Bipolar blog

Drug Trials, Antidepressants and Placebo Effect – Is it Bad?

→ December 12, 2011 - 6 Comments

When drug trials are conducted, the gold standard (and requirement for FDA approval) is a double-blind placebo-controlled study. In this kind of drug study participants are randomly assigned to receive either the medication or an inert (does nothing) pill known as a placebo. Neither the doctor not the patient knows whether they are getting the placebo or the real drug.

The study then compares what happens to those who received the real drug versus those who received the placebo and determines the efficacy of the real drug.

The Placebo Effect

This is critical because of something known as the “placebo effect.” The placebo effect is this odd scenario where people get better just because you give them a pill, even if the pill does nothing. Doctors and scientists don’t understand the placebo effect but not only will people get better on a placebo, but they will even experience side effects – something that isn’t possible given that the placebo is inert. But the brain is a powerful thing and something we don’t fully understand.

Treatment vs. No Treatment OutcomesAnd one of the problems with antidepressants (and many medications) is that sometimes they aren’t better than the placebo. Additionally, sometimes when they are better than the placebo, it’s only by a small margin. Drug companies have to prove that their drug is statistically significantly better than a placebo in order to get FDA approval but even this statistically significant amount can be very small.

However, this isn’t a piece about how effective are when antidepressants are compared to placebos. This is a piece about how effective antidepressants are compared to no treatment.

Depression Treatment vs. No Treatment

Now, each disorder would have to be studied individually, but basically the question is, if you put treatment vs. placebo vs. no treatment, what would happen? ^

I can tell you what would happen – the people who received no treatment would do worse than those who received a placebo.

To the best of my knowledge there is no exact study like this, likely because it wouldn’t make it past an ethics board. If you determine a person is ill and needs treatment it is unethical to offer them none.

There is, however, a comparison of treatment vs. no treatment that I’m aware of. Here, they study people who have received treatment vs. those who have not. (They break down those who have not into three additional groups: those that don’t think they need treatment, those who think they need treatment but don’t get it, and those that don’t need treatment.) Note that “treatment” isn’t specified so it could be of any kind.

What they find for depression is that those who receive treatment go from around 30 to 24 on a depression scale in one year and those that need treatment but don’t get it go from about a 27 to 23 in one year (in both cases a higher number indicates greater depression).

So, treatment moves them 6 points and no treatment moves them 4 points. Approximately.*

No Big Deal?

Well, it depends if you’re the one depressed.

Firstly, it’s important to note that those in treatment were more depressed than those who weren’t. This should be noted as those people would likely have worse outcomes in one year. (The study wasn’t designed to take this into account but does note that symptom severity at outset is the biggest predictor of poor outcomes.)

Secondly, it’s worth noting that 2 points on a 35-point scale can lead to a significantly greater quality-of-life for the person in general. Many people with treatment-resistant depression I know would kill for that kind of improvement.

Thirdly, this improvement marker isn’t the only relevant one; it’s just the only one I have to go on.

Numbers on the kind of improvement seen in treatment versus no treatment vary, but everyone agrees that no treatment is worse. (The above estimate is rather conservative.)

What, No Placebo?

Unfortunately, no. There is no placebo in this study. Sorry.

But as we do know that people on a placebo do almost as well, and sometimes better, than those on the drug, we can guess (yes, guess; again, sorry) that people on a placebo would land somewhere in between the two above outcomes.

Question: How Do We Improve Outcomes without Giving a Placebo?

So the question is, if people on a placebo do better than no treatment (but not as well as those treated) then is there a way to preserve that gain? Doctors can’t prescribe placebos, it’s unethical.

Or is the placebo effect when being given an antidepressant such a bad thing? If, really, you respond to a real medication because of the placebo effect (and you wouldn’t know the difference, no one would) is that really all that bad? Does that not have a value?

People decry the placebo effect saying it proves that antidepressants are worthless. But I say how would all those people benefiting from them, even from the placebo effect, get better without them?

^ See the comment Placebo Effect in Depression as well. 

 * In case you were wondering, people who were depressed but didn’t think they had a problem were less depressed than those that perceived a need for treatment; however, they only moved down the scale from about 18 to 16 in one year.

Personal Story of Medication Noncompliance

→ December 7, 2011 - 27 Comments

It is politically incorrect to say medication “noncompliance.” I suppose this is because it gives the idea that the person taking medication is “complying” to some authority figure and not consciously making the decision on their own.

I get that. But whether you call it medication noncompliance or medication non-adherence, the result is the same – the person is not taking their medications as prescribed by a doctor.

And medication noncompliance can lead to devastating consequences not only in the short-term but in the long-term as well. One reader shares her experience in her own words.

A Story of Medication Noncompliance

. . . I got manic in September without being aware of it. I was over productive, spent a lot of money, barely slept, very irritable . . . While manic, I thought I was normal, since I was stable since several months. I was only on a small amount of an antidepressant, mood stabilizer and a tiny amount of antipsychotic.

All this disappeared suddenly. I was out of energy. I was barely able to move, depressed and the most important: productivity disappeared. Couldn’t move or concentrate . . . for the first time of my life maybe, I started having anger crisis, uncontrollable ones. It was like I push a button and become extremely angry. I went through irritability before but never knew such anger. It was all verbal, no violence but very embarrassing.

I got so angry and stupidly stopped my medication.

Why Were You Angry?

I was mainly angry because high productivity was over. I was angry and frustrated, thought I finally became stable. I was angry for being bipolar. I didn’t want to live (by the way I always think about suicide even when I am high). I hated myself and this life and wanted to punish myself.

I wasn’t thinking logically. What I was thinking: I was taking medication and all was fine for several months and in spite of all this, I had mania so why to continue to take the medication! Plus I wanted to suffer physically, to have tangible pain.

What Happened When You Stopped Taking Your Medication?

Drug NoncomplianceI stopped taking medication although I knew from previous experience (several years ago) that withdrawal is terrible. I thought that since I was on low doses, the effects won’t be that strong. Well I discovered I was wrong.

The first week I was doing more or less fine. Then I started feeling dizziness, nausea, restlessness. I started feeling than something inside me was boiling. I was extremely tired, empty. I could feel that even my eyes were empty. I was very irritable.

I told my therapist (psychologist) about messing with my medication. He tried for several sessions to convince me to take them again. At the beginning of the third week, I couldn’t continue anymore. Told the psychiatrist, he told me to take a mood stabilizer for few days and an antipsychotic and wait. But my situation was going worse. By the end of that week, I agreed with both the therapist and the psychiatrist that I needed to be hospitalized.

I had to be hospitalized because I couldn’t continue on my own. I was about to collapse. I was crying all the time, not able to work, extremely irritable and tired. And I didn’t trust myself that I could force myself to take medication as prescribed. Any single trigger would have pushed me to stop or to take an overdose. I was very suicidal.

I took me 4 days on an IV antipsychotic to start to improve. What helped me the most is that I knew I was safe there, protected against myself.

How Do You Feel Back on Medication?

I am on more medication now. I am still angry about being bipolar but dealing with this in the therapy. But physically I am doing better and I am less suicidal. And I trust myself that I can control myself concerning taking medication.

How Do You Wish You Had Handled the Situation?

I should have told my doctor first place that I stopped the medication. I should have been more aware about the symptoms of mania. I should have set a system or informed my family about the “warning” symptoms of mania. But overall, I took a good decision by asking to be hospitalized.

Wanted to share it with other bipolars and tell them that it is very very bad and harmful to stop medication.

If You Want to Change Your Medication

As always, it is your right to change your treatment plan but as this reader has shared, if you do it the wrong way, you may end up in the hospital or worse. Whenever you make a change it needs to be overseen by a doctor.

And if you do make a mistake and stop taking your medication – be honest and tell your doctor so they can help you. This person did the right thing by admitting she needed help. She got it, and now she’s able to share this message with you. Listen to her.

What’s up at the Bipolar Burble? Good News

→ December 6, 2011 - 14 Comments

I don’t like to write too many self-referential posts because I’m pretty sure masturbatory navel-gazing isn’t why people come here. However, now and then people like to know what’s up.

And right now there are exciting things afoot at the Bipolar Burble and for me as well so I thought I’d let you know about them.

Natasha Tracy Nominated for Health Activist of the Year

WegoHealth is awarding health activists of the year. They have categories for:

  • Best in show
  • Rookie of the year
  • Paperboy award
  • Health activist hero
  • Advocating for another
  • TMI award
  • Hilarious health activist
  • Offline crusader
  • Best affirmation post
  • Best kept secret

Natasha Tracy as Health Activist of the YearThese awards are for people who, “moved you, inspired you, and made a real difference in how you think about healthcare and living well.”

And I am honored to be nominated for Best in Show. And while I suppose everyone says “it’s an honor just to be nominated,” I do mean that. People have said such kind things about me and that’s the fuel that keeps the fires here at the Burble lit.

Have Your Say on Health Activists

Want to have your say? Contact WegoHealth to tell them what you think of me or nominate someone else! (They are also looking for people for their judging panel.)

Bipolar Burble Nominated for Best Health Blog 2011

Yes, in the string of self-congratulations, I must also say that the Bipolar Burble has been nominated for Best Health Blog of 2011 at

Natasha Tracy and Bipolar Burble Best Health BlogBut only you can help me win.

This, alas, is a bit of a popularity contest, so I must ask you to vote for me now and as often as possible (you can vote once a day) in order for me to win. I appreciate every one of your votes and I hope you’ll forgive me for prodding you about it over the next six weeks.

Off Label – An Unbalanced Look at a Bipolar Life – Memoir

You might have noticed that I published an excerpt from my memoir, Off Label, months ago. This was to get some public feedback and to generally let people know what is happening. But the memoir has sort of sat in a bottom folder on my hard drive collecting dust for quite some time. It’s not that I don’t care about getting it published – I do, but because of the way the publishing industry works right now, I have to prove my popularity before an agent will be interested in me.

And recently I’ve managed to do that.

Over the last few days two agents have shown interest in representing me and I’m hoping one of them will sign me as a client.

Now, publishing is still a far off dream, but I’ve taken another big step forward.

And in case you were wondering, a tip of the hat goes to Natalie Jeanne Champagne as she spurred me forward in this endeavour.

Sharing the Good News

So that’s the good news around here. It’s nice to take a break from the medical stuff and bring it to you. Thanks for a wonderful year of support. If you keep it up, I promise to keep working hard and bringing you quality, well-researched information on mental illness.

You all rock.

Doctor Background Checks; ECT in Film; New Borderline Criteria – 3 New Things

→ December 1, 2011 - 5 Comments

Doctor Background Checks; ECT in Film; New Borderline Criteria – 3 New Things

Today we return to my 3 New Things series so I can touch on three new pieces of information I’ve found this week. This week I talk about:

  • How to get a background check on a doctor
  • The sorry portrayal of electroconvulsive therapy (ECT) in film
  • The newly-proposed diagnostic criteria for personality disorders in the DSM-V

Read more

A Damaged Brain and a Mind Trying to Deal with It

→ November 30, 2011 - 37 Comments

A Damaged Brain and a Mind Trying to Deal with It

My Twitter bio says I have, “a damaged brain and a mind trying to deal with it.” This confuses a lot of people. It’s OK. I get it. Most people don’t differentiate between the mind and the brain. But I do. In fact, I consider it a critical distinction for people with a mental illness.

Your mind is who you are; your brain is just what you are.

Read more

Defending Psychiatry

→ November 28, 2011 - 55 Comments

I often find myself in the unenviable position of defending psychiatry. This, in spite of the fact that I am not a psychiatrist nor do I even play one on TV.

Nevertheless, I feel compelled to speak on psychiatry’s behalf. Maybe it’s because when left to their own devices, psychiatrists aren’t very good at it. Or more likely it’s simply because an unreasonable number of people attack psychiatry unreasonably and I think someone ought to bring the concept of reason into the discussion.


There is a faction of folks out there who are antipsychiatry and every time I mention them I get hate mail. But here I am again. Antipsychiatry. Antipsychiatry. Antipsychiatry.

Rather than give you my definition, which people hate and argue with, here are the central points of antipsychiatry according to Wikipedia:

  • The specific definitions of, or criteria for, hundreds of current psychiatric diagnoses or disorders are vague and arbitrary, leaving too much room for opinions and interpretations to meet basic scientific standards.
  • Prevailing psychiatric treatments are ultimately far more damaging than helpful to patients.

Some of antipsychiatry’s other opinions, according to Wikipedia, include:

  • Inappropriate and overuse of medical concepts and tools to understand the mind and society, including the miscategorization of normal reactions to extreme situations as psychiatric disorders
  • Unwillingness to develop and use objective tests (such as intelligence/cognitive tests) to determine patients’ state (such as strong psychosis)
  • Unexamined abuse or misuse of power over patients who are too often treated against their will
  • Relation of power between patients and psychiatrists, as well as the institutional environment, is too often experienced by patients as demeaning and controlling
  • Forced use of government (both civilian and military) psychiatric treatment prevents the patient from choosing private psychiatric or alternative treatment thereby denying the patient of his or her basic rights

You can read it all here.

I have dealt with many of these claims on occasion, but for now, let’s just say that while criticisms are a valid and useful agent of change, the approach taken by these groups leaves something to be desired.

Psychiatry is Perfect. I Love Psychiatry.

See, here’s the thing, psychiatry is neither perfect nor do I love it. Psychiatry is just a branch of medicine like oncology or cardiology. No branch of medicine is perfect nor do I have emotional attachment to any of them. They are just what they are. They are just areas of medicine where doctors try to make the best decisions they can based on the information they have available.

It’s pretty simple actually. No great conspiracy. No great cover-up. Just people doing the best they can.

Psychiatry is Imperfect

Psychiatry then, naturally, is imperfect. Wildly so. I have had encounters with psychiatrists that would curl your hair and make you turn your head around 360 degrees. Psychiatrists can be absolute assholes.

Among other things, psychiatrists tend to appear cold, unfeeling, callous, uninterested, uncaring, indignant and self-righteous to say nothing of poor bedside manner and a general lackadaisical attitude towards the concerns of the patient. Why so many of them are like this, I don’t know, but I suspect it has little to do with psychiatry and much to do with medicine in general.

But I digress.

Why Fight for Psychiatry?

[push]For every asshole psychiatrist, there are people with the opposite characteristics. Some psychiatrists do care, do listen and do take patient concerns seriously. These people deserve recognition.[/push]

That’s easy. Because for every psychiatrist that shows the characteristics above, there are people with the opposite characteristics. Some psychiatrists do care, do listen and do take patient concerns seriously. And even those who appear not to, they get the benefit of the doubt in my mind as doing the best they can. Like most human beings.

And to be clear, doctors went to school for more than a decade to be in a position to help you. Maybe they’re burned out, jaded and cynical at times but likely down there somewhere is a kernel of trying to help. Really. They are.

Psychiatrists Help People

Why Defend Psychiatry from Antipsychiatry FolksAnd they do. Psychiatrists help people every day. Every day they save lives. Every day they make lives better. Every day they make it possible for people to get jobs, have families and relationships. Every day they make it possible for a person to get out of the hospital, be safe and get better from an illness that would otherwise destroy them. Every day they make it possible for me to get out of bed in the morning.

So you see, it’s not that I love psychiatry. I don’t. I think they offer too many meds, not enough psychotherapy and allow insurance companies to dictate too many decisions. They’re not perfect. But no system is. Any medical specialty could be accused of the same.

But they’re worth standing up for because they are the last line of defense between the mentally ill and, well, often death, just like oncology is the last line of defense between cancer and death. They do an important job and fill and important role for people with a mental illness and don’t deserve to be demonized simply for being imperfect. Because not one of us meets that bar at work or anywhere else in life.

N-Acetylcysteine (NAC) – Inexpensive Treatment for Bipolar Depression

→ November 22, 2011 - 40 Comments

N-Acetylcysteine (NAC) – Inexpensive Treatment for Bipolar Depression

N-acetylcysteine, also known as N-acetyl-L-cysteine or just acetylcysteine is a supplement that shows promise in the treatment of bipolar depression. This is really big news because there are very few drugs, supplements or anything else that show promise in the area of bipolar depression. But N-acetylcysteine (NAC) is even better than most because:

  • N-acetylcysteine is an over-the-counter supplement
  • N-acetylcysteine is cheap
  • N-acetylcysteine has very few known  side effects

What is N-Acetylcysteine (NAC)?

Don’t be scared by the fancy name, just think of NAC as a supplement like omega-3 or vitamin D.

N-acetylcysteine is the N-acetyl derivative of the amino acid cysteine, and cysteine is an amino acid required for you to live. Your body uses it in your brain, for digestion and many other things.

And more interesting for people with bipolar disorder, cysteine is a precursor to glutathione, which is a precursor to glutamate – a neurotransmitter in the brain. Like the neurotransmitter serotonin is made more effective by using selective-serotonin reuptake inhibitor (SSRI) antidepressants, glutamate is increased by taking NAC.

The Research on N-Acetylcysteine (NAC) and Bipolar Disorder

I have been watching the research on NAC and bipolar depression for a while and it looks very promising.

Note that NAC is always used as an add-on medication for bipolar depression and is not used alone.

  • A recent open-label trial found statistically significant reductions in bipolar depression scores over the course of eight weeks. Improvements in functioning and quality of life were also seen.
  • A randomized double-blind placebo-controlled study found significant reductions in bipolar depression scores. Reduction in depression was seen by week eight but further (“medium to high”) benefits were seen by week 20.

N-acetylcysteine has also been used to treat compulsive behavior (like hair-pulling, trichotillomania and gambling), cocaine craving and cigarette smoking.

How is N-Acetylcysteine (NAC) Dosed? What is the Cost of NAC?

Bipolar Depression and NAC

This is always a call for your doctor but the double-blind placebo-controlled study mentioned above dosed at 1000 mg twice daily. Some studies have gone higher than this.

I pay about $25.00 per month for NAC and I get it from a vitamin shop.

What are the Side Effects of N-Acetylcysteine (NAC)?

This depends on who you ask. In the double-blind placebo-controlled study no side effects were noted as statistically significant but side effects are, of course, possible with any medication. Long-term data is not available on NAC’s safety.

It’s worth noting that in very high doses (much higher than is used in humans) mice were found to develop damage to the heart and lungs.

Natasha Tracy’s Opinion on N-Acetylcysteine (NAC)

In my non-medical opinion, this medication is worth a try for people who have unresolved bipolar depression. Again in my opinion, it is a low-risk option for treatment that really appears to have no downsides.

And on a personal note, I, personally, have found it effective.

Learning More About N-Acetylcysteine

If you’re interested in NAC I encourage you to click on the studies I have linked to and read Dr. Phelps’ write-up on NAC as it contains more detail than I have provided. You may need to provide this information to your doctor as many doctors don’t know about NAC and bipolar depression.

Important Note

This is an informational article and nothing is intended as medical advice. All medications, including supplements should be taken under the care of a doctor only. Please and thank you.

Generic Olanzapine (Zyprexa) and Generic Drug Benefits – Guest Post

→ November 17, 2011 - 9 Comments

Today’s piece is written by Elaine Hirsch of 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

Generic Olanzapine Saves Patients MoneyPerhaps 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.

Free Drug Samples – Do they Cost More in the Long-Run?

→ November 16, 2011 - 8 Comments

I was recently made aware of an article on MSNBC which alleges free drug samples provided by doctors actually end up costing the patient more money over time. This, of course, is completely counter-intuitive, and I, not in the habit of taking health information from news sources, looked it up.

And yes, it is, in fact, the case that some studies indicate that those who get free drug samples from their doctor actually end up paying more money in the long-run.

How can this possibly be?

Glad you asked.

Do Free Drug Samples Cost the Consumer More Money?

Well, that depends on who you ask.

First off, for some reason insured and higher-income folks tend to receive more drug samples than their uninsured and less-income counterparts. (Although not all research agrees on this point.) Why? Well, I’m not sure, but if I had to guess I’d say that rich (or insured) people go to nicer clinics where there are more free drug samples to pass around. Poorer (or uninsured) folks tend to go to less expensive clinics where more people are vying for the same number of free drug samples. But that is just a guess on my part.

And while it’s convenient not to go to the drugstore (and sometimes even necessary due to severity of illness) and additionally convenient to trial several drugs for free before settling on one for which to pay, really it’s those who can’t afford drugs that should be receiving the free samples (if you ask me).

Secondly, some studies report that by providing free drug samples, the patient’s out-of-pocket expenses for drugs actually increases.

Well, Maybe Free Drug Samples Don’t Cost More Money

Free Drug Samples and Prescribing Practices

Of course, depending on the study, some researchers have shown that free drug samples do, in fact, cost patients less, although the benefit may be marginal.

Free Drug Samples are Marketing Tools

And whether you believe free drug samples cost patients more money or not, make no mistake about it, “free” drug samples are, in fact, marketing tools. Pharmacology companies aren’t providing free samples out of the goodness of their heart (assuming they have one), they are providing free drug samples because they know that it increases the chance that their branded medication will be prescribed over their generic medication. And research definitely bears this last point out. (This may be even more true for psych meds.)

And naturally, while generics can be every bit as effective as brand medication, drug companies don’t make money on generics – only their brand. (Although generics are very good for the consumer, costing up to 80% less than the brand name in the United States. In case you were wondering, the difference is only about 20% in Canada because we don’t allow the kind of brand name prices seen in the US.)

Are Free Drug Samples Good or Bad?

Considering the conflicting information, I believe it comes down to the prescriber. Some doctors are quite capable of making good free drug sample providing decisions and this can lower the prescription cost, particularly for those who are needy. However, free drug samples can affect prescribing practices in negative ways and not only cost more money but stick you with a brand medication when a generic might be just as good.

So, me personally? I’m a fan of free drug samples. I think it’s the only way that many people could receive the medications they are currently on. But it comes down to the responsibility of the healthcare provider – as prescriptions always do.

Mental Illness Words You Can’t Say

→ November 14, 2011 - 52 Comments

Mental Illness Words You Can’t Say

As a writer I take claim to any and all words. They are mine and I do with them as I please. This includes mental illness / mental health terms. However, some people would argue that as a mental health writer and advocate, it is my responsibility to promote certain language and verbiage.

I did not agree to that.

I agreed to be a writer. I agreed to be opinionated. I agreed to be passionate. I agreed to be well-researched. I agreed to be intelligent. I did not agree to push a political agenda.

Mental Illness Words You Can’t Say

Nevertheless, people still insist that I not use the following words / phrases:

  • Whackjob
  • Nutjob
  • Nutbar
  • Crazy
  • Bonkers
  • Off his rocker
  • Mentally unstable
  • “The mentally ill”
  • Bipolars
  • “I’m bipolar”

And about a million other things. The politically correct people have told me I’m not allowed to refer to anyone’s mental capacity in anything but the most politically correct way. Which is, in case you were wondering, a person with a mental illness or a person with bipolar disorder, etc.

Again, not to flog a horse that happens to be dead, but I have poetic license which means I get to do whatever I want with words.

I’m Bipolar. I’m Crazy. Sue Me.

I’ve talked about saying I’m bipolar before. I do not consider this to be belittling or stigmatizing and I’m sorry that you do, but that’s really not my problem. It’s a proper English statement with actual English words and if you don’t like it, feel free to take it up with Funk and Wagnells.

This is similar to the statement of I’m crazy. I am. It’s just the way it is. It’s reality. I’m using the words in a proper English fashion. Sue me.

Creative Terms for Crazy

And given all the political correctness in the world I certainly can’t use a term like whackjob or nutbar. Except, of course, that I do. I don’t use the terms liberally, I don’t apply them to the mentally ill, but I do use them. Because they’re words and I need words in order to express what I’m trying to say.

(In the case of something like bonkers I’m referring to someone with a tenuous grasp on logic, reason and sanity, which is not to say mentally ill. The most mentally well person can be nutbar – trust me.)

Words You Aren't Allowed to Say Mental Illness

But I’m Offended!

Sorry to hear that. But perhaps you could respect a writer’s right to actually use words for self-expression. When I start using actual mental health terminology in a degrading way you can call me on it. Until then, I’m not terribly interested.

I’m Passionate. I Eschew Political Correctness.

One of the things people like (or perhaps loathe) about me is that I am passionate. That I am insanely (yes) attached to ideas and concepts and am willing to say so in a way that makes sense for me. And that doesn’t fall within the bounds of political correctness. Art never does. Poetry never does. Shakespeare never did. Political correctness forces tepidity. I have no intention of being tepid.

Fine Then, I Don’t Respect You

I’m sorry to hear that. But that’s OK by me. If you read more than a smattering of my work then you’ll know who I am – virulently defendant of me and my kind. And if that isn’t enough for you to respect, because you don’t approve of the letters that make up a sentence, that’s your prerogative. But I’m not going to stop because the political winds blow. I have no desire to offend but I do have desire to describe. And I’m going to do that in the best ways I know how.

The Daily Athenaeum Response Regarding the Depression Article

→ November 10, 2011 - 6 Comments

Last night I received a response from John Terry, the managing editor at The Daily Athenaeum. While I am rather disappointed to its content as it seems to have missed my points, I do appreciate someone from the paper taking the time to answer my email.

Objection to the Depression Article and Abusive Comments

Depression Article Response

One of the points John makes is that they cut off comments because the comments became “abusive, attacking.” While I don’t agree, the comments seem pretty tame to me, I will say that I do agree with his point that it isn’t acceptable to abuse or attack the author of the article or other commenters. In my opinion, the issue with The Daily Athenaeum’s piece has more to do with editorial permission to publish and less to do with the individual author. Any one person can be ignorant and uninformed but that’s when it’s up to the editor to step up and make sure that such content does not get published.

Moreover, my objection is around the content and the effect it has on others. This takes precedence over even editoral judgement. That multiple people that such stigmatizing and minimizing remarks were acceptable to print at all is the problem, not the individuals, per se.

Response from The Daily Athenaeum

I will be replying to John later in the day, but until then, here is his response:

Hi Natasha,

Thanks for the email.

We would be happy to work with you on running a Letter to the Editor in an edition of our newspaper. Letters must include your name, and a title for the letter. Please keep it between 350-400 words. While you must refrain from attacking the author of the piece, please feel free to state your point.

Also – please note that we close comments when they become abusive, attacking, or veer off point. Our site management software sometimes catches inappropriate comments, but when comments start to slip through that are inappropriate it is our policy to close off comments. Our commenting policy can be found here.

Our writer is entitled to her opinion and no opinion is ever intended to offend, but to instead present a viewpoint. All of the columns in our opinion section are not necessarily representative of the entire staff of The Daily Athenaeum. For many of the columns that are run, this one being no exception, there are many different opinions of our staff. We have young writers on our staff, and it’s a constant learning process; this is no exception. While the writer of this piece did use a study, this is a situation where it would have been better to name the study in the article itself. We’ve talked with the writer and she feels bad about offending people when she had no intention to do so. It’s just an example of another learning opportunity for a member of the staff.

We always encourage a lively dialogue with the community, and I hope you do submit a letter to the editor. You can send it to me and I will pass it on to our opinion editor.

Thanks for reading,

John Terry

Managing Editor

Letters to the West Virginia University Regarding Depression Article Feedback

→ November 8, 2011 - 2 Comments

The following is a copy of the two letters I have sent to the West Virginia University (see why I’m fighting their stigma here). I have yet to receive a reply. You are welcome to copy and paste any parts that you like and send them yourself. The most voices the better.

Send Your Email to the Newspaper and Other University Staff

I sent this letter to everyone at the paper as well as psychology and journalism heads at the school:

To: ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’

CC: ‘’; ‘’; ‘DAA&’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’; ‘’

To the Editors and Management of the Daily Athenaeum as well as the psychology and journalism professionals at West Virginia University,

After a lack of response regarding my prior feedback on the Depression can be treated through lifestyle changes article, I’m forced to again express my extreme disappointment in the handling of this situation.

I would like to encourage the editorial team to take this as an opportunity not only to acknowledge the questionable reporting, but also to help remove stigma from the mental health community. I strongly ask for:

  1. A retraction and correction of the published piece posted online, on Facebook and Twitte
  2. A series of education-focused articles on the mental health services available for WVU students and mental illness stigma
  3. A guest column on mental illness to be published (I would be happy to contribute this)

I am asking for professional journalism behavior as are the hundreds of other people who have read my articles on this subject. I look forward to your reply.

Natasha Tracy

Mental Health Advocate and Writer

My Original Email to The Daily Athenaeum (no reponse)

To the Editors and Management of the Daily Athenaeum,

I am writing this letter to inform you as to my disappointment in a recent Opinion column and your actions around said column.

The column in question is: Depression can be treated through lifestyle changes by Danielle Faipler.

This column shows a variety of inaccuracies and in spreading these inaccuracies, increases the stigma of the mentally ill.

As an example,

Antidepressants are good for short-term treatment, but they do not facilitate with the long-term changes needed to treat the illness, and they add to the growing prescription drug abuse problem in the U.S.

In no way are these statements accurate and moreover, the reporter cites no references to backup these faulty statements. From what I can tell, they are simply made up and completely contrary to journalistic ethics not to mention the practices of an institution of learning.

Antidepressants do benefit people short-term as well as long-term as I’ve discussed with regard to a scientific study here. Additionally, there is no evidence that antidepressants are abused nor are they shown to be addictive as I’ve discussed here. And unlike your reporter, I refer to actual studies and references in regards to my comments.

Which brings me to your paper’s actions around this criticism.

A number of people left comments on this article expressing concern over its inaccuracies and its further stigmatization of people with a mental illness. And instead of addressing these concerns, you removed all comments and disallowed further discussion.

This isn’t acceptable.

Just because you don’t like criticism, that doesn’t give you the right to ignore it or sweep it under the run. If your paper is to be considered a journalistic outlet of any sort then you must support free speech and you have done anything but. We, the mental illness community, will not sit idly by and allow you to silence our very real and reasonable concerns.

I encouraged you to write a retraction or a clarification in an article I wrote on October 31st. I now again ask that you correct these factual errors in the hopes that the mentally ill reading this column do not feel further stigmatized by a very serious, life-threatening illness. If your paper stops one person from reaching out and getting real medical help – it is far too many. I suggest you think of the one-in-eight people with bipolar disorder who commit suicide the next time you consider publishing material that trivializes a serious medical condition.

Natasha Tracy

Mental Health Activist and Writer


The Daily Athenaeum has bowed to pressure and reinstated comments on their article. I will continue to push to have them address our concerns.

Thanks to everyone for your help with this. Keep it up!

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