treatment issues

Active Placebos, Depression Influencers and Depression Prognosis – 3 New Things

→ December 14, 2011 - Comments off

Time to learn another three new things about mental health. This week we have:

  • Further discussion on Antidepressant Effectiveness (vs. Placebos)
  • Infographic on influential depression information sources
  • Depression prognosis over 10 years

1. Antidepressants: Lifesavers—or Active Placebos?

Monday I discussed the rate at which people with depression respond to placebos (pills that do nothing). My point was not that antidepressants don’t work – far from it – it’s that some people do respond to sugar pills as if they were real medication.

Some people may have mistaken this for me suggesting that antidepressants aren’t effective, however. And it just so happens that the Psychiatric Times was considering this subject just as I was, so please check out Antidepressants: Lifesavers—or Active Placebos? for all the details on this subject.

To quote the article:

. . . the treatment of depression is an art that requires many tools—from family support, to CBT, to medication.

“We will not save lives by dismissing any of the tools we have today just because they are not effective for everyone,” he said. “But we should not be limited in the future by current treatments.”

2. Top 10 Online Influencers Making a Difference in Depression

Natasha Tracy Top Depression InfluencerThis week ShareCare announced their list of the Top 10 Online Influencers Making a Difference in the World of Depression. ShareCare isn’t a site with which I’m overly familiar but among other things, they have subject matter experts that answer your questions on health topics.

Their top 10 depression influencers list is presented as an infographic and you can see it here. Yes, I’m at number two in a list of incredible people working for major organizations. I’m honored to have made their list.

3. Depression Prognosis Over 10 Years

I can tell you that about 75% of people respond successfully to appropriate depression treatment.* I can tell you that if you work with a doctor and a therapist you will likely experience meaningful symptom remission over time.

What I cannot tell you, however, is whether you will be depressed again in the future. It depends on a lot of variables but even knowing all of those, it’s still difficult to predict.

This study, though, followed people from the start of their treatment for major depression for 10 years. And here’s what they found:

  • 77% of the follow-up months were spent non-depressed (euthymic)
  • 16% of the follow-up months were spent in a sub-threshold depression (some depressive symptoms but not rising to the level of clinical depression)
  • 7% in major depression

Unfortunately, I don’t have access to the full text, but the data, nonetheless, is interesting. I think knowing that you are statistically likely to spend three-quarters of your life symptom-free is a hopeful positive.

Thanks all. I’ll let you know when I learn more and do better.

* I was asked where this comes from. It is a widely-accepted number; you’ll note it’s used here.


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.

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

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.

Antipsychiatry

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.


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

→ November 17, 2011 - 9 Comments

Today’s piece is written by Elaine Hirsch of MastersDegree.net. She writes today about the benefits of generic drugs for patients. Note: This is in no way an endorsement of, or advertisement for, olanzapine (Zyprexa).

The Food and Drug Administration (FDA) must approve any medication before it is made available to patients, this includes generic medications. As highlighted in one of Natasha’s earlier articles (Are Brand Name Drugs Better than Generics? – Drugs are not Cornflakes), generic drugs must go through rigorous FDA tests just as their brand-name counterparts do. The approval of generic olanzapine (Zyprexa) for bipolar disorder the FDA has taken a step forward in providing better healthcare to men and women who suffer from mental health issues.

What is olanzapine (Zyprexa)?

The FDA has approved generic olanzapine (Zyprexa), an antipsychotic, for the treatment of bipolar and schizophrenia. This medication is a new and less expensive version of the brand name medications Zyprexa and Zyprexa Zydus. The active ingredient in the medication is the same in the non-brand form.

The purpose of olanzapine is to treat schizophrenia and bipolar symptoms. Such symptoms include disturbed thinking, loss of interest in life, inappropriate emotions and mania.

What are generic drugs?

Generic drugs are the same as brand-name equivalents as far as ingredients, measurements, and effects are concerned. The difference is generic medication is offered as a much lower price than branded medications so patients are more easily able to obtain it.

Benefits of generic drugs

Americans often have a skewed vision when it comes to generic medications. As many as one third of Americans don’t realize generic drugs have the same ingredients as their brand-named counterparts and are just as effective. Fortunately, gradually increasing knowledge about the benefits of generic medications is making the release of generic olanzapine more significant for bipolar patients.

Cost of generic drugs

The main benefit of generic drugs is the lower cost when compared to brand name options. Brand name medications are expensive and insurance companies do not generally cover the full cost of the drug. This means more money is coming out of the pocket of consumers. Generic medications come at steep discounts and many are covered in-full by prescription drug insurance coverage.

Availability of generic drugs

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.


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: ‘DAnewsroom@mail.wvu.edu’; ‘DAPerspectives@mail.wvu.edu’; ‘Alan.Waters@mail.wvu.edu’; ‘Tracy.Morris@mail.wvu.edu’; ‘Kevin.Larkin@mail.wvu.edu’; ‘William.Fremouw@mail.wvu.edu’; ‘Maryanne.Reed@mail.wvu.edu’; ‘Diana.Martinelli@mail.wvu.edu’; ‘CHERUKURI@huffingtonpost.com’; ‘Danielle.Faipler@mail.wvu.edu’

CC: ‘velasconyc@yahoo.com’; ‘DASports@mail.wvu.edu’; ‘DAA&E@mail.wvu.edu’; ‘Erin.Fitzwilliams@mail.wvu.edu’; ‘John.Terry@mail.wvu.edu’; ‘Alex.Koscevic@mail.wvu.edu’; ‘Mackenzie.Mays@mail.wvu.edu’; ‘Lydia.Nuzum@mail.wvu.edu’; ‘James.Carvelli@mail.wvu.edu’; ‘Ben.Gaughan@mail.wvu.edu’; ‘Berry@mail.wvu.edu’; ‘Jeremiah.Yates@mail.wvu.edu’; ‘Jakob.Potts@mail.wvu.edu’; ‘Charles.Young@mail.wvu.edu’; ‘DACalendar@mail.wvu.edu’; ‘Matthew.Sunday@mail.wvu.edu’; ‘DA-Editor@mail.wvu.edu’; ‘BoFisher@mail.wvu.edu’; ‘Kyle.Hess@mail.wvu.edu’; ‘Alan.Waters@mail.wvu.edu’; ‘Pam.Dodson@mail.wvu.edu’; ‘chris.mcelroy@mail.wvu.edu’; ‘Jami.Christopher@mail.wvu.edu’; ‘roy.batesr@mail.wvu.edu’; ‘danewsroom@mail.wvu.edu’

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

https://natashatracy.com

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

https://natashatracy.com

Update

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!

Disallowing Depression Misconceptions – Newspaper Response

→ November 6, 2011 - 24 Comments

Disallowing Depression MisconceptionsLast week many people read my article Disallowing Depression Misconceptions containing critical remarks about a piece in West Virginia University’s school paper, The Daily Athenaeum. The piece was entitled Depression can be treated through lifestyle changes and suggested, among other inaccuracies, that all people needed to help depression was, “a walk in the park.”

I found Depression can be treated through lifestyle changes to be stigmatizing and just plain inaccurate and I said so both here at the Bipolar Burble and in the comments on The Daily Athenaeum’s website as well. I’m pleased to say many of my readers also stopped by to express rather notable disapproval of the article.

The Daily Athenaeum’s Response to Criticism

And so what did The Daily Athenaeum do?

They removed all comments from the piece and disallowed new ones.

What a disappointing reaction. Instead of admitting to a mistake, instead of printing a clarification or reaction, instead of responding to all the concerns, the newspaper did the most dishonest thing I can think of doing – they covered it up.

This is unacceptable.

How dare a newspaper conceal legitimate concerns and silence criticism? That is the very antithesis of journalistic ethics. I don’t know what this newspaper thinks it’s teaching its staff, but it certainly isn’t how to be a good reporter or writer.

I will be writing The Daily Athenaeum a letter detailing why I feel this is unacceptable and I encourage others to do the same. We, the mental illness community cannot let stigma-spreading inaccuracies to be swept under the rug. We cannot allow our voices to be silenced.

Is a Newspaper Article on Depression in Some University Newspaper a Little Thing?

Maybe. But it’s the principle. This newspaper doesn’t have the right to silence feedback just because they don’t like what we have to say. We have voices. And we will keep exercising them.

Contact the Daily Athenaeum

For anyone who would like to contact the Opinion columns editor you can email DAPerspectives@mail.wvu.edu or call (304) 293-5092 ex 4.

The Daily Athenaeum is also on Twitter and on Facebook.

For anyone who may be interested, here is a list of every email address they have on their website, I sent my email to all of them:

DAnewsroom@mail.wvu.edu; DAPerspectives@mail.wvu.edu; DASports@mail.wvu.edu; DAA&E@mail.wvu.edu; Erin.Fitzwilliams@mail.wvu.edu; John.Terry@mail.wvu.edu; Alex.Koscevic@mail.wvu.edu; Mackenzie.Mays@mail.wvu.edu; Lydia.Nuzum@mail.wvu.edu; James.Carvelli@mail.wvu.edu; Ben.Gaughan@mail.wvu.edu; Berry@mail.wvu.edu; Jeremiah.Yates@mail.wvu.edu; Jakob.Potts@mail.wvu.edu; Charles.Young@mail.wvu.edu; DACalendar@mail.wvu.edu; Matthew.Sunday@mail.wvu.edu; DA-Editor@mail.wvu.edu; BoFisher@mail.wvu.edu; Kyle.Hess@mail.wvu.edu; Alan.Waters@mail.wvu.edu; Pam.Dodson@mail.wvu.edu; chris.mcelroy@mail.wvu.edu; Jami.Christopher@mail.wvu.edu; roy.batesr@mail.wvu.edu; danewsroom@mail.wvu.edu

See the letters I have written to the West Virginia University here. Feel free to copy and paste and send them yourself. We have power in numbers.

As a Side Note

Athenaeum is defined as:

an institution for the promotion of literary or scientific learning.

Apparently their name is to be taken with a grain of salt.

Update

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

Why Aren’t Lifestyle Changes Frontline Treatment for Depression?

→ November 3, 2011 - 13 Comments

Many people complain about overmedication. They lament that the first thing doctors do is prescribe a medication for depression or another mental illness rather than suggest lifestyle changes like exercise and meditation.

This is often true. Doctors, including psychiatrists, often prescribe medication over suggesting lifestyle changes when a mental illness like depression is diagnosed.

And that’s a completely reasonable thing to do.

Mental Illness Diagnosis

When someone gets a mental illness diagnosis, it’s because they are very ill. No one goes to the doctor when they’re not ill. No one goes to the doctor because they’re having a bad day. People go to the doctor because they need help. Not need-help-in-a-little-while, but need help now.

And what do we know helps? Medication.* Antidepressants.**

Yup, I know people don’t want to believe that, but for a severe mental illness, we know that’s what works. Or, at least, we know it works better than anything else of which we know.

The Mentally Ill and Major Lifestyle Changes

Typically when people are mentally ill, they are not capable of making major life changes. People with severe depression can’t even get themselves out of bed to take a shower let alone ensure a quality diet and exercise program – if that could even help, were they capable of doing it. In fact, going to the doctor, getting a prescription filled and taking medication is enough of a battle for severely ill people.

It’s not reasonable for them to leave a doctor’s office with a “prescription” for kale, sunshine and park-walking. Because it just won’t happen. And it probably won’t work.

And then that severely ill person? They could die. Yes. Die.

In fact, most people who attempt suicide have seen their doctor within seven days of their suicide attempt. Many people within 24 hours of their suicide attempt. Doctors are aware of these statistics. They know the dangers of letting a severely ill person out of their office without offering them real help.

And how would you like death on your hands after suggesting a person take up jogging?

Exercise as Antidepressants Treatment for DepressionAlternative Treatments Alongside Medication

This is why I recommend that people try alternative treatment with medication (and therapy). Because if the person successfully stabilizes, they can taper off the medication if they so choose. If they feel whatever lifestyle changes they’ve made have helped their illness to the point where they no longer need the medication, they can get off of it. It’s not really rocket science.

American College of Physicians Recommendations

And for the record, the American College of Physicians (ACP)recommends the use of antidepressants in the treatment of depressive disorders. The ACP then recommends the treatment be altered if the patient does not show a positive response to therapy in 6-8 weeks. Further, once the patient shows an adequate response to antidepressants, the ACP recommends continuing the therapy for 4-9 months if it is the first episode of depression.

In other words, in those without a longstanding mental illness, antidepressants are a temporary treatment. And many people have had depression and used antidepressants in just this way.

A Note on Exercise for Depression

There was a study not too long ago that showed that an exercise program for depression could be as effective as an antidepressant in some cases of depression. This is still a questionable finding. It’s worth noting, however, that no long-term benefit was noted in exercise study participants upon follow-up.

It is for these reasons that exercise is not considered a treatment of depression.

Frontline Treatment of Depression is Medication for a Reason

So while lifestyle factors can impact depression, sometimes dramatically, they are not a frontline treatment because medication works better, overall, in the treatment of mental illness.

By erring on the side of medication, you run the risk of overmedicating people. By erring on the side of non-medication you run the risk of killing people. One of these things can be corrected, the other cannot.

*Technically, electroconvulsive therapy is the most effective treatment for depression; however, it is not a frontline treatment for a host of reasons.

**And psychotherapy but that is not the focus of this article. Therapy is also a frontline treatment but is often not chosen due to cost to the patient.

Is There a Cure for Bipolar Disorder, Mental Illness?

→ November 2, 2011 - 15 Comments

Is There a Cure for Bipolar Disorder, Mental Illness?

In the world of mental illness we talk about “response” and “remission” and not cure for mental illness. The reason is very simple – we don’t know of a cure for mental illness. One may exist, but we don’t know of any such cure for bipolar disorder, depression, schizophrenia and other mental illness.

What are Treatment, Response, Remission and Relapse?

The words we use most often are treatment, as in I’m in treatment for bipolar disorder; response, as in I’m responding to treatment for schizophrenia; and remission, as in I’m in remission from depression.

  • Treatment – treatment is whatever is applied to make an illness better such as therapy, medication, mindfulness and so on.
  • Response – response is generally positive or negative and indicates whether a treatment is working. A positive response means you have shown improvement on a given course of treatment, it does not necessarily mean that all your symptoms have disappeared, only that there has been positive movement in some way.
  • Remissionremission is the state in which all or most of your symptoms have “remitted” or gone away. People have remissions from cancer, and many other illnesses as well as mental illness.
  • Relapse – relapse is a state in which the symptoms reassert themselves after a period of successful treatment or remission.

Is There  a Cure for Bipolar Disorder?What is a Cure for Mental Illness?

A cure for bipolar, depression, schizophrenia or other mental illness would be a state of recovery where no more symptoms were present and you were returned to health permanently. This is the one that is contentious in mental illness. Most doctors believe that even once a mental illness goes into remission, relapse is possible, and in some cases, even likely. It is thought that the mental illness – the fundamental neurobiological causes – never go away, but they may be successfully treated for a period of time. This amount of time could be forever, but it most often is not.

So if a disease goes into remission forever, isn’t that a cure?

I guess that depends on who you ask. If you have to be treated for the rest of your life, even if you’re in remission I’d say it’s hard to argue that you’re “cured.” On the other hand, if you get better, taper off treatment, and remain better, then maybe you would consider that a cure. I’d be hesitant to use the word “cure,” personally, but that’s me.

Who Goes Into Long-Term Remission? Who’s Cured of Mental Illness?

That’s a toughie. I’d start out by saying that it’s impossible to know who will go into long-term remission or get “cured” of mental illness, but that isn’t exactly true. We know that people with milder forms of the disease have a much better chance of full remission. We know that you have a better chance at a mental illness “cure” if:

  • You don’t have a family history of mental illness
  • You have a more mild form of mental illness
  • You have a good support system
  • You have access to quality medical (including mental health) care
  • You have had fewer episodes of mental illness in the past

Unfortunately, most of us reading this right now do not fit into this category. It doesn’t mean that you won’t find long-term remission; it just means that you’re not in the most likely group.

Is a Cure for Mental Illness Possible?

Mental illness is not one thing and all mental illnesses are not created equal. Depression isn’t the same as bipolar disorder which isn’t the same as schizophrenia. And with different severity levels, these diseases become, yet again, different.

But in the case of severe mental illness, is there a cure?

No.

Not if you ask me.

[push]I think suggesting there is a cure for mental illness overall just isn’t true. We don’t yet have a cure for mental illness. [/push]

I have no doubt that some people with a mental illness can experience long-term remission and some may even consider themselves “cured.” But I have yet to see a person with schizophrenia make that claim. I have yet to see anyone who suffers from psychosis make that claim. I have yet to see anyone with severe, long-standing symptoms make that claim. So it is possible? Maybe. In some cases. But maybe in those cases the disease just isn’t like the other cases. Maybe they are in a category by themselves. Maybe (undoubtedly) we just can’t recognize who is in that category.

So I wouldn’t want anyone to think that a cure absolutely is or absolutely is not possible for any given person, because I don’t know. But I think suggesting there is a cure for mental illness overall just isn’t true. We don’t yet have a cure for mental illness. We’re just going to have to live with that fact. But that’s OK. It puts us in good company with epileptics, Parkinsonians, diabetics and many, many others.

A Sidenote

As an aside, the closest thing we currently have to a cure seems to be deep brain stimulation. For those who get it, and for whom it works, it seems to “cure” depression. But this treatment is still in its very early research stages.

Disallowing Depression Misconceptions

→ October 31, 2011 - 26 Comments

Depression MythsI despise bad reporting and I don’t care if you write for a newspaper with a circulation of 3 people or the New York Times – there is no excuse to report badly on mental illness, there is quality information available everywhere.

Point in case is Depression can be treated through lifestyle changes by Danielle Faipler in West Virginia University’s student paper, The Daily Athenaeum.

Comments on Depression can be treated through lifestyle changes

This article contains some of the most widely-spread mistruths about depression and mental illness and is inexcusable. It doesn’t even pass a sanity check (even by an insane person).

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.

That is absolutely false and I would enjoy seeing any research that indicates otherwise. As I have shown, depressed people who take antidepressants do better long-term and antidepressants are not addictive. Stating otherwise is ignorant or untruthful.

A side effect of antidepressants is hallucinations, and most of the time, different medication is prescribed to the patient.

If the number of people who experienced hallucinations from taking antidepressants alone were to get together for a party, they could fit in my freaking apartment. Yes, it can happen with some antidepressants, but it’s far from common. (And what was the second half of the sentence? What different medication?)

Further Stigmatizing Depression and Mental Illness

A walk in the park may be all it takes for someone with depression to get out of their funk.

If that isn’t one of the most stigmatizing statements, I don’t know what is. Depression is a medical illness and not a bad mood that can be cured by a stroll.

This type of reporting, even if by a student, is unacceptable. It spread lies and does so without scientific backing of any kind. This particular writer and editor should be ashamed of themselves and write a public apology for such nonsense.

It is not acceptable for a newspaper to spread mistruths and further stigma of depression and mental illness. Period.

Please view The Daily Athenaeum’s shameful response to this criticism.

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