is an issue. If the first thing we do is make them suffer more they will be unlikely to stay around long and may not even go to another psychiatrist.
- Even though we know the antidepressant is causing harm often time the patient thinks either the antidepressant is helping or every time they try to go off they feel much worse.
- Waiting until they are better is usually a good thing.
- Also waiting longer usually means that the patient is going to be more educated about bipolar in general.
When to Get Off an Antidepressant Recommendations
I think Dr. Phelps’ recommendations are good ones, otherwise I wouldn’t have them here, but note where he says there are more exceptions than he has listed, so keep in mind, you might fall into one of the unlisted exceptions.
And I think the part above where Dr. Phelps talks about trust and making sure the patient is better before messing around with their cocktail is key. It shows he’s respecting the patient and their health, not to mention the doctor-patient relationship which is very important.
Talking to Your Doctor about Getting off Antidepressants is Scary
I know it’s scary to think about going off antidepressants, even if you do think they are causing problems. But think about it, discuss it with your doctor and make the right decision for you. And don’t do anything until you read the next part about how to get off antidepressants without withdrawal.
Bipolar Disorder – Getting off Antidepressant Series
- Bipolar Disorder – When Not to Take Antidepressants
In the first of this series I discussed antidepressants and addiction. Some people contend antidepressants are addictive; however, not only is the term “addiction” not defined medically, the use of antidepressants does not generally match the symptoms of any defined substance use disorder either. (More information on substance abuse and substance dependence.)
This time antipsychotics are up to bat. Are antipsychotics addictive? Are people dependent on antipsychotics? Do antipsychotics cause withdrawal?
I am very medication-reactive. Not so much with the positive effects, but I can almost guarantee you I’ll get all the side effects.I get every side effect for antidepressants, every side effect for antipsychotics and every side effect for pretty much anything else.
And sometimes, just for good measure, I’ll get side effects that doctors say “aren’t possible”. They are my favorite. And those overractions are often on the lowest known effective dose of the medication.
But if you add a low dose, lower than thought effective, of an antipsychotic, can this be helpful?
I have written thousands and thousands of words in this blog and elsewhere about how much I hate medication.
I hate it in the car, I hate it on a train, I hate on a boat, I hate it in the rain.
I hate it in the snow, I hate it in the sun, I hate it standing still, I hate it on the run.
I hate it before breakfast, I hate it after lunch, I hate it in the morning, I hate it during brunch.
And while I could fill an entire blog with all the ways I hate psych meds, I still, take them, everyday.
Weird you say?
(Well, yes. But no more so than the disease it treats.)
Because no matter how much I might hate psych meds, medication non-compliance kills.
It Doesn’t Matter that I Hate Meds, I Am Medication Compliant Anyway
Someone said to me that I have such conviction for a method that has been proven fruitless again and again. Well, yes, but there has been the odd pomegranate here and there. Moreover, I can’t think of anything better with which to convict, so I have to go with what has the greatest (however small) possibility of working. [push]Psych meds are backed by science and doctors and experience; not to mention my personal experience with medication where it has definitely been useful from time to time.[/push]
But I completely understand people who want off their meds. Now. Like. Now. No more medications. No more antidepressants. No more antipsychotics. No more mood stabilizers. No more tranquilizers. No more medications. Medication non-compliance. Now.
Bipolar Medication is Horrible
I get it. Psych meds are horrible. My list of psych med side effects is terrifying, even to me. Some I wouldn’t go through again no matter what. So I totally get it. Bipolar medications and side effects can all but ruin a life.
But Bipolar Medication Saves Lives
But psychiatric medication saves lives too. In fact, it may be saving your life right now, without you even knowing about it. The fact that you’re not trying to kill yourself may be thanks to the little pink pill that you take in the mornings, even though it is your least favorite part of the day.
And that’s the thing. I understand the consuming desire to excise the poison of psych meds from one’s body, but doing so can be just plain dangerous and life-threatening. All sorts of nasty things happen to people when they suddenly stop their medication. This is known as medication non-compliance and is a topic I wrote about at Breaking Bipolar.
There is so much to know about Seroquel, and really, you’re so right to be afraid.
Over the last week-and-a-half I’ve been writing at HealthyPlace about the full prescribing information for Seroquel. I’ve done this to make a point – the full prescribing information for Seroquel or any drug is a treasure trove of knowledge. The full prescribing information really let’s you know what you’re getting into bed with and in the case of Seroquel, you’re getting into bed with a very dangerous substance. (That’s OK. I mean really, the only people worth getting into bed with are dangerous.) And whenever you take a (psychotropic, psychiatric) medication it’s worth knowing the risks. Seriously. Like, really worth it. And the risks of taking a medication are laid out in black and white in the prescribing information.
Antipsychotic Seroquel Information
I discuss Seroquel prescribing information section by section:
Part II: Seroquel warnings and precautions
And just to be clear, I’m not attacking Seroquel here. Seroquel just happens to be the highest grossing psychotropic medication and that’s why I picked it. Prescribing information and all its nastiness is available for any drug. I do think though, particularly everyone on an antipsychotic should look at its full prescribing information. I’m not suggesting these are bad medications, but what I am suggesting is that they are very dangerous and you need to be made aware of it before you stay on them for years.
Does Pristiq Just Serve to Extend the Effexor Patent?
If you live in the US, you’ve probably seen all the commercials for the new and pastel-pink-coloured antidepressant Pristiq. (Yes, prescribed for depression.) Pristiq is new and has a huge marketing push behind it and is a selective serotonin norepinephrine reuptake inhibitor (SNRI) antidepressant. In other words, it’s an antidepressant that works on both serotonin and norepinephrine neurotransmitters. It is not the only antidepressant to do this, but SNRIs are a smaller class of drugs than those that just effect serotonin alone (like Prozac). (Although admittedly, there seems to be a suspicious number of SNRI antidepressants in development.)
I have bipolar-disorder-type-II-ultradian-cycling. I diagnosed myself when I was 20 years old, and once I finally agreed to see a doctor, he agreed sometime thereafter. My diagnosis was fairly easy for me. I’m very self-aware and I could pick out discrete moods and swings. But as a 20-year-old, in university, using research, and having a fairly high IQ, this is not terribly surprising. If I were five-years-old, the picture would have been a little different.
Epidemic of Children Diagnosed with Mental Illness
There is an epidemic of children, as young as two, being diagnosed with psychiatric disorders in North American right now. It’s made the cover of Time magazine and countless articles have been written on the phenomenon.
So, Antipsychotics are Now Approved for Children
It was once thought that disorders like bipolar did not occur before adulthood, but thoughts on this seem to be changing as diagnoses go up and more drugs are approved for treatment of children.
Antipsychotics FDA-approved for use in children (under 18) is:
- Quetiapine (Seroquel) – schizophrenia, ages 13-17; bipolar I, ages 10-17
- Olanzapine (Zyprexa) – schizophrenia and bipolar I, ages 14-17
- Risperidone (Risperdal) – schizophrenia, ages 13-17; bipolar mania, ages 10-17; autism, ages 5-16
And so on. And of course, doctors are free to prescribe any medication off label to children just like adults.
Antipsychotics Can Fuck You Up
I have been on all three of those antipsychotics and all three have fucked me up. Specifically seen has been weight gain, blood pressure changes, twitching, extreme fatigue, incurable hunger, and in the case of Geodon, psychosis. Among other things.
What Do Antipsychotics Do?
Antipsychotics turn down the dopamine in your brain. That’s what’s the do. They also turn down serotonin. These are two of the “feel good” chemicals in your brain, and you are turning these down. This seems to help with certain disorders like schizophrenia, but dopamine in integral for motivation, reinforcement, learning, and memory. If, for example, your five-year-old eats his peas, and you praise him, he feels good because a shot of dopamine is released. This then reinforces the pea-eating behavior, so that next time, he will again eat his peas. If you take away dopamine, he may not be able to make this link. And if you take away dopamine from a child’s (naturally developing) brain for a long period of time, no one has any idea what would happen.
I cannot, in any world, imagine giving these drugs to a child.
We Don’t Know How to Diagnose Bipolar In a Child
The truth is, no one knows what bipolar looks like in a child, or if it even exists. There is no diagnostic criteria in the DSM. Psychiatrists are using relaxed versions of symptoms seen in adults for diagnoses. This is patently ridiculous.
Children are Naturally Crazy
Kids blur the line between fantasy and reality. Kids act out. Kids throw tantrums. Kids ignore you. Kids break rules. Kids often don’t show a great regard for their safety or the safety of others. Kids throw broccoli across the kitchen table. Kids do, the darndest things. They’re kids. It’s what they do. None of this makes them crazy.
Recently a friend of mine was talking about a girl who hallucinated a dead robot baby. Moreover, this same girl spent her recent birthday having an elaborate funeral for a bird found dead in her back yard. Sound crazy? Not for a seven-year-old. It might be a bit unusual, but to me this speaks of intelligence creativity and compassion, not a mental disorder.
And let’s face it, some kids are very challenging to handle. Some are overly aggressive, or sad, or obstinate. They hit their sister, break a vase, or refuse to stay in their room for a time-out. This still doesn’t make them crazy, this just makes them challenging. Parents don’t get a pass just because their job is harder than they thought it was going to be.
Kids Can Be Crazy and Still Perfectly Normal
Basically, kids can have almost any pattern of behavior and still be pretty darn normal. And that doesn’t take into account all of the environment factors that are effecting kid’s behaviors. I’ve never seen great parents with a kid with huge behavioral problems. Yes, I’m sure it happens, but generally, kids are a reflection of their home lives. And kids with bad home lives don’t need or deserve drugs. They deserve better home lives.
And on top of all of this, if a child really is having behavioral problems there are specialists who can help with that, they’re called child psychologists. They help children and parents all day long. And they don’t cause weight gain and high blood pressure.
And don’t get me started on how idiotic it is to diagnose a two-year-old with a mental disorder. Two? Really? It can take an adult two years for an adult to get a diagnosis of bipolar. That sounds like a parent disorder if ever I heard of it.
Children on Antipsychotics and Other Psych Medication Seem Like Lab Rats
It feels to me like these children are being treated as lab subjects, and not real people. I am highly suspicious of any doctor that would medicate a child. Could it possibly be a reasonable thing to do? Well, maybe. But you’d be hard pressed to convince me.
Mental Illness as Self-Fullfillment
And in addition to whatever drugs are being fed to these children, they are also being saddled with a diagnosis – for the rest of their lives. As an adult it can be extremely detrimental to be labeled “crazy”, but as a child I can only imagine it would be infinitely worse. These children don’t even have a chance to find an identity before they’re told they’re crazy. How can that label not result in self-fulfillment?
Victims of Fad Diagnoses
When the movie Cybil based on a woman with “multiple personality disorder,” came out, the diagnosis of this disorder exploded across the US. A disorder that had virtually never been seen was suddenly everywhere. But over the decades that followed, medical professionals were able to determine that these were not genuine cases. In fact, some doctors feel that there has never been a documented case of “multiple personality disorder” as featured in the film. There are other disorders with similar features, but the giant outbreak seen after the film, just didn’t exist.
Is Childhood Bipolar a Fad Diagnosis?
And one has to wonder if we’re seeing something similar here. If more adults are being diagnosed as bipolar, then naturally, we are looking for markers of it at younger ages, and in their genes. We want this information to help people, to help treat the disease, but it can just as easily be used to further label people before we even know how to do it properly. Multiple personality disorder looked like a correct diagnosis until we figured out it wasn’t.
And if someone as young as a toddler gets diagnosed with some behavioral disorder, don’t these children deserve time to correct this issue via safer methods than drugs? It seems that out of an eight year life, it’s impossible that enough other treatments have been tried to warrant drugs.
Now, it’s true, I’m not a doctor, or a parent. And I do have a strongly held belief that doctors and their patients should be able to choose treatments without judgment from the outside world. But I also think any doctor worth seeing is going to try the least harmful treatment first, especially in a population that has been radically understudied. True, behavioral therapy might not work, but it’s unlikely to cause debilitating side-effects. And what about waiting for a child to grow out of behavioral issues? I hear that was a thing that used to happen. Before we got all diagnos-y.
I’m not suggesting that no one under 18 is sick, or that no one under 18 should be treated with medication. What I am suggesting is that diagnosis and treatment of children needs to be handled with extreme care and caution. I’m an adult and I give informed consent to fuck with my brain; children do not have that ability, and yet, they will be the ones that have to live with the results. They deserve every possible solution that avoids nasty, unknown side effects. Parents need to be held to a higher standard of decision-making and not pick what is easiest for them, but what is best for their child. Doctors need to be held to a higher standard to care with children, ideally with third party monitoring of underage drug-treatment. This is not something to be taken lightly on any front.
Someone needs to sanity-check the parents. Kids need to be able to act crazy, without getting labeled crazy.