treatment issues

Who Do You Trust for Mental Illness Medication Information?

→ April 11, 2010 - 3 Comments

As you might have noticed, I’ve been writing about bipolar and mental illness for a really long time. Seven years in internet time is a lifetime or so.

I Write About and Research Mental Illness

Trusting Mental Health SourcesAnd in all that time, in addition to the writing, I’ve been reading, or more commonly, researching, mental illness. I’ve been looking up information on mental disorders, psychiatric medications, mental illness treatments, supplements and everything else of which you can think. This is because I like to be educated about my bipolar disorder, healthcare and treatments. I often share researched information with my readers because I think others should be educated about mental illness too. I strive to make anything I write accurate and provide links to reputable information sources.

Who Do You Trust for Mental Illness Information?

But what information should you trust? Who should you trust for mental health information? Should you trust me, a random blogger? People on discussion groups? Information sites? Drug company sites? Doctor sites?

Almost always, no.

Here are a few ideas about trusting information online:

  1. Do not make any decisions about your mental health or treatment without talking to a real, live doctor in person. Period. You can take all the self-assessment questionnaires you want, but you can’t pick a mental illness treatment or a diagnosis without the help of a professional. These tools can help you bring information to your doctor, but nothing is a substitution for a real professional.
  2. If you can’t check out a person’s credentials, don’t trust them. Anyone can claim to be a psychiatrist, nurse or have a Phd, but that doesn’t mean they aren’t actually a teenage, mosquito trainer practicing pirouettes in a tent in rural Lesotho (although they’re probably not). If someone is offering you professional health advice, they should have no problem supplying their credentials. One of the reasons I love Jim Phelps’ site is the fact he is forthright about who he is, and how he’s funded.
  3. Check how a healthcare site is funded. If a site doesn’t tell you who’s supporting it, who’s funding it and where the information comes from don’t trust them. As a general rule, sites funded by drug companies or special interest groups should be treated with extreme suspicion. Special interest groups can include religious groups and even some charities. While they may have good intentions it’s likely their information is slanted and partial.
  4. If there are no links to actual data or research studies approach with extreme caution. I could be a doctor making the claim carrots cure depression, and that might be a very appealing claim to a lot of people as anyone can buy carrots. I can even say, “I’ve seen it work over and over,” but if I can’t back that up with real scientific data, then the claim holds no water. (That being said, there’s no harm in asking your real-life doctor about even questionable mental health treatments, if you’re interested. That’s what they’re paid for.)
  5. Any referenced study must be published in a reputable journal. Psychology Today is a magazine not a journal, the Journal of Clinical Pharmacology is a reputable journal. Real studies are listed here and are published in peer-reviewed journals. Also, in reputable studies any conflicts of interest must be disclosed. Implications from research can be confusing so print out the study and ask your doctor about it. Some groups are really good at making information look authentic but if it wasn’t published in a reputable peer-reviewed journal, it’s not to be trusted.
  6. HONcode accreditation. About.com’s Nancy Schimelpfening suggests that HONcode accreditation is also a good thing for which to look.

I have to stress, there are many medical sites out there that are trying to sell you a product or idea. Please keep in mind there are some groups that are very anti-psychiatry and anti-medication and try to push that agenda. They masquerade as self-help sites, discussion groups, individuals on discussion groups, and drug rehabilitation/addiction sites. There are people pushing products that use the same techniques.

Be Skeptical About Mental Health Information Sources

Be skeptical. If the information doesn’t sound right, ask a professional. Please don’t let random online weirdo’s make choices for you or influence how you feel about yourself and your mental disorder. You’re better than that.

[And just for the record, I don’t portend to be anyone other than a mouthy bipolar writer with a lot of tears, screams and things to say. I’m pretty smart and try to help people, but that’s about it. Oh, and I’m essentially funded by no one. Just ask my landlord.]

Mental Illness Resources I Trust

Curious about who I trust for mental illness information? See my resources list here.

Update: I just found this open-access peer-reviewed journal online. Interesting.

Anticonvulsants as Calcium Antagonists in Mood Stabilization

→ March 20, 2010 - 2 Comments

This is a paper I wrote for a psychology course I am taking so the level of discourse is quite high, sorry about that. I promise though, it is comprehensible. What I’m basically talking about is calcium-channel blockers and other calcium antagonists (they turn calcium down). This refers to calcium in your brain and not calcium in your blood.

Mood Stabilizers and Bipolar Disorder

Because inadequate response, poor compliance, chronic recurring symptoms, and functional disability are constant challenges is the treatment of bipolar disorder, (Gitlin, 2006) efforts have been made to search out new mood stabilizing medication and determine new methods of action. There has been an effort to treat bipolar disorder with a class of medication termed “mood stabilizers”, most notably consisting of some anticonvulsants (also known as antiepileptics) in addition to the traditional lithium.[1] [push]I will show that these anticonvulsants, stabilize mood in bipolar disorder, at least partially, through their ability to act as calcium antagonists.[/push]

While anticonvulsants are widely used in the treatment of mood disorders, their method of action in mood stabilization is mostly unknown.[2] Recent research has indicated that disrupted calcium homeostasis is present in bipolar disorder, and that anticonvulsants and lithium effect calcium channels and concentration in the brain (Amann, 2005). The mood-stabilizing effects of calcium channel blockers like Nimodipine (Levy, 2000) further add to the evidence that calcium antagonism is useful in the treatment of bipolar disorder. I will show that these “mood stabilizers”, anticonvulsants, stabilize mood in bipolar disorder, at least partially, through their ability to act as calcium antagonists.

Bipolar Disorder and Calcium Levels

A review of hypercalcemia and hypocalcemia shows links from calcium blood levels to depression, irritability, delirium, and psychosis – symptoms that are similar to a bipolar disorder. Additional to calcium’s powerful abilities in the blood, it also plays a vital role both as primary and secondary messengers in the brain and according to Gargus (2009), is known to regulate “physiological systems at every level from membrane potential and ion transporters to kinases and transcription factors”. Calcium also plays a role in long-term changes to the architecture of a neuron (Amann, 2005). Disruption of intracellular calcium homeostasis is now thought to underlie many diseases such as Autism, Migraine, Seizures, and psychological disorders like bipolar (Gargus, 2009). Additionally, atrophy and glial death now found in mood disorders may be avoided by increasing cellular plasticity, accomplished through reducing intracellular calcium concentrations (Landmark, 2008).[pull]Atrophy and glial death now found in mood disorders may be avoided by increasing cellular plasticity, accomplished through reducing intracellular calcium concentrations.[/pull]

In some studies, the bipolar population has been found to have abnormally elevated intracellular calcium, elevated basal platelet and lymphocyte calcium concentrations, and elevated B-lymphoblast calcium (Silverstone, 2005). Found more consistently the bipolar population, both in the manic and depressed phase, is an enhanced calcium response to agonist stimulation (Silverstone, 2005). This may partially be explained by the enhanced platelet intracellular calcium mobilization found after stimulation by serotonin in bipolar disorder (Suzuki, 2003). This research suggests that not only are calcium levels elevated, and calcium activities dysregulated, but this may become worse if the patient is treated with a selective serotonin reuptake inhibitor (SSRI), which is often the case.

Lithium and Calcium

Lithium has long been the standard therapy for bipolar disorder both for acute and maintenance treatment due to its quality and quantity of supporting evidence (Gitlin, 2006), (Levy, 2000). Part of lithium’s biological effects is to both inhibit the entry of calcium intracellularly acting as a calcium antagonist, and to block calcium channels directly. This, in turn, inhibits other cellular responses of subtypes adrenergic, serotonergic, and cholinergic (Levy, 2000). Moreover, adding Verapamil, a calcium channel blocker, to unresponsive lithium treatment, improves outcomes, (Mallinger, 2008) suggesting that both calcium itself and calcium channels benefit from antagonists.[3]

Calcium Channel Blockers as Mood Stabilizers

A number of calcium channel antagonists have been studied with varied results likely resulting from their specific affinities to different calcium channel subtypes and their individual ability to cross the blood-brain barrier. Verapamil, one of the most studied calcium channel blockers, is not the most lipophilic and is likely not as effective as other calcium channel blockers like nimodipine (Gitlin, 2006), although Verapamil has been shown effective in some studies and does work on calcium ions in a way similar to lithium (Levy, 2000).[pull]Nimodipine is not only a calcium channel blocker but has also been shown to have anticonvulsant properties and has shown great potential as a mood-stabilizer particularly for cycling forms of bipolar disorder.[/pull]

Nimodipine is not only a calcium channel blocker but has also been shown to have anticonvulsant properties and has shown great potential as a mood-stabilizer particularly for cycling forms of bipolar disorder (Goodnick, 2000). While its efficacy needs further study, there have been positive results shown for bipolars in manic, depressed, and rapid cycling states.

Anticonvulsants spawn a broad range of medication and methods of action. Useful actions for treatment of psychiatric disorders are thought to be: increases in GABAurgic transmissions, decreases in glutamate, inhibition of voltage-gates sodium and calcium channels, and interference with intracellular modulators (Landmark, 2008). For the treatment of bipolar disorder, specifically mood stabilization, carbamazepine and Lamotrigine, have been identified, and accepted as treatments through their inhibition of voltage-gated sodium and calcium channels (Landmark, 2008).[push]Anticonvulsants that work on calcium channel blockers are also known to be helpful in the treatment of neuropathic pain, which some researchers believe is closely tied to psychological pain, here in the form of bipolar disorder.[/push]

Carbamezapine and Lamotrigine have also been seen to positively affect mood while GABAurgic transmitting anticonvulsants have not. The general decreased excitability found with Carbamezapine and Lamotrigine may also be responsible for their role in preventing affective episodes (Landmark, 2008). Valproate is also considered an accepted treatment although likely functions more from the combined actions mentioned above, making it an anti-mania treatment as well as possibly useful for mood stabilization (Landmark, 2008). The effects of anticonvulsants are compared to the therapeutic effects of lithium on calcium, calcium channel blockers, and inositol concentrations, another secondary messenger indirectly acting on calcium signals (Berridge, 1993). Anticonvulsants that work on calcium channel blockers are also known to be helpful in the treatment of neuropathic pain (Landmark, 2008), which some researchers believe is closely tied to psychological pain, here in the form of bipolar disorder.

Lithium acts in the body as a complex agent, making it difficult for scientists to specify exactly how it stabilizes mood in the bipolar population, in spite of its being used for decades. It is clear; however, that part of its biological action is to antagonize calcium concentrations as well as calcium channels. This action is shown to have positive mood stabilizing effects as proven by successful treatments with calcium blocking agents like Verapamil and Nimodipine. These same mood stabilizing effects are seen with some anticonvulsants which also act as calcium antagonists. Therefore, it is reasonable to assume that part of the reason why some anticonvulsants stabilize mood is because of their ability to work on calcium, calcium channel blockers, and inositol, as seen in Lithium and calcium channel blockers.

_________________________

[1] There are several antipsychotics also in this list but are outside the scope of this paper.
[2] Treatment of bipolar disorder and mood stabilization in this paper will refer to non-acute treatment, although some of the drugs mentioned can be used in acute treatment also. No distinction will be made between types of bipolar.
[3] It should be noted that Mallinger (2009) posited that the positive effects of combining Lithium and Verapamil may also be due to the inhibition of protein kinase C (PKC) activity provided by the Verapamil.

References

(I apologize for the departure from APA style, blog formatting issues.)

Amann, B., & Grunze, H. (2005). Neurochemical Underpinnings in Bipolar Disorder and Epilepsy. Epilepsia (Series 4), 4626-30.
doi:10.1111/j.1528-1167.2005.463006.x.
Retrieved from EbscoHost Mar. 14, 2010 AN = 17118993

Berridge, M. J. (1993). Inositol Trisphosphate and Calcium Signaling. Nature 361, 315-325.
doi:10.1038/361315a0
Available online: http://www.ncbi.nlm.nih.gov/pubmed/8381210

Farooq, M., Moore, P., Bhatt, A., Aburashed, R., & Kassab, M. (2008). Therapeutic Role of Zonisamide in Neuropsychiatric Disorders. Mini Reviews in Medicinal Chemistry, 8(10), 968-975.
Retrieved from Academic Search Complete database.
Retrieved from EbscoHost Mar. 15, 2010 AN = 34436130

Gargus, J. (2009). Genetic Calcium Signaling Abnormalities in the Central Nervous System: Seizures, Migraine, and Autism. Annals of the New York Academy of Sciences, 1151133-156.
doi:10.1111/j.1749-6632.2008.03572.x.
Retrieved from EbscoHost Mar. 14, 2010 AN = 35830926

Gitlin, M. (2006). Treatment-resistant bipolar disorder. Molecular Psychiatry, 11(3), 227-240.
doi:10.1038/sj.mp.4001793.
Retrieved from EbscoHost Mar. 14, 2010 AN = 19892243

Goodnick, P. (2000). The use of nimodipine in the treatment of mood disorders. Bipolar Disorders, 2(3), 165.
Retrieved from Academic Search Complete database.
Retrieved from EbscoHost Mar. 15, 2010 AN = 6500123

Landmark, C. (2008). Antiepileptic Drugs in Non-Epilepsy Disorders. CNS Drugs, 22(1), 27-47.
Retrieved from Academic Search Complete database.
Retrieved from EbscoHost Mar. 15, 2010 AN = 28088990

Levy, N., & Janicak, P. (2000). Calcium channel antagonists for the treatment of bipolar disorder. Bipolar Disorders, 2(2), 108-119.
Retrieved from Academic Search Complete database.
Retrieved from EbscoHost Mar. 14, 2010 AN = 5788405

Mallinger, A., Thase, M., Haskett, R., Buttenfield, J., Luckenbaugh, D., Frank, E., et al. (2008). Verapamil augmentation of lithium treatment improves outcome in mania unresponsive to lithium alone: preliminary findings and a discussion of therapeutic mechanisms. Bipolar Disorders, 10(8), 856-866.
doi:10.1111/j.1399-5618.2008.00636.x.
Retrieved from EbscoHost Mar. 14, 2010 AN = 35323933

Silverstone, P., McGrath, B., Wessels, P., Bell, E., & Ulrich, M. (2005). Current Pathophysiological Findings in Bipolar Disorder and in its Subtypes. Current Psychiatry Reviews, 1(1), 75-101.
doi:10.2174/1573400052953574.
Retrieved from EbscoHost Mar. 14, 2010 AN = 18882320

Suzuki, K., Kusumi, I., Akimoto, T., Sasaki, Y., & Koyama, T. (2003). Altered 5-HT-Induced Calcium Response in the Presence of Staurosporine in Blood Platelets from Bipolar Disorder Patients. Neuropsychopharmacology, 28(6), 1210-1214.
doi:10.1038/sj.npp.1300159.
Retrieved from EbscoHost Mar. 15, 2010 AN = 22436847

Caffeine and Mental Illness and Caffeine Disorders

→ February 21, 2010 - 13 Comments

Caffeine and Mental Illness and Caffeine Disorders

Caffeine is the world’s most popular psychoactive substance. So many of us love it a la Starbucks, Tim Hortons or just out or our home coffee machine. Me, I love coffee and I’m a fan of caffeine too. Coffee’s the nectar of the gods and nothing will convince me otherwise.

It seems though, caffeine can actually hurt you. I know, I never thought my beloved coffee could harm me, but I suppose anything that you abuse, will abuse you back. So, here is everything you ever needed to know about caffeine, caffeine disorders and caffeine and mental illness but were afraid to ask.

Read more

Physiological Causes of Depression – Surgeon’s General Report

→ July 6, 2009 - 2 Comments

I like to think I know almost all there is to know about mood disorders, but I was pretty shocked when I read this:

The Surgeon’s General Report

Differential Diagnosis
Mood disorders are sometimes caused by general medical conditions or medications. Classic examples include the depressive syndromes associated with dominant hemispheric strokes, hypothyroidism, Cushing’s disease, and pancreatic cancer (DSM-IV). Among medications associated with depression, antihypertensives and oral contraceptives are the most frequent examples. Transient depressive syndromes are also common during withdrawal from alcohol and various other drugs of abuse. Mania is not uncommon during high-dose systemic therapy with glucocorticoids and has been associated with intoxication by stimulant and sympathomimetic drugs and with central nervous system (CNS) lupus, CNS human immunodeficiency viral (HIV) infections, and nondominant hemispheric strokes or tumors. Together, mood disorders due to known physiological or medical causes may account for as many as 5 to 15 percent of all treated cases (Quitkin et al., 1993b). They often go unrecognized until after standard therapies have failed.

(bold mine)

I’m shocked. No one ever mentioned anything about birth control pills to me and I’ve been on them for years. YEARS. This is yet another reason why doctors so often get on my bad side.

This quote was taken from the Mental Health: A Report of the Surgeon General. The whole report is a good read, but very long. It’s everything you wanted to know but didn’t know you needed to ask.

I’m disgusted.

Description of Deadly Rash Caused by Medications Like Lamictal

→ July 1, 2009 - Comments off

In a small number of cases people who take Lamictal or some other anticonvulsance can develop a deadly rash named Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) (a more severe version). Again this is rare. However, if you develop a rash, here is a description of SJS leisions.

If you this there is even a small rash is related to this syndrom see a doctor immediately and tell them what medications you are on. Again, without treatment this can kill you.

A. Description of lesions

1. The rash begins as a round erythematous papule, which enlarges up to 1 to 2 cm over 24 to 48 hours. The periphery of the lesion is erythematous and raised or edematous. The center becomes more cyanotic looking and can be white/yellow or gray. This is the pathognomonic “target lesion,” but it may not be present in all cases. If a blister forms in the middle, the term “iris lesion” is more appropriate.
2. Lesions are generally symmetrical, with acral to central spread including extensor surfaces, face, palms, and soles. Mucosal lesions indicate a more severe type; bullae with sloughing in large sheets suggests TEN.

More info here and here.

AstraZeneca Accused of Hiding Seroquel Dangers

→ May 25, 2009 - Comments off

AstraZeneca plays hot potato with Seroquel side effects. Here are the highlights from the article (bold and italic text added by me):

AstraZeneca E-mails Show Debate on Seroquel Risks
Associated Press – May. 20, 2009

TRENTON, New Jersey–Marketing executives at British drug maker AstraZeneca PLC for years blocked efforts by company scientists to raise concerns the antipsychotic drug Seroquel caused weight gain and other problems, saying that would harm sales, plaintiff lawyers say.

Ed Blizzard, a Houston attorney whose firm is helping to represent about 6,000 Seroquel plaintiffs, said data showing Seroquel was “not very effective” and had serious side effects “was either spun or skewed or outright concealed.”

Seroquel was AstraZeneca’s No. 2 drug in sales last year, with revenue of $4.5 billion.

In a chain of e-mails in one document, a scientists’ safety evaluation committee in June 2000 recommended removing “limited” before the words “weight gain” in the list of Seroquel side effects, because many patients gained significant weight.

Marketing staff suggested trying other explanations, such as whether patients took other drugs that could be blamed. One marketing executive, Medical Affairs Manager Richard Owen, then wrote that such a change “is potentially damaging to Seroquel.”

The change in the drug’s label was finally made in 2002. That was after Barry Arnold, the vice president for clinical drug safety, complained repeatedly to the physician in charge of Seroquel drug safety about “Commercial (executives) having such an influence.”

Yet soon after the label change, AstraZeneca trademarked the term “weight-neutral” as an advertising slogan for Seroquel, Blizzard noted. He said data showed about one-quarter of patients taking Seroquel increased their weight by more than 7 percent. (Note that this is only the 7% weight gain noted during the study which is a much shorter duration that typical treatment.)

Later in 2002, Simon Hagger, global brand manager for Seroquel, e-mailed nearly 20 marketing staffers to say “we are under clear instruction from the highest level within AstraZeneca at this time not to discuss details surrounding trial 41,” outside the company. That patient study, concluded that year, found elevated levels of blood sugar.

In April, a panel of FDA scientific advisers said Seroquel’s side effects, including weight gain, high blood sugar and potential heart problems, were too troubling to make it a first choice against depression or anxiety. On a split vote, the panel said Seroquel could be used as an added therapy for patients taking other medicines but not getting relief from depression. The FDA has yet to issue a final ruling.

AstraZeneca faces roughly 15,000 lawsuits over Seroquel, about 60 percent of them in state courts. The first state trial is set to begin in Delaware on June 29. No federal trials have been held yet.

You have to register (it’s free) to see the whole article. I can’t say enough bad things about antipsychotics, myself, but definitely worse than the drug are the marketers and executives that try to hide the dangers to thrust the horrible side-effects onto an unsuspecting public. Nail their asses to the wall say I.

L-methylfolate as Antidepressant Enhancing Agent

→ January 6, 2008 - Comments off

I do a lot of psychopharmacology research reading. Like, a lot. I try to post things that I find interesting and not bore you with everything else. Similarly, I try to post things that are decently easy to read and understand. Today though, you have not gotten off so lucky, but the article is interesting.

What is L-Methylfolate?

L-methylfolate (MTHF) is a compound your body makes from folate (and the help of a few other things). Folic acid is the synthetic version of folate, available to take in supplemental form. Pregnant mothers generally take folic acid. As you would assume, taking more folic acid, will up the level of MTHF found in the brain.

The problem comes with an MTHF deficiency. This deficiency cannot necessarily be corrected by taking folic acid as some people genetically do not synthesize enough MTHF from folate from the diet or through supplements, moreover, there is some evidence to suggests that MTHF can “turn up” the efficacy of antidepressants even when no deficiency is present. It can also take many, many times the amount of folic acid to synthesize the amount of MTHF needed than would be found in the diet or available supplements. Anticonvulsants (mood stabilizers, like Lamictal and others) can also create a depletion in MTHF.

What Does This L-Methylfolate Stuff Mean?

The long story short is this, there is some evidence to suggest that taking MTHF supplements is warranted when antidepressants have either stopped working, or are not working at all. MTHF supplements are considered neither a drug, nor a food by the FDA (funny huh) but are still regulated and require a prescription.

This is really preliminary data there are all kinds of studies needed to bear out these findings, and my explanation above has been really simplified. But the really great thing about knowing about it is that it can help you, without causing the kind of side effects you typically see with pharmacological drugs. My doctor, who is seriously a no-nonsense woman made me aware of this, really respects the author of the article, and has given me a prescription for the stuff, whatever that’s worth. When you think about it, this actually makes a lot of sense. After being on anticonvulsants for years (like, eight of them) it’s not surprising that I’m deficient in a nutrient or two. This would explain why antidepressants just don’t seem to work in some people, and also seem to stop working after some time.

The article itself is good, but it’s extremely complicated and has so many chemical names in it it makes my brain hurt. There are pictures though. Kind of funny ones, I think. So, try to wade through the article, or just print out a copy and take it into your doctor and see what the say.

Article found here. Enjoy. (At least look at the diagrams. Steve there has a sense of humor.)

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