mental illness issues

Depressed People Who Take Antidepressants Do Better Long-Term – Part 2

→ May 16, 2011 - 5 Comments

As I mentioned last week, it’s very difficult to measure long-term outcomes of depression treatment due to the confounding depression variables like severity of depression, duration of depression, number of depressions and so on.

In short, the sicker you are, the more depressed you are, the more likely it is you’ll get treatment.

Antidepressant Treatment Outcomes Long-Term, A Study

I discussed the basic outcomes of this study: The association between antidepressant use and depression eight years later: A national cohort study by Colman et al. (you may have to select Science Direct to see the study, you don’t need a subscription) which tries to take these variables into account.

Colman et al. showed those who took antidepressants had better depression treatment outcomes than those who didn’t, eight years later, once confounding variables were taken into consideration.

I’ll now point out the strengths and weaknesses of this study as well as some other interesting tidbits shown or cited in the study. Oh, and I’ll give my opinion on what it all means.

Strengths of this Depression Treatment Outcome Study

No study, of course is perfect, but each has its strengths. In the case of this study on depression treatment outcomes, some of the strengths include:

  • An attempt to quantify and account for factors we know will affect treatment outcomes
  • Study uses a large, heterogeneous, real-life, population base
  • Quality, fairly comprehensive data available
  • Replicated findings of a British study involving anxiolytics (anti-anxiety medication) and antidepressants

Weaknesses of this Depression Treatment Outcomes Study

Weaknesses mostly bias the outcome towards the conservative. In other words, the relationship between antidepressant use and a positive long-term outcome may be stronger than reported.

  • Does not have 100% data over eight years (Those who dropped out had worse depressions. This biases the data likely indicating a stronger relationship than shown.)
  • Not a randomized controlled trial (not likely possible)
  • Does not capture comorbid (co-occurring) disorders (likely indicating a stronger relationship than shown)
  • Does not specifically capturing other treatments*
  • Didn’t control for perception of need for treatment. In other words, those who were able to identify the need for, and seek, treatment took antidepressants and had better outcomes. So a factor then would be the person’s treatment-seeking behavior.

For all the nitty gritty on the strengths and weaknesses of this depression treatment outcome study, see here.

Outcomes of Antidepressant Treatment of Depression, Facts

In addition to their main findings, here are some other interesting depression treatment outcome facts either shown or referenced in the study:

  • Antidepressants are particularly useful for those with severe symptoms
  • Of 285 depressed patients, those using higher levels of antidepressants were significantly more likely to recover from symptoms in the short term (from a 20-year study)
  • British study found that of 204 depressed patients, those using antidepressants or anxiolytics (anti-anxiety medication) were significantly less likely to be suffering from symptoms of depression ten years later
  • Maintenance use of antidepressants has been shown to reduce future depressions
  • Those with partial remission (still having some depression symptoms) are far more likely to experience future depressions
  • The longer depressive symptoms persist before treatment the worse the long-term prognosis
  • The most strongly correlated value to better outcome was recent antidepressant use

Depression Long-Term TreatmentFunding of Depression Treatment Outcome Study

Because I knew you’d want to know (I did too):

Funding for this longitudinal depression treatment outcome study was provided by government, grant and award money. Study was cleared through the Health Research Ethics Board of the University of Alberta.

So Long-Term Antidepressant Use is Good?

Well, I can’t say that. What I can say is this study is suggestive^ of the fact that people who are depressed and take antidepressants do better over the long-term than those who don’t. But remember:

  1. People weren’t necessarily on antidepressants the whole eight years.
  2. The key (shown in studies and in my opinion) is to treat the depression as soon as possible and get all symptoms into remission.

So, that doesn’t mean get and stay on antidepressants forever, nor does it mean go on and off antidepressants. Those are individual choices depending on the person’s situation. If you can achieve #2 then your prognosis (in my opinion) is very good. And generally this is done with antidepressants, but depending on your personal situation, you may be able to achieve it through other means.

This also shows people taking antidepressants don’t do worse. This matters because there is a meme out there that taking antidepressants will somehow eat your brain and create mental illness.** This study suggests not.

A Little Bit More

* Study also talks about the role of therapy in depression treatment but no relationship was found between those who got therapy and those that had more positive outcome, suggesting there was no benefit to therapy. However, this is likely due to the broad definition of the word “therapy.” This is why I chose to omit information therapy findings.

^ This is not a causational relationship (where we know one thing causes another) as causation is hard to ascertain without real double-blind placebo controlled randomized study. And we don’t have that.

** Antidepressants actually increase the creation of neurons (neurogenesis) and increase brain volume.

Depressed People Who Take Antidepressants Do Better Long-Term

→ May 12, 2011 - 17 Comments

Recently the controversy over long-term outcomes of those who use psychotropic medication has flared up again. Some people argue depression/bipolar/mental illness patients do the same, or better, when they don’t take psychiatric medications long-term. However, the statistics they use to assert this claim are often faulty.

A study from Calgary, Alberta, Canada (yes, we do research up here too, select Science Direct to see the study) has attempted to fix some of the bias seen in other long-term depression treatment outcome statistics. I’ll cut to the chase for you:

Over the course of eight years people with depression who took antidepressants had better outcomes.

Depressed People Do Not Do Better by Taking Antidepressants

The reason people say those with depression who take antidepressants do not do better, or do worse, goes something like this:

We looked at 100 people with depression and over five years those who didn’t take antidepressants were less depressed.

Put that in the middle of some persuasive text and the villagers gather with pitchforks at the doors of psychiatrists everywhere.

Why are they Wrong? What’s the Problem with This Data?

Treatment Outcomes in Depression

Um, OK. Anyone see the problem here? Anyone?

It should be obvious. Those who don’t take antidepressants (or who go off antidepressants) are typically less sick than those who do take antidepressants. If you’re sicker, you’re more likely to get treatment. It’s not rocket science.

For some reason everyone wants to gloss over that bit.

This is what you call sampling bias.

Measuring Depression Treatment Outcomes Long-Term

Trouble is, you can’t randomly assign people people with a mental illness to treatment/no treatment over the course of a year or more. Sure, the depression treatment outcome data would be better, but the people might not fair so well.

We have to think smarter. If you can’t assign people at random, can you account for variables like duration of mental illness and severity of depression symptoms?

The association between antidepressant use and depression eight years later: A national cohort study by Colman et al. tried to take these variables into account.

Confounding Depression Variables

As I’ve mentioned in the past, depression is not one thing, depression is a spectrum disorder. You may have a variety of symptoms with a variety of severities and still be “depressed” (bipolar is the same). Somehow, we have to quantify that.

We do know some variables that correlate to depression treatment outcomes. Colman et al. measured:

  • Severity of depression
  • History of depression
  • Duration of past depression
  • Suicidal behavior
  • Physical health
  • Demographics (gender, education, etc.)

Depression variables were measured based on scientific scales derived from various methods including personal interviews. You can read all about it here.

Population of People with Depression

For this study, patient population data used was collected by a Canadian agency in the National Population Health Survey in 1998/99 through 2006/2007 every two years. 486 people (of 17,276) were identified as having depression in 98/99 and were followed, 66% of which provided complete data in 06/07 (321 people). Population was all ages, treatments and representative of general population.

Colman et al. analyzed the above variables for all 486 so they could ascertain who was most likely to drop out of the study (or give incomplete information) based on their variables; however, obviously only 321 were used to determine treatment outcome measures.

Depression Treatment Outcomes and Adjusting for Variables

As I said above, if you do not adjust for variables that lead to treatment likelihood, you get statistics that aren’t valid (they’re too biased). Sicker people get treatment.

So, the numbers when you do not account for bias look like this in the depressed population over eight years:

  • Those who took antidepressants were as likely to be depressed as those who didn’t take antidepressants.

But when you adjust for the mentioned variables, that changes to:

  • Those who took antidepressants in 98/99 were less likely to be depressed eight years later (OR = 0.36, 95% CI: 0.15–0.88)

(There are other findings and statistics (not overly significant and in scientist-eze) here.)

Long-Term Depression Outcomes Better with Antidepressants

All that is a fancy way of proving the people who took antidepressants were less likely to be depressed eight years later.

In part two, discussion about the strength and limitations of this study and other interesting findings and citations.

Are All Doctors, Psychiatrists and Scientists Lying All the Time?

→ April 28, 2011 - 91 Comments

One of the problems with the antipsychiatry movement is they assert all of psychiatry, all doctors, all science is lying, pretty much all of the time. Any biological evidence for mental illness must be wrong, because if it isn’t, then psychiatry might make sense. Any evidence antidepressants help a brain must be wrong, because otherwise antipsychiatry views might come into question.

But seriously, does any rational, thinking person really believe all of science, all over the world, is lying?

Read more

Is There a Blood Test for Schizophrenia? – VeriPsych Tests for Schizophrenia

→ April 18, 2011 - 7 Comments

Hot on the heels of the Bipolar Burble’s post about the neurobiological evidence for major depressive disorder comes this: the first blood-based diagnostic aid for schizophrenia.

Um, what’s that again?

[At this time I’m forced to remind you that I am not a doctor or researcher and everything stated is my opinion or interpretation. Thanks.]

A Blood Test for Schizophrenia

A company VeriPsych, affiliated with Rules-Based Medicine Inc., is offering a blood test for schizophrenia. Or, more specifically, they are offering to test your blood and supply a likelihood that you have recent-onset schizophrenia.

A sample VeriPsych Conditional Probability of Schizophrenia report can be found here.

VeriPsych and a Blood Test for Schizophrenia

The VeriPsych folks, through Rules-Based Medicine, apparently in conjunction with the US Military, ran a study to look for biomarkers of schizophrenia and then develop a test for them. (I should mention here the only thing VeriPsych appears to do, according to their web site, is offer this “diagnostic aid for schizophrenia.”)

Now, admittedly I am not a doctor or a researcher, but here’s what I make of the VeriPsych schizophrenia biomarkers study.

[FYI: Biomarker: a protein measured in blood whose concentration reflects the severity or presence of some disease state.]

Blood Test for Schizophrenia Research

Specifically: Validation of a Blood-Based Laboratory Test to Aid in the Confirmation of a Diagnosis of Schizophrenia by Emanuel Schwarz et al. Biomarker Insights 2010:5 39–47

The study was in two phases, in the first phase researchers looked for reproducible schizophrenia biomarkers and in the second phase, a test was developed to use these biomarkers to test for schizophrenia.

Phase One: Schizophrenia Biomarker Selection

  • Assed 181 biomarkers
  • Used 806 clinical samples
  • Participants were in multiple countries, some from the US military

Initial assessment resulted in the finding of 22 biomarkers. These were retested in 63 subjects 3 months later and showed a correlation of 0.83 (83%).

Nine addition biomarkers were added for phase two due to known association with schizophrenia.

VeriPsych then did something odd: they included 20 biomarkers they felt indicated bipolar disorder, “to facilitate the future development of a test with differential diagnosis capability,” and to “enhance[d] the accuracy of VeriPsych.” (The former is from the research paper, the latter is from the website.)

Notes on Schizophrenia Biomarker Selection

This says to me they are really testing 31 biomarkers of schizophrenia, and 20 for “other reasons.” So when they claim to use a 51 biomarker test, that stretches the truth a little.

Also, the numbers on these seem to vary from the paper to the website making it difficult to deduce exactly how many biomarkers are used for each purpose. A spot on the website says: 36 identified and 15 added. Sorry, it’s just not clear.

Phase Two: Validation of Schizophrenia Biomarkers

  • Phase two used 480 samples for biological test validation
  • Biomarkers appear consistent for paranoid and nonparanoid schizophrenia
  • Biomarkers test seems to work even after 4-6 weeks of antipsychotic treatment (85% accurate)
  • Accuracy increases with chronic schizophrenia
  • Appears (to me) to have more false-positives than false-negatives
  • “Overall sensitivity of 83% and specificity of 83%”

Accuracy of Schizophrenia Blood Test?

There are some super-math algorithms and statistics going on here, but from what I can tell:

  • You get a “score” from the blood test
  • Depending on the score, you get a percent chance of having schizophrenia
  • Some tests are inconclusive

Who Tested the Validity of These Results?

Good question. No one except the lab (Rules-Based Medicine) from what I can tell. This is not an FDA-approved test as it is a “laboratory-developed test.”

Laboratory-developed tests are:

  • The activity of a single laboratory, not a traditional device manufacturer
  • Not commercially marketed to other labs
  • Wikipedia says: assays developed in the laboratory for internal use, or research use only, and not intended for diagnostic or medical use, and therefore treated differently by regulatory agencies; describes most current genetic testing.

Blood Test for SchizophreniaSo, Is This a Blood Test to Diagnose Schizophrenia?

No. It isn’t. This isn’t a blood test to diagnose schizophrenia. They mention this on their home page. This test is to, “aid a psychiatrist in the diagnosis of recent-onset schizophrenia.”

In other words, it’s a freaking guess with a number attached.

This test can’t tell you whether you have schizophrenia, it can provide a somewhat-accurate statistical likelihood. So how useful is that? You have an x% chance of schizophrenia plus-or-minus some variable. Based on one study by one company Does that sound useful? Actionable?

It doesn’t to me.

In Natasha Tracy’s Opinion:

This is a money-grab taking advantage of desperate mentally ill people.

I actually find this “diagnostic aid” blood test for schizophrenia to be bordering on unethical. VeriPsych can cover their ass with math and statistics and probabilities and legal-eze and I’m sure that makes it “OK,” but if you ask me, they are a hair’s breath away from lying. It feels irresponsible to me to hand out these kinds of results about a very serious illness based on one study. One. And there is so much math needed to make this model work that I would fall down dead if there wasn’t a mistake in there somewhere. Nobody gets it right the first time.

This test should be in a lab, used for further research and study, and not be used on the paying public.

(I have other reasons why I don’t like this test too, but as this has gone on long enough, I’ll save them for another day.)

Psychiatric Myths Dispelled by Doctor – Fighting Antipsychiatry

→ April 5, 2011 - 198 Comments

Or How Antipsychiatry Groups are Wrong

If you’ve been reading my writings here at the Bipolar Burble for a while, you’ve probably gathered that I don’t like antipsychiatry groups. These groups are often under the “mad pride” flag or “psychiatric survivors” or people for “human rights” or people fighting psychiatric abuses. Often the language they use is solely designed to convince you that psychiatry is evil, psychiatry should be stopped, no one should take psychiatric medication and in many cases, psychology is also evil. Many antipsychiatry groups are sneaky. Antipsychiatry groups sounds reasonable on first glance but it’s only once you dig into them that you see how insidious they are.

Psychiatry and Psychology are Not EvilAntipsychiatry groups are ridiculous.

I’ve tried to look into antipsychiatry groups to see if there’s something worth understanding but they have no evidence. Just ardent supporters that make wild claims without proof. And their tactics of cruel, personal, abusive attacks are not worth my time. It assures that their groups have no credibility whatsoever.

I Fight Antipsychiatry Groups

And sometimes I spend entire days fighting antipsychiatry people. Antipsychiatry shows up on the Bipolar Burble, antipsychiatry finds me on Twitter, antipsychiatry follows me to Facebook, antipsychiatry shows up on Breaking Bipolar. And these charming antipsychiatry folks, for whatever reason, read all about me and then use those personal details to ensure their personal attacked will be as nasty as possible.

Yes, antipsychiatry groups are ridiculous.

Who has Time to Scientifically Refute Every Cockamamie Antipsychiatry Argument?

I don’t have time to research every one of their outragous claims and make cogent counter-arguments. Because it’s endless. It can always be done but it’s more work than I have time for.

Myths About Psychiatry by Nada Logan Stotland M. D. – Huffington Post

Luckily for me and for you, Dr. Nada Logan Stotland M. D. has written the most amazing anti-antipsychiatry article I’ve ever read. (She doesn’t say she’s anti-antipsychiatry, but this piece is certainly a shot across the bow of antipsychiatry.)

Psychiatry Myths Dispelled by a Doctor

Aren’t mental health diagnoses randomly added to the Diagnostic and Statistical Manual (DSM) and applied to individuals?

When deciding what to include in the DSM, “. . . specialists have to look at the evidence and then make judgments about the criteria for medical diagnoses. The difference between a benign tumor and a cancer is a matter of how many sick cells appear under the microscope. “

“Differentiating them [psychiatric disorders] from normal is no different than deciding what level of blood pressure is ‘hypertension,’ how many pounds add up to ‘obesity,’. . . A condition rises to the level of disease when it handicaps a person, is associated with bad outcomes, and/or can be treated — in psychiatry just as in the rest of medicine.”

We don’t understand mental illness the way we understand other illnesses.

“We all know that diabetes is caused by the failure of the pancreas to secrete normal amounts of insulin. But what causes that? We say it’s an autoimmune condition — the body attacks its own insulin-secreting cells. Why does that happen? We don’t know.”

And, of course, we treat diabetes in spite of this lack of knowledge just like we treat mental illness.

Psychiatry illnesses aren’t real, don’t exist, because there are no diagnostic tests for mental illness.

“The substrate, the physical location, of thought, mood, and behavior, is the brain. That’s not a part of the body we like to biopsy without an extremely good reason . . . Using brain scans, however, we now can distinguish between the brain of a person with depression and a person who is not depressed — and make many, many other such observations.”

This is something antipsychiatry groups bring up all the time. But as Dr. Stotland points out, we can distinguish depressed brains from non-depressed brains in a brain scan. In fact, there are many illnesses that show on brain scans (and sometimes blood tests) but it is early days and brain scans aren’t the kind of thing people can afford (or necessarily even get access to).

Don’t psychiatrists have a vested interest in making everyone “sick” so they can make more money?

“There is a shortage of psychiatrists. I don’t know any psychiatrists with time on their hands. Our incomes are at the lower end of the medical totem pole, along with family medicine and pediatrics . . .”

No one is saying they don’t make oodles of money, they do. But the notion they are not trying to help people and they are trying to create more patients is ludicrous. It takes months to see my psychiatrist because he’s so busy. He doesn’t need any more sick people. Not to mention the fact that in Canada, many profit motivation arguments just don’t hold a lot of water.

There is no science behind psychiatry.

“The New England Journal of Medicine some years ago published a paper demonstrating that far fewer than half the treatments used for cardiovascular diseases are supported by good scientific evidence. Psychiatric treatments work about as well as other medical treatments.”

I’m kind of shocked about cardiovascular disease, but if you think about it, they are in the same position. They are trying to save people’s lives, just like psychiatry is, in the best way they know how.

Please read Dr. Stotland’s full article.

The Motives of Doctors, Psychiatrists and Psychologists

And as many problems as I have with psychiatry, psychiatrists, doctors and psychiatric medication, I believe that psychiatrists are trying to help. They’re not always successful, but their motive is not evil and it’s not money – it’s making people better.

 

Breaking Bipolar Articles You Should Read – Updated Resources

→ March 29, 2011 - 2 Comments

Breaking Bipolar at HealthyPlaceAs most of you know, in addition to the Bipolar Burble I also author Breaking Bipolar on HealthyPlace.com. I write a column there twice a week as well as produce one bipolar-themed video and two audio files per month. It’s a fairly well-received bipolar blog often with much discussion, feedback and sharing.

Recent Breaking Bipolar Blog Highlights

If you haven’t had a chance to check out Breaking Bipolar lately, here are a few of the highlights:

Upcoming Bipolar Burble Articles

I’m sure that’s more than enough for now. Upcoming pieces on the Bipolar Burble will likely be about hypomania and delusions and possibly regarding the black box warning on antidepressants actually increasing suicides (you can yell at me about that after I write it). There will probably be a piece about my own ECT experience as well as that’s not really covered here (I wrote quite a bit about it on another blog.)

If you’d like to see a topic covered on the Bipolar Burble or Breaking Bipolar or have a question you can always contact Natasha Tracy. I can’t promise I’ll respond but I’ll do my best.

New Mental Health Resources Added

The bipolar and mental health resources page has also been updated. These are good resources you should know about.

Angry at Bipolar: Dealing with the Anger of Mental Illness

→ March 16, 2011 - 44 Comments

Also known as: I’m Mad at the Jungle

People don’t like it when I get angry. They don’t like it when I rant. On my very own blog. On the internet. Sheesh people, I am human you know.

And I’m not an angry kind of person. I have a theory about why you shouldn’t be angry and I try to use the idea that there is no reason to be angry, and allow anger to roll off my back. It usually works. [push]One might suggest it would be absolutely nutty not to rant. Pixels, it seems, breed ire.[/push]

But I think all sick people have a right to be angry. Don’t get me wrong, it’s not a good idea to live in that anger. It’s not a good idea to spread that anger. But for fuck’s sake, you’ve been given a life-long mental illness that requires too many doctors and debilitating psychiatric medication. You have the right to be a little angry about that.

I’m Angry at My Brain

But there is a problem with being mad at bipolar – there’s really no one to yell at. It’s really hard to yell at your brain. It never seems to work. It morphs into yelling at yourself; which isn’t the point at all.

I’m Mad at the Jungle

A couple of weeks ago I was fairly catatonic with depression. And so, not moving, I watched many of the shows on my PVR; one of which is called Off the Map. There was the following scene:

A woman comes upon a girl angrily cutting her way through the jungle with a machete. The woman asks her if she’s angry. The girl says yes, she’s angry at the jungle.

The girl is sleeping with a beautiful man whose wife is in a coma. He feels ever-so-guilty about seeing anyone else even though his wife’s condition hasn’t changed in four years. He told the girl when they started seeing each other it would always be casual and he would never commit. But the girl, naturally, fell in love with him anyway.

So the girl, hacking away with the machete, says she can’t be mad at the man for being withholding, because he always said he would be, she can’t be mad at the wife, as she’s in a coma; so, she’s mad at the jungle.

Angry at Bipolar: Mad at the jungle

See, I’m mad at the jungle.

I’m Angry at My Life with Crazy

There is no point in being mad at bipolar, depression, hypomania or crazy: they’re not going anywhere. There’s no point in being angry with medications and nasty side effects as they are what they are. There’s no point in being angry with “evil” doctors because they’re doing the best they can. And there’s no point at being mad at the effects crazy has on my life as that’s not going anywhere either.

So I’m mad at the jungle.

(Granted, there’s no jungle around these parts and I don’t own a machete, but I love the phrase.)

I’m Angry at Stones on the Beach

A typical therapy suggestion is to go to the beach, envision a stone as whatever you’re angry with, or your anger in general, and throw the stone into the water as far as you can.[1]

Arg. Therapy annoyance.

I have tried this, and many similar things over the years but it doesn’t make anything change at all. Not a thing. Ever. I suspect that’s because there’s always new pain with bipolar disorder. Bipolar never passes. Mood disorders just kind of hang around fucking up your life.

I’m Mad at the Jungle

So, as I understand there is no real cause or cure for my anger, I try to just let it be. I feel strongly that the anger deserves acknowledgment. Then I let it go. I say “hi” now and then, and wave goodbye.

But I’m mad at the jungle will be my new catchphrase. Because fuck it if I don’t just feel that way sometimes.[2] And I think that’s reasonable.


[1] To be fair, I have found some success with this and similar methods on other issues. Latent anger from things like abuse. Those things are just different because they’re in the past. They’re not coming back to clobber me in the skull.
 
[2] Just an FYI. It’s actually the case that I just increased a medication and that’s causing most of the anger. But somehow, it feels just as real as any other kind.

Why Should I Continue to Fight the Pain of Depression for Another 40 Years?

→ March 3, 2011 - 170 Comments

A commenter, Jessica, left a comment yesterday that so succinctly expresses what so many of us feel about depression, bipolar and mental illness, and continue to feel. The following is her comment and my response.

“when I just feel so sick and tired of fighting for what seems like nothing…what seems like a never ending battle…what seems like someone hitting me over the head with a two-by-four every two minutes, telling me it will never stop until the day I die, and then they explaining to me why I should continue to fight to live for another 40 years.”

Yes. I know.

Fighting the Pain of Depression

We fight to the death for millimeters when we really need a mile. I know.

Fighting Suicide and Bipolar DisorderWhy should I continue to fight the pain of depression for another 40 years?

I have asked myself this question a thousand times. Why should I continue to fight the pain of depression?

I have pondered it. I have written about it. I have talked about it it. Believe me, I understand this question. Depression, suicide and I go way back.

I have no answer, no answer at all, but I can tell you this:

  • If, 12 years ago I had killed myself, I never would have experienced a skydive
  • If, 8 years ago I had killed myself, I would have never discovered I could write
  • If, 5 years ago I had killed myself, I never would have flown with the eagles in Venezuela
  • If, 2 years ago I had killed myself, I would never have helped all the people I have today

While sometimes I refuse to admit it, my work, my words, my effort matters.

Fighting Depression Matters

See, life is funny that way. You eke out a millimeter when you really need a mile, but sometimes that millimeter matters. To you. To others.

I despise being hit over the head with a 2 X 4 while downing pills, sticking to ridiculously strict schedules, seeing doctors and fighting to the death. Oh yes. I hate it.

And don’t get me wrong, I frequently want to give up. I frequently want to surrender to depression. I frequently want to end this fucking fight.

But all I can say is: your fight matters. Your millimeter matters.

Your comment here matters. To me. To others. That millimeter that you fought against depression for, mattered.

I do not know how to win the fight, but I do know, that for no reason I understand, the fight matters. It just does.

Mental Illness and Crazy Block Goals

→ February 28, 2011 - 21 Comments

You can be anything you want to be. Dream it and you can be it. Do it now.

We have all heard these things. These are the things we tell our children. These are the some of the lies we tell our children.

Tell the Crazy They Can Do Anything they Want, I Dare You

[push]We’re trying to encourage our children to be who they want to be. We want them to get what they want.[/push]

And as far as lies go these ones aren’t bad. We are trying to encourage kids to be presidents, astronauts, fire engines (seriously, kids love fire engines), CEOs, police officers (they don’t want to be police cruisers for some reason), doctors, lawyers and so on. We want them to obtain their dreams. It’s so terribly noble of us, to lie to our children like that.

No, You Can’t Do Anything You Want

Of course doors for a person are closed the second they take their first breath. What is their race? What is their sex? Where are they born? Who are their parents? How much money do they have? Into what time are they born? What is the political climate? Are they born with a birth defect? Do they have a disability? Do they have an illness? And so on, and so on, and so on. And with every circle around the sun, more and more limitations are placed on them.

Life with Limited Opportunities is Still Limitless

This, of course, is OK. Life is still basically limitless. You can keep closing doors and still have an entire world of possibilities. Can’t be a heart surgeon? Be a veterinarian. Can’t be president? Become a member of congress. Can’t pee standing up? Learn to write your name in the snow with a stick. There are alternatives to everything. Whatever your goals today, they can be modified as time passes to allow for a fulfilled existence. Humans are good that way. We adapt.

Before I was Crazy, I Had Goals

And this is as true of me as anyone else. When I was a child I wanted to be a ballerina. Why? Because I wanted to wear a pink tutu. Then I realized I could wear a pink tutu anytime I wanted, and decided I didn’t want to unwrap my point shoes to find blood.

Then I wanted to take over my mother’s position as the head administrator at a dental office. Why? Because I thought she was the epitome of success (I was ten). Then I realized that her position led to a chronic stress-related condition and decided I didn’t like dentists anyway.[pull]And so on, and so on. Dreams come, and go, and are replaced with other things.[/pull]

I look at my life, and wonder what my new goals should be. I have goals, I really do. I have things I would like to get done. There are accomplishments I want to have in my obituary. I don’t want to just be, whatever this is, forever.

Crazy is Blocking My Goals

But there’s a problem, of course there is. I’ve tried on some goals. I’ve laid them on top, wiggled around, and seen if they fit. Some do, some don’t, like everyone, there are options.

Bipolar in the way of goalsThe problem is, I look at the goal, out bobbing up and down ahead of me, and there is a huge obstacle in my way. There is the crazy, and the crazy is a force with which to reckon.[push]Crazy has a great real estate agent, and its carpenter is no slouch either.[/push]

There is a space in my brain, a space that used to hold memories of white pet bunnies, polynomial equations, and how to knit one purl two, that is now overtaken by bipolar. The crazy has set up house there. In fact it isn’t a house, it is a mansion of crazy. It has wings, and maids, servant’s quarters, and crazy butler’s pantries.

And there is the crazy, carved in stone, under lacquered wood, and in stained glass, before me. It sprawls over the neighbors and dwarfs those that approach it, and I think if you look closely, you’ll see there is a moat and a portcullis to be dealt with, if ever you were actually to get that close to crazy.

Sometimes Goals Are Taken Away, Even from the Non-Crazy

Sometimes when your goal is taken away, you don’t know what to do. Sometimes you counted on one experience so much that when it disappears, you’re lost and have nothing solid to hang on to. People then usually go through some kind of crisis. You see it when women who really want kids can’t have them, or when a spouse dies, or when a person becomes disabled. Their lives shift so suddenly they didn’t know what to do. But with few exceptions, these people do get back up, dust themselves off, and work towards something new. They are injured, but they have survived.

No Matter What I Do, Crazy Stands Between Me and Most Everything Else

But for me, no matter what I pick, there is always the same roadblock ahead. Everything I want to do is delayed, destroyed, decimated, by the crazy. I don’t know what to do. I don’t know how to climb it, go around it, get over it, get under it, get through it, destroy it. It’s just always there. It’s the indomitable foe. It’s that which cannot be conquered.

I feel like whatever I have not accomplished now, I will never do. I feel like it’s over. There’s no where to go. There’s nothing to do. I’m done. We all have a limited amount of time on the planet and it feels like my useful working hours have come to a close. Now I’m just treading water. Or surviving waterboarding. It’s tough to tell.

The Goal Always Seems to be Not Dying From the Crazy

[push]All my life is devoted to dealing with crazy, trying to stop it from expanding the east wing, blocking more of the sunlight and further raising property taxes.[/push]

I feel like this is no life at all. It’s a war of attrition. Parts of me die, parts of it are destroyed, but in the end nobody wins. It’s too strong to defeat, but it hasn’t won. So we stand, staring at it each, over the line in the sand. Fighting for inches. Winning then loosing. Loosing then winning. Forever more, it is always the same. Crazy and I are at an impasse.

Is Not Dying a Goal Worth Living For?

So what about that is worth continuing? Fight the good fight? Fight the fucked fight. A life destined by the stars. No tutus, or engines, or pianos, or dentists to be found. Just fighting, blood, and death. And yet suicide is supposed to be wrong. Giving up is supposed to be wrong. One day someone will have to explain that to me. I can hit them in the head with a two-by-four every two minutes and tell them it will never end, and then they can tell me why they should live another 40 years. That would required some seriously fervent and advanced logic and desire. Any takers?

Psych Meds, Psychiatry and Psychology Are Evil

→ February 8, 2011 - 55 Comments

I hear from quite a few people, generally part of special interest groups, who think psych meds are evil, psychiatrists are evil or psychologists are evil. Usually these statements of hatred come from negative personal experiences with psych meds or psychiatry/psychology. Usually these people are lashing out emotionally because they didn’t like how the medicine or other form of treatment went.

I Understand Why People Think Psychiatry and Psychiatric Treatments Are Evil

Psychologist Are Not Evil

Pardon the image of smiling doctors; I couldn't find one where they were all twirling handlebar mustaches.

I get this. I really do. When you tie yourself in knots and live through painful psych treatments and do things you never thought you would do to get better, and then you don’t get better, you get a little bitter. I’d say that’s pretty normal and understandable.

(I am jaded and perhaps bitter but far too even-minded to form such a fanatical stance.)

But here’s the thing, psychiatry is no more evil than any other branch of medicine; psychiatrists are just doing the best they can with what they have. (And yes, I wish they had better options.)

Negatives about Psychiatry and Psych Meds

If we take me as an example, I have had many nasty interactions with the field of mental health:

  • I had a psychiatrist not listen to me, or my symptoms, which led to a misdiagnosis
  • I’ve had doctors not care about painful side effects
  • Psychiatrists have typically not tracked blood pressure and weight even when it is standard practice as defined by the prescribing information on antipsychotics
  • I wasn’t made aware of the tardive dyskinesia and diabetes risks with antipsychotics
  • Psychiatrists refused to treat me because (essentially) I was a lost cause

Granted, that sounds pretty bad. I get that. Totally. But keep in mind some of these things could have been averted by me, and we’re talking about more than 12 years of data. Stuff happens in 12 years.

Positives about Psychiatry and Psych Meds

  • I’m not dead

I could list others like quality of life and quality of skydive, but when it comes down to it, not being dead is really the key.

Special Interest Groups (Like Scientology) Skew Psychiatry Beyond Recognition

I don’t usually call people or groups out on my blog. That’s because I don’t want to engage in some sort of ridiculous war. I like to live and let live. But honestly, Scientologists and antipsychiatry groups like them, harm the mentally ill so gravely that they cannot be ignored.

Lies and Misinformation from a Scientology Group

A major Scientology site has articles like:

State Hospitals are Still Snakepits¹ of Patient Abuse, Betrayal of the Public

“The state hospital purpose appears to be one of keeping people institutionalized at the state’s expense with no concept or intention of improvement or rehabilitation.”

Psychiatric Drugs Cause Violence

“Psychiatrists continue to “sell” the wrong causes—from mental illness and poverty to broken families and genetic makeup (none of which they can cure)—yet the psychiatric drugs can themselves cause violence.”²

Psychiatry’s Pills That Kill

“Human suffering is NOT “mental illness””[push]”People suffer.  But when this suffering is labeled “mental illness,” it is a guarantee that the patient will never experience a recovery.”[/push]

“People do get depressed.  They can become overwhelmed by their emotions and start to feel that their minds or bodies are out of control.  There is always a reason for this, whether it be an emotional upset, a loss or a situation with the body that is best addressed by a medical doctor or allied practitioner, such as a nutritionist or chiropractor.””

“Psychiatry is NOT medicine”

“Based on the DSM, psychiatrists declare that their drugs and other treatments work to improve mental illness, even though psychiatrists admit that they do not know how or why these drugs “work.””³

Psychiatry: Synonymous with Fraud

[pull]”If they don’t know the cause, then asserting that it is physical, chemical, biological or brain-based is fraud.””[/pull]

“Psychiatrists and the mental health industry claim that mental disorders, such as “ADHD,” “obsessive-compulsive,” and “bipolar” are medical conditions that are brain-based, due to a chemical imbalance or other physiological medical cause.¹¹  This claim is used to justify the use of electroshock, psychosurgery and psychotropic drugs to treat the so-called medical condition.  This claim — that psychiatric disorders are no different than medical diseases — is fraudulent…”[push]”Psychiatry has no objective tests that prove the existence, cause or physical basis of a single psychiatric disorder.  Psychiatrists merely observe a behavior or set of behaviors and give it a name.  It looks like medicine and it sounds like medicine and that is where the similarities end…”[/push]

“Psychiatrists frequently cite “chemical imbalance” as the cause.  This is nothing more than another psychiatric theory that has never been proven.  This popular misconception is due to nothing more than heavy public marketing; we’ve just been hearing it for so long that many take for granted that it is true.  It is not true and has in fact been thoroughly discredited by researchers.”

Psychiatrists & Psychologists: Professional Rapists, Perverts and Pedophiles

“But psychiatrists and psychologists rarely consider that raping a patient is rape. Instead, it is euphemistically called “sexual contact,” a “sexual relationship” or “crossing the boundaries” when one of its members sexually forces themself on a patient, often with the help of drugs or electroshock treatment.”

Misdiagnosis is Malpractice. Psychiatry is Misdiagnosis.

“Psychiatrists admit that there is no science to psychiatry and that they cannot cure their patients.  But they prescribe heavy mind-altering drugs with a reckless abandon that has become a growing concern to the FDA and similar agencies abroad.  The foregoing cases and thousands of others like them bear testament to the fact that psychiatry is a profession of willful negligence, refusing at nearly every turn to search out and treat the actual conditions that manifest as “mental illness.””²²

Note these people feel they have evidence for these statements (sort of). I really don’t have time to refute all their “evidence” but it certainly can be done. (I’ve added a few footnotes to the bottom of the page about the above quotes.)

If you would like to know more, simply Google one of the article titles and I’m sure you’ll find it. I’m not linking to these people as I consider them to be extremely harmful.

OK, so I have given this antipsychiatry group a lot of space and I have quoted only very brief parts of their biased crap. Some thoughts on antipsychiatry:

Some Doctors Do Bad Things

Orbitol frontal cortex different in depressed

Represents difference between brain activity levels of healthy and depressed subjects. Shows healthy subjects had more activity in lateral portion of orbitofrontal cortex which plays a major role in regulating emotions.

I would never suggest that there aren’t bad, abusive, fraudulent, money-focused, uncaring doctors, psychiatrists or psychologists out there. They are like every other segment of the population: some of them are paragons of their profession and some of them definitely aren’t. And those who break the law should surely be prosecuted, just like anyone else.

But really, basing the opinion of an entire field of medicine on the minority who hurt others is like getting food poisoning at a restaurant and then never going out to eat again because “all restaurants are out to make you sick.”

Psychiatry and Psychology Have Saved Thousands of Lives

I could write an article every day for a month on how many people psychiatry has saved. I know nasty special interest groups deny it, but every day people are helped by mental health care professionals.

Mental Illness Exists

One of the more hurtful lies these people tell is that mental illness doesn’t exist. Again, I could fill an entire book proving the physical nature of mental illness, but for now I’ll just link to PsychEducation.org’s explanation to the biological nature of depression.

Psychiatry and Psychology Have Saved My Life

I wasn’t kidding about that. For all their flaws, of which there are many, I wouldn’t have survived this long without psychiatry, psych meds and psychology. Moreover, I wouldn’t have experienced the quality of life I have had for the past decade+. [pull]It’s quite possible to rid someone of cancer only to have it reappear years later. This isn’t because the doctor did anything wrong per se, it’s just that we’re working with the best medicines we have, and they’re far from perfect.[/pull]

Now isn’t the best time for me. Now psychiatry is having a really hard time with me. Now things are looking extremely bleak. But current failure does not destroy past success.

If you hate psych meds, psychiatrists and psychologists you are quite free to do so. I’m not going to drag you to an appointment. But to make claims that essentially assert psychiatry and psychology are evil and that mental illness doesn’t exist is to be uninformed, disingenuous, ignorant and ultimately extremely harmful to the people around you.

Make a choice for yourself and stop spreading this vitriolic hatred that stops mentally ill people who truly need help from getting it.

(Feel free to agree or disagree but know up front there will be no personal attacks permitted.)

Footnotes:

¹ Term used in the early 1900s to describe insane asylums. Probably warranted at the time.
² This is not exactly true. While there are risks of rage associated with antidepressants, let us not forget that the population who is taking these  drugs are mentally unwell to begin with. Also note that alcohol use is more strongly associated with violence then any other drug.
³ It is not the case that no one with a mental illness recovers. People recover every day, some continuing medication and some going off of medication. Moreover, while it is the case that our understanding of psychopharmacology is limited, the exact mechanism of action of Tylenol is unknown too, but I don’t see people lighting their hair on fire over that. The medical community uses the scientific method to determine what works. Sometimes we know exactly why and sometimes we don’t. But in the case of psychopharmaceuticals our knowledge grows by leaps and bounds every year.
¹¹ Yes, doctors say there is a physical cause because there is one. And tests too. We don’t know it all, but we’re learning.
²² Honestly I’ve never seen a doctor willfully not look for another cause. I’ve had blood tests up to my neck looking for other causes. Believe me, I wish there were one.

“Mood Disorder” Doesn’t Describe Bipolar, Pain or Crazy

→ February 7, 2011 - 23 Comments

“Mood Disorder” Doesn’t Describe Bipolar, Pain or Crazy

(timeless thoughts from a psych patient)

It is a stupid, cyclical life that I lead. I just keep going round and round the insanity-go-round, the mood-go-round, the crazy-go-round. It’s said insanity is doing the same thing over and over and expecting a different result.

Welcome to my life.

Read more

Suicide – Is This Depression The Last Depression?

→ February 4, 2011 - 5 Comments

One of the truly horrible things about a lifetime of bipolar, hypomania, depression and mental illness is that you’re always left wondering, is this depression the last depression? Is this my brain and my mind’s breaking point? Is this the depression I end with suicide?

Others Wonder if This is the Time You End Depression with Suicide

And worse, people around you, in idle moments, might wonder if this the last time they’ll have to hear you sobbing on the phone. Is this the last time they see your depression? Is this the last time they have to be scared for you?

Ah yes, a mental illness reality that is a treat for everyone.

this is the last depressionI Wonder About the Last Depression that Leads to Suicide

I do wonder about the depression that leads to suicide. I don’t tell anyone I wonder about this, and if they ask, I tell them not to worry (and they shouldn’t, there’s no point) and deftly assuage their concerns. I can do assuage fears; it’s one of my powers. If I did, in fact, kill myself tomorrow their worry today would have done nothing other than ruin their dinner. No need to do that.

The Idea of a Last Depression Troubles Me

And still, I find the idea of the last depression and the suicide troubling.[push]There is still some vague hope that refuses to die that I might actually do something useful with my existence. OK, I admit, it’s unlikely, like I said, it’s a vague hope. (Yes, I am aware that I’m useful here and there, but somehow between the crazy and the crazy meds, nothing feels meaningful.)[/push]

There really is no logical reason to stay alive, other than to say, perhaps, there will be plenty of time to be dead later, so there’s no point in speed up the process any.

There is a biological trait that all humans have, the desire to stay alive. Self-preservation, and then of course procreation, is the drive of all life. This is a biological necessity, obviously. Suicide is like a 12-car pile-up during the drive.

I mean if I plunked a bunch of life forms on a planet, I would make sure they had a vested interest in staying there too. After all, I did go to all the bother of putting them there in the first place.[pull]Yes, I’m aware people are built to prolong life, not to end life. It’s instinctual.[/pull]

Suicide is the opposite of this driving force, of our instincts.

(Of course, murder is pretty opposite too, and people do that all over the place.)

My Instincts Don’t Want Me To Die

This explains my illogical hesitation.

But people defy biological urges all the time. In fact, it’s pretty much what a society is designed to do. So even though surviving might be the most ingrained biological imperative, it certainly can be ignored. And no one ignores a biological imperative like me. I left my humanity in my other lifetime.

If you’re feeling like you might hurt yourself get help now. You are not alone. It gets better.

Author’s note: This is a piece of writing. Not to worry.

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