Archive for May, 2011

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The business of ADHD

Wednesday, May 25th, 2011

SFGate.com City Brights Blog
By Winston Chung, Child Psychiatrist
May 24, 2011

Psychiatrists convened in sunny Honolulu for the 164th Annual Meeting of the American Psychiatric Association (APA) last week, discussing, among other things, moving forward with plans to make the diagnostic criteria for ADHD less stringent: proposed changes include reducing the number of required symptoms from 6 to 4, for adults and teens, and increasing the age-of-onset criteria from 7 to 12.

Russell Barkley, Ph.D., and Joseph Biederman, M.D., have written about abandoning or generously broadening age-of-onset criteria, arguing that the current, precise age-of-onset criteria poses “unwarranted practical problems for the study of older adolescents and adults.” These two men are considered ADHD experts and contributed to the American Academy of Child and Adolescent Psychiatry (AACAP) Practice Parameters for ADHD, which serve as guidelines by which most child psychiatrists practice.

According to a story from the New York Times, Joseph Biederman did not tell university officials about more than a million dollars received from drugmakers from 2000 to 2007, and he promised Johnson & Johnson research results that would benefit the drug company. On the list of AACAP Conflicts of Interests for Practice Parameters not listed in the Practice Parameters, Russell Barkley receives or has received research support, acted as a consultant and/or served on a speaker’s bureau for Eli Lilly and Company and Shire Pharmaceuticals Group.

Shire Pharmaceuticals Group has a substantial focus on ADHD meds, and they have been pulling out all the stops to try and turn a profit in the face of competition from generic drugs.

Earlier this month, Reuter’s Health described how drugmakers, including Shire, have raised prices to make up for lack of new products and loss of patent protection.

“Prices were just shoved up every year to make more money and meet earnings, to be blunt,” Shire (SHP.L) Chief Executive Angus Russell said.

Shire’s CEO also indicated that the FDA is supporting their plan to study the use of their ADHD drug, Vyvanse, for use in depression and schizophrenia, hoping for billions of dollars in extra sales through expansion of potential indications. Amphetamines for schizophrenia? Hmmmm…..

Jim Edwards of BNET wrote about Shire increasing the price of one of their own ADHD drugs, Adderall XR, to encourage users to switch to their branded, cheaper and newer ADHD drug, Vyvanse, leading to increased sales.

Shire somehow sold more ADHD drugs during a recent, national shortage of ADHD medications – their sales of Adderall XR increased 21 percent in the first quarter of 2011 – a time when many of the patients in San Francisco’s public mental health system were unable to receive their regular ADHD medications.

BNET posted excerpts of separate lawsuits filed by Impax and Teva, manufacturers of generic forms of Adderall XR. They claim that Shire did not honor their contracts and hoarded product for themselves during this recent shortage. In the Wall Street Journal, the associate director of FDA’s drug shortages program reported that this national ADHD drug shortage mostly affected generic forms of ADHD meds. Coincidence?

Other ways of getting around stagnant drug development and generic competition include taking an old drug or active ingredient, and changing the delivery system or duration of action and presenting it as a new, patent-protected product. Here are a few examples that have been associated with Shire:

- Vyvanse: Also known as lisdexamfetamine, Vyvanse is a prodrug of dextroamphetamine. Dextroamphetamine has been used since 1937 to treat hyperactivity in children, so it is hardly new. Vyvanse was marketed as having lower abuse potential – specifically, preventing abuse from snorting, since the prodrug requires digestion to release the active form. In my clinical experience, most abuse of stimulants is due to people taking it without a prescription or shaping their symptoms to get a prescription, and a prodrug likely does little to curb college students from seeking stimulants to study for exams.

- Daytrana: The transdermal methylphenidate (methylphenidate is the active ingredient in Ritalin) patch is worn on the skin and was developed as a way of bypassing the digestive tract, and my experience prescribing this drug was met with equivocal reports from patients and families. I guess there is a reason I can’t remember anyone saying it worked – Shire gave up on the ADHD patch after 9 product recalls and a federal probe.

- Intuniv: An extended release form of guanfacine, Intuniv is touted as a new, non-stimulant treatment for ADHD. But child psychiatrists have been using guanfacine in ADHD for years, and this ‘extended-release’ form has a half-life of about 18 hours, while generic guanfacine has a half-life of about 17 hours – not a robust difference, in my opinion.

I liken these approaches to gimmicks utilized in the mass-produced, beer market: color changing labels to let you know if your beer is cold, wide-mouth beer cans, or vortex bottles. Do any of these ‘innovations’ really change the fact that you’re drinking cheap beer?

As the DSM-V looms closer to becoming a reality, I can’t help but think of words from the man who chaired the committee for the DSM-IV. Allen Frances, M.D., wrote in the in the LA Times:

As chairman of the task force that created the current Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), which came out in 1994, I learned from painful experience how small changes in the definition of mental disorders can create huge, unintended consequences.

Our panel tried hard to be conservative and careful but inadvertently contributed to three false ‘epidemics’ – attention deficit disorder, autism and childhood bipolar disorder. Clearly, our net was cast too wide and captured many ‘patients’ who might have been far better off never entering the mental health system.

The DSM-IV was and the DSM-V will be published by the APA. The same APA that, in 2010, rejected internal recommendations – led by an APA past-president – to regulate or curtail individual psychiatrists’ relationships with the pharmaceutical industry.

Loosening the diagnostic criteria for ADHD, as proposed, will no doubt lead to more people being diagnosed and, inevitably, taking more ADHD drugs. I like to think that the APA and their doctors pushing for the changes are motivated by helping patients and not drug company profits.

After all, if anyone can identify and address unconscious conflicts or psychologically-defended, aggressive drives, it’s a psychiatrist, right?

Read article here:  http://www.sfgate.com/cgi-bin/blogs/wchung/detail?entry_id=89494

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The Small Group of Thoughtful, Committed Citizens Has Been Drugged

Tuesday, May 24th, 2011

OpEdNews
By David Swanson
May 23, 2011

Movements for justice have historically been driven by a small percentage of any population. One percent of Americans nonviolently occupying Washington, D.C., could make Cairo and Madison and Madrid look like warm-up acts. It is certainly true that a small group of thoughtful, committed citizens is the only thing that ever has changed the world for the better.

So, what happens if a society picks out a significant slice of its population, one including many thoughtful and committed citizens, and drugs them?

The Drug Enforcement Administration (DEA) held a first-time, one-day, little publicized event last September that allowed people to turn in their extra prescription drugs. The DEA reports collecting 242,000 pounds or 121 tons. A second such day was held in April with 376,593 pounds or 188 tons of pills collected. This is the stuff nobody wants and is willing to hand in to the government. This is not the amount that’s out in circulation. That amount is no doubt in proportion to the roaring flood of television ads for the stuff. “More Americans currently abuse prescription drugs,” says the DEA, “than the number of those using cocaine, hallucinogens, and heroin combined. . . . [I]ndividuals that abuse prescription drugs often obtained them from family and friends, including from the home medicine cabinet.” And that’s just the users said to be abusing.

Ted Rall suggested drugging to me as a possible explanation for the big mystery staring us in the face, namely why Americans sit back and take so much more than other people from their government. The Patriot Act is being put on steroids with hardly a peep of protest. The “Defense Authorization Act” now before Congress would give presidents virtually limitless power to single-handedly make wars or imprison people. This is the biggest formal transfer of power in the U.S. government since the drafting of its Constitution. This undoes the American War for Independence. But perhaps we’d still be 13 colonies if Prozac and Zoloft had come along sooner.

“Like many people,” says Rall, “I have often wondered why so many Americans seem so emotionally flat and politically apathetic in response to a political and economic landscape that cries out for protest, or at least complaint. Could it be that our society’s most angry — justifiably angry — are being medicated into quiescence?” It does seem possible. I don’t mean to discount the fact that the United States imprisons record numbers of people. I’m willing to share some blame with our education system, our so-called news media, our religiosity, the two-party trap, and several other likely factors. But drugs looks like the big one that is nonetheless hardest to see. People don’t usually tell you they’re drugged, but chances are at least one in 10 people you meet is.

Two years ago, a study found that “the number of Americans taking antidepressants doubled to 10.1 percent of the population in 2005 compared with 1996, increasing across income and age groups.” One year earlier, another study had found that close to 10 percent of men and women in America were taking drugs to combat depression, and that 11 percent of women were taking antidepressants.”

Author and clinical psychologist Bruce Levine tells me this may be even worse than it sounds. “If you are around certain populations,” Levine says, “that 10 percent stat seems very low, especially among healthcare professionals and college students.” College students? I can remember them getting pretty thoughtful and committed in times past. “And that 10 percent,” Levine adds, “only includes the ‘official antidepressants’ such as Prozac, Paxil, Zoloft, Lexapro, Wellbutrin, Effexor, etc. This stat doesn’t include people using ADHD drugs such as Ritalin, Adderall, etc. to stimulate themselves.”

Adderall, Levine explained, is an amphetamine that affects the same neurotransmitters as cocaine (dopamine, serotonin, and norepinephrine), “and if one takes the antidepressant Effexor (affects serotonin and norepinephrine) at the same time one is taking the antidepressant Wellbutrin (affects dopamine), one can sense the hypocrisy in labeling certain psychotropics (drugs that affects neurotransmitters) as ‘antidepressants’ and other psychotropics as ‘ADHD psychostimulants.’ Lots of people — especially young people — are popping ‘Addies’ (street name for Adderall) to ‘motivate’ them to get them through their lives, especially during exam time.”

Levine said he’s counseling a young man who is supplementing his income by selling ADHD psychostimulant drugs to his fellow college students. He gets the best price around final exam time. “He told me, ‘Bruce, you’ve got to do better improving the self-esteem of these young kids who you are counseling.’ Why, I ask him, why do you care? ‘Well,’ he says, ‘these little brats who are getting their freebie prescription Addies feel so crappie about themselves that they are giving away their Addies to their older brothers for free just so they will hang out with them, and all those freebie Addies on the market are driving price down for me.”

Levine stresses that Adderall, like nicotine or caffeine or cocaine, provides a buzz that antidepressants do not. In fact, he points out, the so-called antidepressant drugs make people twice as likely to commit suicide. Levine concedes that some people swear antidepressants have saved their lives, but points out that people will say that about a placebo as well. The evidence, Levine says, shows antidepressants working no better than a placebo at lifting people out of depression.

Antidepressants may bear as Orwellian a name as the Patriot Act, but Levine finds the latter easier to talk about with people. “I get less grief,” Levine tells me, “when I talk about something like anarchism and Emma Goldman than when I talk about antidepressants’ effectiveness and [author] Irving Kirsch, as abstract political ideologies are far less threatening than people’s very own drugs.” Political movements may in fact be less threatening to those in power, because of people’s drugs.

Read article here:  http://www.opednews.com/articles/The-Small-Group-of-Thought-by-David-Swanson-110523-181.html

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Mother battles Michigan over daughter’s medication

Monday, May 23rd, 2011

Centre Daily Times
By Corey Williams
May 22, 2011

This May 12, 2011 photo shows Maryanne Godboldo in Detroit. Godboldo is locked in a battle with Michigan's Department of Human Services over her right to determine whether her physically impaired daughter should continue taking the anti-psychotic drug Risperdal, since she claims the girl has responded better to holistic treatment. AP Photo

DETROIT — Frustration over her physically impaired daughter’s medical care led Maryanne Godboldo to lash out at what she considered state interference and into a 12-hour standoff when Detroit police came to take the girl away.

When it ended, the unemployed mother was in handcuffs; her daughter placed in a psychiatric hospital for children.

Godboldo now is locked in a bitter battle with Michigan’s Department of Human Services over her right to determine whether the girl should continue taking the anti-psychotic drug Risperdal and the government’s responsibility to look after the child’s welfare.

Godboldo doesn’t trust doctors much – she blames some of the girl’s past medical problems on possible physician negligence and complications from childhood immunizations, but did not name the doctors or release her daughter’s medical records to The Associated Press. She claims the girl has responded better to holistic treatment that does not include Risperdal.

But the state is not budging on its assertion that without the proper medication, Ariana is at risk.

“Our mandate is to go into court and prove there is medical neglect,” said Human Services Director Maura Corrigan, who declined to speak directly about Godboldo’s case due to the ongoing court proceedings.

“Is there harm to the child? That’s what we are trying to assess,” Corrigan told the AP in a recent interview.

A defiant Godboldo still believes she was right to defy police, despite five days in jail and criminal charges, including discharge of a firearm, three counts of assault with a dangerous weapon and resisting officers.

“I was in my home. Why should I come out? They were invading my home,” Godboldo said.

Citing the charges, Godboldo declined to say if she fired a gun when police arrived at her home March 24. But officers said a gun and about 43 rounds of live ammunition were in the house, and a spent shell casing was found after the standoff, according to court records. Ariana also was in the house.

“I would always be concerned with a parent who has a gun and is using it when a child is present because accidents happen,” said Oakland County Probate Court Judge Linda Hallmark, who isn’t connected to the case but handles child custody issues. “If a parent feels the child is going to be removed and there isn’t a basis for it, there are legal avenues that the parent needs to follow.”

Ariana already had her share of medical troubles when Godboldo started giving her Risperdal more than a year ago at a doctor’s suggestion. She had lost her right leg below the knee as an infant and wears a prosthesis. Godboldo claims she also developed encephalitis, or inflammation of the brain, before entering 6th grade.

She said her daughter complained often of being dizzy and had a hoarse voice, became more clingy and fearful, and avoided playing outside.

“It happened slowly at first, but it was enough to know when your child makes a change,” Godboldo said.

She sought help at a Detroit area center. Staff there put Ariana on a treatment plan that included Risperdal, said Allison Folmar, one of Godboldo’s attorneys.

Child Protective Services in its petition wrote that Ariana was diagnosed with “psychosis NOS,” or “not otherwise specified,” Folmar said.

“They are saying ‘it’s something going on in her head, but we don’t know what it is,’” the attorney added.

But Godboldo balked at a suggestion that her daughter be placed in a mental hospital. She took the girl’s treatment to another center. She also decided to wean her from Risperdal, which sometimes is used to treat schizophrenia.

“Ariana has some issues. She requires one-on-one attention,” said Folmar, describing how the girl at times appears unresponsive. But “she writes. She reads.”

Risperdal often is used to contain behaviors like aggression and even treat autism, said Derek H. Suite, a board certified psychiatrist and president and chief executive of Full Circle Health in the Bronx, N.Y. Risperdal use has shown dramatic reductions in psychotic symptoms, but there can be side-effects, he added.

“Sometimes kids can have neurological problems … muscular tics,” Suite said. “These drugs can slow you down.”

After Godboldo’s confrontation with police, Ariana spent about a month in a children’s psychiatric facility. She now is living with Godboldo’s sister, Penny. A judge has ordered that other adult relatives be present when Godboldo visits with her daughter.

But “to this day, there is not one court order saying give her the medication,” Folmar said. “No one has recommended giving the child the medication.”

It’s not unusual for parents and the state to be at odds over what’s best.

Two Idaho parents lost a civil lawsuit last year when a judge ruled their rights were not violated by an officer who took custody of their infant daughter so a doctor could check for signs of meningitis. Dale and Leilani Neumann of Wisconsin were convicted of reckless homicide following the 2008 death of their 11-year-old daughter, whose undiagnosed diabetes was treated with prayer instead of conventional medicine.

Godboldo said the state was not involved in the care of her daughter until she pursued a more holistic treatment. When asked by the AP what that entailed, she replied: “God’s medication.”

After Godboldo refused to attend a meeting with Child Protective Services, officers arrived at her home to remove Ariana. Godboldo claimed they never showed her a court order.

Detroit police declined to comment about the case “because of the litigation involved,” Sgt. Eren Stephens said in an email.

When Godboldo refused to allow police in, the officers tried to force their way through a side door but backed off after hearing a gun shot, court documents said.

“Maryann did not shoot at police and she did not fire a gun with any intention of scaring the police,” Folmar said. “But even if she did fire a so-called warning shot, right now the question is of self-defense.”

Read article here:  http://www.centredaily.com/2011/05/22/2728095/mother-battles-michigan-over-daughters.html

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Ending a Midlife Affair with Meds by Paulina Porizkova

Monday, May 23rd, 2011

“My affair with an antidepressant reinforced what I already knew: I’m not one for affairs. I’d rather fight tooth and nail to keep and restore what I have than take a break from it. But that is so much easier said than done with a Klonopin in my pocket.”

Huffington Post   May 18 2011

by Paulia Porizkova – Supermodel


I felt guilty. I felt unnatural. I felt ashamed. Finally, I broke down and confessed my dirty little secret to a girlfriend and found that she not only knew what I was talking about, but she was doing it, too. And the more I opened up about it, the more I found that I was not alone. Women in their late 30s and 40s were all having the same affair.

With an antidepressant.

I started taking Lexapro after my anxiety attacks came back and, for all intents and purposes, practically crippled me. I’ve always had anxiety attacks, or panic attacks as some know them, but after years of learning how to deal with them, I thought I had them under control. While my kids were little, the anxiety attacks even subsided to the point where they hardly bothered me. But at the stroke of 40, they came back worse than ever.

I couldn’t get in a car, a bus and certainly not an elevator without panic overwhelming me: a crippling, terrifying sense of dread. I couldn’t draw a proper breath, my heart pounded and heat flashed through my body, making me break out in sweat. To top it off, my PMS symptoms of frustration, depression and irritability stretched two to three weeks instead of the typical one.

My doctor, fully aware of my dislike for medication of any kind (please, I had two kids all natural, I could take some pain!) suggested that I deserved a break from anxiety. Rebooting the system, he called it. He also fully supported the idea that I begin talk therapy, but in the meantime, he offered me the following analogy: you can build a house with your hands, or you could use power-tools. Either way, you’re building a house, right?

I had just gotten kicked off of “Dancing with the Stars” (as the first contestant) and my ego traveled back to ninth grade, when I was the least popular kid in school and just couldn’t figure out what I had done wrong to be so disliked. But I had to get over myself, quick. I had children who needed me. I had a husband who needed me. I also had my novel (that took me five years to write) to finally promote. This was no time to sink under!

I knew that unless I did something drastic (far more drastic than my new and intense exercise routine and healthy diet-plus-vitamins, but less drastic then running away from home and my life, screaming, blinded by tears and rain, down, say, Fifth Ave), I would at the very least alienate all my friends, my children and my husband.

Lexapro it was.

At first, the stuff didn’t seem to work. It wasn’t until a few months into treatment that I realized what had happened. My world had quieted. The constant buzz of anxiety became noticeable only by its absence. It was like spending your entire life in a room buzzing with fluorescents, and then, one day, they stop. I wasn’t even quite sure what to do with this silence, how to live in it.

When I had to have a physical for insurance on “America’s Next Top Model,” I truthfully wrote down the only medication I took, Lexapro. Writing was admitting it, and I did so with a fair bit of trepidation. Unfortunately, this was promptly broadcast all over the “ANTM” production set. It seems I couldn’t be properly insured on a TV set if I was taking an antidepressant. I had just started taking it, and this reaction was exactly what I had feared. I was judged crazy. Unstable. It was almost enough to get me to stop it before it had even had a chance to work. Fortunately, the woman in charge of all this paperwork laughed and admitted that she was also taking said medication — weren’t we all? The production could just write a waiver taking their chances with crazy ol’ me. And they did.

As I got braver and dared to speak more openly about what I perceived as a terrible weakness, my girlfriends, one by one, stepped up and admitted that they were also on antidepressants. At one point, I found myself at a girls-night-out dinner and discovered all eight of us were on assorted antidepressants! One girlfriend took it because she was depressed. One took it because she got too angry. One also suffered from anxiety attacks. The reasons were diverse, but what we had in common were our age ranges and being married with children.

This shocked me. It also got me wondering. What was going on here? Was this a sort of universal malaise that hit peri-menopausal women? Without antidepressants, would we all be quietly suffering, or exercising like maniacs, having sexual affairs, turning to alcohol or drugs? Was this the female equivalent of a male midlife crisis — Botox and antidepressants instead of the fast car and young chick?

I spent two years with my lover Lexapro; the two most mellow years of my life. My immediate frustrations were comforted, my resentments muffled, my anxiety calmed; I was wrapped in a thick, warm comforter, insulated against the sharp pangs that came with living.

But I was also insulated against or from fun things like my creativity and sexuality. I used to joke to my friends that after 24 years with my husband, we were, sexually speaking, a finely tuned precision engine. But now it felt as though I was being touched through a barrier, or, in this instance, a thick and cumbersome rug. After a while, it seemed like being intimate was just too much work for too little pay.

And as for creativity, well, with my new sense of peace, I found I had no need to actually say anything. This, for a writer, is akin to a cook who has no appetite. Sure, it’s possible to work, but the results will be uninspired at best. I no longer bothered to fight with my girlfriends, or husband; I could just shrug and walk away from situations that previously had me in endless knots analyzing and discussing. And so, for two years, I learned nothing new. I felt emotionally Botoxed. Who was I under the blankets? What did I really feel like? I began to wonder and to want me back, even at the steep price of misery.

I decided that this affair had all the drawbacks of an affair: the sexual distancing from my husband, the guilt, the lies; and the benefit — silence from the fluorescents — didn’t seem worth the price.

The weaning was predictably unpleasant, three weeks of being tired and shaky from wrangling with awful dreams. And then anxiety came creeping back: the clamminess, the suddenly speeding heart, the heat flashes, the disorientation. But this time, I also became aware of something I may have previously neglected under the loud hum of anxiety, or failed to identify, or perhaps simply didn’t have: depression. It could have been circumstantial: after all, with my career at crossroads, my children no longer needing me every minute and my face and body beginning to cave under the demands of gravity, I had something to be a little down about.

I upped my exercise routine to every day. I could finally understand the drug addicts who had cleaned up but wrestled with the urge to use every day. With the drug, I didn’t feel like me, but without it, I also didn’t feel like me — at least not the me I remembered, the one I wanted to be. My kids got to know a whole other side of mommy: an irrational, frustrated, weepy woman who had previously been tightly leashed and only let out when I was alone. I felt sorry for myself and then terribly guilty because I had absolutely no right to feel sorry for myself. The world seemed to be too heavy to carry by myself, but I could not ask for help, because I had never needed help before and didn’t know how to ask. There were moments of sunshine, though. And I could feel its warmth and take pleasure in it rather than just noticing it.

The years since have been categorized by a fair deal of misery and soul-searching — but also learning. I am on some sort of an accelerated life comprehension program I didn’t sign up for, but nevertheless must process. This got me thinking: could it be possible that these feelings are growing pains? Perhaps they are necessary to cross to the other side where peace and confidence of age will finally triumph. After all, it’s not only teenagers who have to adjust to changing hormones, and most of us can still remember the misery.

And I’m starting to wonder whether antidepressants can often be the emotional equivalent of plastic surgery. With them, we can stave off the anguish of change; we can take breaks from the afflictions of living. But is it also possible that through the serendipitous use of these brand new staver-’off’ers, we will ultimately pay a price: the price of going through life anesthetized and smooth with all the self-awareness of a slug?

I will never cease to be grateful to live in a time where knowledge has made it possible for people to no longer suffer. But would that knowledge exist without a little suffering? I’m certainly not an anti-medicine crusader — in most cases modern medicine saves lives. There must be a large percentage of people for whom an antidepressant makes the difference between life and death, or at the very least, the difference between a life worth living and a life to be endured.

But I also think that those who try to take the shortcuts — the pill to lose weight, the pill to be happy, the pill to be smart, to sleep, to be awake, are just running up their tab. And there may not be a pill when you’re presented with the bill. Which you will. (Sorry for the trite rhyming, I couldn’t resist.)

My affair with an antidepressant reinforced what I already knew: I’m not one for affairs. I’d rather fight tooth and nail to keep and restore what I have than take a break from it. But that is so much easier said than done with a Klonopin in my pocket.

http://www.huffingtonpost.com/paulina-porizkova/ending-a-midlife-affair-with-meds_b_862442.html

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The Problem With Rehab: Medicalizing Drug Addiction

Sunday, May 22nd, 2011

ABC News

by STEFAN P. KRUSZEWSKI, M.D.

"clients are continuing to rely heavily on pills to combat their anxieties, mood changes and addiction. "

In my specialty as an addiction  psychiatrist, I have often advocated for residential treatment when unremitting drug and alcohol problems persist because other, less intensive, services have failed. That may soon change.

Over the past two years, I’ve witnessed a worrisome trend: the medicalization of addictions. Some of this makes no sense to me. Let me explain.

There have always been drug treatments for acute detoxification of drug and alcohol problems. The drugs have changed over the years, but the concept of providing a brief period of drug stabilization to prevent seizures or delirium or to mitigate psychosis has gone one unabated.

For instance, barbiturates were once used to minimize alcoholic delirium, but the barbiturates were replaced by benzodiazepines and, although still commonly in use, the benzodiazepines have been more recently supplanted or co-administered with anti-seizure drugs, like valproex or gabapentin. The endpoint has largely been the same: we will stabilize the patient over an acute period of rapidly changing health conditions (sweating, diarrhea, pulse, blood pressure, temperature, pain) and, once the detoxification has been successfully completed and the patient is comfortable and alert, we will begin a process of education and behavioral health techniques to foster a hoped-for drug free recovery state.

That is changing, however, in certain facilities in ways that I believe are destructive and counter-productive.

Two cases serve as illustration: I’m asked to review the medical necessity and reimbursement for care provided in a high profile and nationally-acclaimed drug rehab. The case is of a 20-year-old male from the northeastern United States who is addicted to a drug, methadone (an opioid agonist replacement medicine) and alprazolam, a benzodiazepine anti-anxiety drug. He enters treatment and spends 29 days in rehab, where he is provided buprenorphine (a partial opioid agonist replacement drug for opioid dependence) in decremented detox and maintenance for the duration of his stay and clonazepam (used as a substitute for his alprazelom addiction). He is discharged with the recommendation and prescription to return home and continue methadone and clonazepam.

That’s worth repeating. The patient is discharged to continue the same addictive drug for which he was admitted and a longer-acting (and still habit-forming) benzodiazepine drug to replace his other anti-anxiety medication. And with a price-tag of nearly $40,000.

Separately, I’m asked to review, for medically necessity and reimbursement purposes, the care of a 53-year-old woman. Like the young man in the above synopsis, she enters a world-class drug rehab in Florida, but this time for alcoholism. At the time of admission, she is also taking an SSRI antidepressant and a benzodiazepine anti-anxiety drug.

She spends 27 days in the facility. At various times during her admission, not unlike many individuals being weaned off alcohol, she complains of mood fluctuations, anxiety, sleeplessness and body aches. At the time of discharge, she has been taking — and she is recommended to continue to take — seven drugs: citalopram, an SSRI antidepressant; bupropion, an SNRI antidepressant; a small dose of an antipsychotic, aripiprazole, to augment the antidepressant effects of her two different antidepressants; a small dose of thyroid supplement, thyroxine, to do the same; gabapentin, an antiseizure medicine and clonazepam, both prescribed to decrease her anxiety; and carisoprodol, a centrally-acting anti-muscle spasm drug to minimize her musculoskeletal discomfort.

Capsulizing the above: A woman with alcohol dependence on one drug for depression is treated in rehab for almost a month (at a cost of a little more than $45,000) and is discharged on seven drugs, including not one, but two (clonazepam and carisoprodol) with significant habit-forming and addiction-enhancing characteristics.

Message to substance providers: We have a problem. Although addiction experts may justify these “treatments” because education and solace is provided to the patients, I believe that this mocks the purpose of (the very important and necessary) addiction treatment. There is little, if any, harm reduction, because the clients are prescribed the same or other addictive compounds during and after rehab. The clients are also prescribed new drugs, particular in the latter case of the alcoholic woman, whose potential for drug-drug interactions and future adverse events cannot be accurately predicted.

The clients are receiving expensive inpatient care for services and treatment that could easily be managed in cheaper and less-acute-care outpatient settings, like intensive outpatient or partial hospital programs. And, most importantly, the clients are continuing to rely heavily on pills to combat their anxieties, mood changes and addiction.

Problem? Relying on pills got them to rehab in the first place. So what’s the point of attending and paying for — or charging a commercial insurance carrier, Medicare or Medicaid, or any other third-party payer — for an expensive retreat that leaves you in virtually the same mental place, or worse, than you started? Not that much.

Dr. Stefan Kruszewski is an addiction psychiatrist and CEO of Kruszewski & Associates, a Harrisburg, Pa., company that focuses on health care and financial fraud.

http://abcnews.go.com/ad/gmaintroad.html?goback=http://abcnews.go.com/Health/MindMoodNews/addiction-treatment-medicalization-wrong-approach/story?id=13642451

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Is ADHD a Fictional Disease?

Saturday, May 21st, 2011

Some psychiatrists argue that ADHD is little more than a marketing gimmick

The Mark
By Fred Baughman
May 18, 2011

Dr. Fred Baughman, Child neurologist; opponent of ADHD diagnosis

Some 5.4 million children in the United States have been diagnosed with attention-deficit hyperactivity disorder, or ADHD, with two-thirds of them taking psychiatric drugs. Sales of ADHD drugs reached $1.2 billion in 2010, a demand level so high that the U.S. is experiencing an ADHD drug shortage. But an increasingly vocal contingent of psychiatric experts is speaking up against diagnosing children with ADHD, arguing it is a non-existent condition drummed up by pharmaceutical companies to increase sales.

What makes you convinced that ADHD is not a real disease?

During my time in practice, I’ve authored papers and discovered real diseases and so on. Psychiatry in 1948 was distinguished from neurology. Neurology is the specialty dealing with physical and organic diseases of the brain and nervous system. Psychiatry is the specialty dealing with emotional and behavioural things which are not actual, physical diseases – things like depression, anxiety, panic, and so on.

Insofar as ADHD is concerned, it seems clear that in the ’50s, as the first psychiatric drugs came to market, that psychiatry – in cahoots with the pharmaceutical industry – came upon the market strategy of, “Well, we’ll call these things ‘diseases.’” And the prototypical invented disease was called ADHD.

It was initially in a 1970 congressional hearing in the U.S. that psychiatrists appeared and testified that, what was then called hyper kinetic disorder or minimal brain dysfunction, was a disease that needed diagnosing by a physician, and as a disease it justified the use of drugs to treat it. So that was the official beginning of ADHD in particular and of psychiatric diagnoses in general as being due to a disease of the brain. In every case, they say there’s a subtle chemical imbalance in the brain, which of course they never have a means of diagnosing in life and have never in scientific literature authored proof that there is in fact a disease. And yet they are allowed by [the U.S.] Food and Drug Administration to say that there is a chemical imbalance and that the drugs balance the imbalance.

So it’s been a market strategy. This lie has been allowed to be published by the drug industry and by psychiatry, by our regulatory agencies, specifically the Food and Drug Administration. So that’s where we are today.

All physicians learn in medical school that a disease is a physical abnormality. When you go to your physician, they may see a rash or they may find something microscopically abnormal, such as cancer cells. Then there are a lot of chemical diseases – diabetes being the best known. There are about a hundred examples of inborn errors of metabolism or body chemistry. These can all be tested for, they’ve all been proven, and they exist in the scientific literature – whereas there is not a single psychiatric diagnosis that exists in scientific literature of the world.

In 2008, I was counselling a young father from Kingston, Ont., who was in a divorce situation, and the mother insisted the children be seen by psychiatrists and the psychiatrist had made a number of diagnoses and had this one boy on large amounts of about five or six different types of medication. I helped the father author a letter to Health Canada asking where – in the case of ADHD or any psychiatric diagnosis – there is proof of a gross or microscopic abnormality.

This gentleman got a letter back from the director-general of Health Canada saying there is no gross, microscopic, or chemical abnormality in any psychiatric diagnosis; there is no objective way of verifying a psychiatric diagnosis as a disease.

That’s why psychiatry’s claims that their diagnoses are chemical imbalances is nothing but a lie and a deception. And yet, because of their financial might on the world scene, no one will challenge them. They have friends bought and paid for in government and in all of the governmental health-care agencies.

Here in the States, as of 2007, the Centers for Disease Control announced that 5.4 million U.S. schoolchildren five to 17 years old had ADHD. And you can be sure that they have all been on ADHD drugs, which are, for the most part, amphetamines, which are known to be addictive, dangerous, deadly.

I’ve heard estimates of 20 per cent of schoolchildren in the U.S. with a psych diagnosis and who were on psych drugs. It’s exploding, it’s increasing all the time.

Is the issue that we’re overmedicating ourselves, or that ADHD is not real?

When it’s a total fraud, you don’t call it overmedicating. There is no such thing as ADHD as a disease, so there is never justification for it. It’s a total fraud.

What is there to gain from diagnosing children with ADHD?

Ritalin has passed $1 billion a year in sales. Ritalin is no longer the top ADHD drug in the U.S. I think Adderall, which is made up of amphetamines, passed Ritalin a few years ago in market share.

It’s a complete fraud, they’ve invented diseases for which their drugs are a cure. The rate of diagnosing ADHD has been going up by a million a year in the U.S. This is a market strategy.

The book Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All Into Patients [by Ray Moynihan and Alan Cassels] talks generally about inventing diseases for which to sell drugs. In the foreword of that book, the authors quote the former president of Merck Pharmaceutical Co., Henry Gadsden, who once said he was anxious to find ways to market his products to normal people, just like the Wrigley chewing gum people did. This was kind of an after-the-fact confession they were trying to market drugs to normal people, and calling all psychological dilemmas diseases for which they needed a pill. This was the strategy.

It’s almost unimaginable, it’s almost unthinkable that this has been going on, but that’s exactly what’s been going on.

How would you diagnose a child that was considered to have ADHD?

Look at the criteria that are used to call a child ADHD. They talk out of turn, they don’t sit still, they wiggle around too much in their seats, they are impulsive, disorderly, and so on. It’s a bunch of behaviours that are seen in just about every child at some stage of their life. This is by design; they have taken kind of irritating, bothersome, disruptive behaviours in children and have kind of cobbled them together and called it a disease.

They get a lot of parents to buy it because a lot of parents are now busy with their job in the workforce and there’s no longer a full-time parent in the home, and so, “Here’s why Johnny or Janey is such an irritant to me, they’ve got ADHD.” It takes the pressure entirely off the parent for not being a presence and for not being there full-time to mould the behaviour of the child, and they’re calling these behaviours a disease and saying we’ve got a pill for it. That’s very seductive. That’s a far more appealing analysis than, “Gee, you’re divorced, there’s no one in the home to discipline the child real time,” and so on.

These are not diseases, they are behaviours. Today, you hang a psychiatric label on a child, you surely stigmatize the child and these drugs are exceedingly dangerous. In 2005, there were several deaths in Canada of young children from Adderall. It was temporarily taken off the market, but then the power of the industry won out and Adderall’s back on the market. Pure amphetamines.

Read article here:  http://www.themarknews.com/articles/5193-is-adhd-a-fictional-disease?page=1

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Crap Psychologist May Lose Job Over Racist Article

Friday, May 20th, 2011

Jezebel
By Anna North
May 20, 2011

Psychologist Satoshi Kanazawa

Evolutionary psychologist Satoshi Kanazawa stooped to new levels of awfulness in his post claiming “black women are significantly less physically attractive than women of other races.” His racist remarks could cost him his job at the London School of Economics.

According to the Guardian, many LSE students lodged complaints after Kanazawa’s offensive post made the rounds. Said Sherelle Davids of the LSE students’ union, “Kanazawa deliberately manipulates findings that justify racist ideology. As a black woman I feel his conclusions are a direct attack on black women everywhere who are not included in social ideas of beauty.” And Amena Amer, the union’s incoming education officer, said,

We support free speech and academic freedom, but Kanazawa’s research fuels hate against ethnic and religious minorities promoted by neo-Nazi groups. Not only does he use the LSE’s credentials to legitimise his ‘research’ but this jeopardises the academic credibility of the LSE.

The union has voted unanimously that Kanazawa should be fired. Now the school has launched an internal investigation that will evaluate his claims and decide whether to punish him. They’ve already issued a public statement saying he doesn’t speak for the LSE: “The views expressed by this academic are his own and do not in any way represent those of the LSE as an institution.”

Amer is correct that Kanazawa’s comments are an embarrassment to her school. Even if his views are his own, as long as they continue to employ him, they’re implicitly vouching for his merit as a scholar. And unless they’re prepared to say that his bar graphs about black women’s supposed ugliness are actually good science, it’s time for them to let him go.

Read article here:  http://jezebel.com/5803889/crap-psychologist-may-lose-job-over-racist-article

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The Death of Mental Illness

Wednesday, May 18th, 2011

PsychCentral
By Will Meecham, MD, MA
May 18, 2011

In writing this post, I may be crashing the American Psychological Association’s annual blog party. Naturally, I’m in favor of joining others to increase awareness and reduce stigma around psychiatric problems. But despite the spirit of solidarity, I’m perhaps an outsider, because I no longer believe ‘mental illness’ serves as a helpful concept.

In this era of burgeoning diagnoses, it’s a bit awkward to declare our great emperor, the Diagnostic and Statistical Manual of Mental Disorders (DSM), naked and unfleshed. Especially at a party.

Let me be clear: people sometimes behave in ways that look incomprehensible or even insane. Suicidal behavior, profoundly delusional speech, and irresistible compulsions represent severe behavioral problems for individuals and society. No doubt they stem from cognitive activity and emotional tones that differ from average day-to-day awareness. These sorts of disordered conduct do indeed derive from ‘mental’ processes, but do they qualify as ‘illnesses?’

It seems to me that to define something as a disease implies that we can also recognize its absence. But this isn’t always easy with mental conditions. Take the example of suicide. Frank attempts on one’s own life lie at the extreme end of a spectrum of self-destructive thoughts and actions. Some of these get labeled as mental illness, and some don’t, but the distinction is rather arbitrary.

I suspect a majority of the population would have to admit to moments of wondering if life is worth the effort, and to brief thoughts of ending it. We aren’t mentally ill just because we have moments of doubt. How frequently or how seriously does a person have to question life’s value in order to be deemed sick? Or consider that a man with advanced emphysema who continues to smoke kills himself just as surely as a woman who takes an overdose of pills. But our culture doesn’t define the dying smoker’s senseless behavior as mental illness. What’s the difference? Does the fact that a man doesn’t admit to wanting to end his life relieve him of responsibility for doing so? The honestly suicidal woman is arguably more rational and clear than the smoker clouded in denial who works toward the same end.

Or consider delusions. If a man believes the CIA has implanted thought control devices in his brain, everyone agrees he is out of touch with reality; we call this paranoid schizophrenia. But if a political leader proclaims that environmental exploitation isn’t a problem, even as the ecosystem destabilizes, no one considers her delusion a sign of mental illness. Director Tom Shadyac’s delightful documentary, I Am, makes a similar point about how many of the values our culture promotes are actually insane.

What about obsessions? Someone who won’t leave the house without checking the doors and windows two dozen times earns a diagnosis of OCD. But a billionaire obsessed with accumulating ever more money gets worshiped like a modern deity.

Furthermore, psychiatrists dismiss highly positive spiritual experiences as delusional and hallucinatory simply because such states hint at phenomena that aren’t endorsed by materialist science. When for a time I entered what seemed like profoundly awakened consciousness back in 2000, I wasn’t congratulated. The psychiatrists labelled my experience a ‘manic psychosis’ and started me on Haldol. I was too trusting to doubt them at the time, but now I wish they’d referred me to a spiritual leader rather than the psychiatric ward.

Obviously, people spiral into all kinds of behavioral crises and need help. Sometimes they recognize their need for assistance, and sometimes not. But whether a particular maladaptive conduct gets labelled as mental illness or not has to do with cultural values, not medical science. If there weren’t so much stigma, and so much risk of over-medication, it wouldn’t matter. But a life may be derailed for years (or forever) after the hammer of a major psychiatric diagnosis shatters a person’s reputation and self-image.

Tradition tells us that the seventh century Korean Zen Buddhist Wonhyo achieved enlightenment when following an exhausting journey without water he collapsed at night in a deep cavern. He found an ivory bowl while groping in the dark, and relished the sweet water it contained with a rush of relief. But when he arose the next morning he realized he had reclined in a tomb. The ‘bowl’ was the cap of a human skull, and he saw that he had not drunk clean water but a putrified soup of decay. At first nauseated and repulsed, he spiritually ‘awoke’ shortly afterward when he recognized how what he thought about reality (and not reality itself) so decisively determined his experience.

The conditions we label mental illness are a bit like that, only in reverse. In my case a lifetime of profound sadness, plus the ministrations of countless therapists and doctors, convinced me that I suffered from a major psychological disease caused by my upbringing (which included early bereavement and severe child abuse) and genetic endowment (my depressed mother committed suicide). This view of myself had a major impact on my self esteem for much of my life, but I don’t believe it anymore. Now I understand that my sadness was a natural grieving reaction that may have been prolonged because no one validated my understandable sorrow after such a childhood.

No longer do I see my melancholy as the psychiatric equivalent of a decomposing skullcap. I now appreciate that life dealt me hardship early on, and I reacted normally. With time I overcame my grief, so that the traumatic past now stands as one of my most important teachers. Despite its ordeals, it led me to how I feel today: contented and more than a little knowledgeable about misfortune and its transcendence. The skullcap has transformed into the ivory bowl. Of course, neither perspective is necessarily ‘correct’ in any objective sense. But which picture I hold in mind has a powerful impact on how I feel.

I’ve already sketched how psychiatrists diagnosed as mania an experience that in another time and place would have been viewed as a divinely granted spiritual awakening. My epiphany landed battered and defamed in the charnel grounds of mental illness, when it could have been an elegant container of grace.

How experiences are framed determines how we feel about ourselves and how others view us. Does the frame of mental illness serve the majority of patients? Or does it more often sap vitality and confidence? I read in many blogs of the relief people feel when doctors finally define their problems as diagnosable mental diseases. I remember reacting similarly myself when a lifetime of moodiness finally earned me the ‘bipolar’ label. It felt so comforting to have my condition named and seemingly validated. But instead of decisively helpful treatments, the mental health system strung me along with decades of therapy and thousands of little pills, none of which improved my mood or outlook very much. It seems to me that if psychiatric diagnoses were truly valuable, they would guide clinicians to life-changing therapeutic choices. But how often do people diagnosed with ‘major mental illness’ leave the Psychiatry Department with an effective cure? Although they may feel transiently relieved, they and their family now must endure the burden of ‘knowing’ their minds are sick.

Read entire article here:  http://blogs.psychcentral.com/happiness/2011/05/the-death-of-mental-illness/

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Unregulated prescription of antipsychotic drugs in elder care facilities on the rise

Monday, May 16th, 2011

Santa Cruz Sentinel -  May 15, 2011

A recent study by the Office of the Inspector General of the United States indicates that residents of some nursing homes may be regularly given atypical antipsychotic drugs as a means of chemical restraint, sometimes to the detriment of their health, including death.

The report, published May 9, states: “For the period January 1 through June 30, 2007, we determined using medical record review that 51 percent of Medicare claims for atypical antipsychotic drugs were erroneous.”

A member of Congress requested the office evaluate the extent to which nursing home residents receive atypical antipsychotic drugs and the associated cost to Medicare. The member expressed concern with these drugs were being prescribed for off-label conditions — i.e. conditions other than schizophrenia and/or bipolar disorder — and/or in the presence of a condition specified in the Food and Drug Administration’s boxed warning.

“We determined that 83 percent of Medicare claims for atypical antipsychotic drugs for elderly nursing home residents were associated with off-label conditions and that 88 percent were associated with the condition specified in the FDA boxed warning,” the Office of the Inspector General found.

The California Advocates for Nursing Home Reform has been concerned about this issue for some time. For more information, visit www.canhr.org/help.html

http://www.santacruzsentinel.com/ci_18067580

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Plea to free children from ‘chemical cages’

Monday, May 16th, 2011

Sydney Morning Herald – May 15, 2011

by Andrew Taylor

A photograph of an unnamed boy in a cage features in Sean O'Carroll's exhibition about Ritalin.

A BOY crouches naked in a steel animal cage, with the downcast eyes of a prisoner.

This confronting image, meant to represent a ”chemical cage” of drugs to treat attention deficit hyperactivity disorder, is part of an exhibition called Ritalin by photographer Sean O’Carroll.

O’Carroll, a former teacher, said the exhibition expressed his concern about the widespread administering of what he called addictive mind-altering drugs to young boys, which was ”a catastrophic failure on the part of our society to deal with the challenge of raising active, energetic and ‘difficult’ boys”.

”It makes my stomach churn. I feel like it’s a dangerous abuse of their rights as human beings.”

The show, which opens in Melbourne in July, features seven boys, including O’Carroll’s sons Moses, 4, and Elijah, 3, as well as two nephews and the sons of friends.

One image from the exhibition is on display at Gaffa Gallery in Sydney alongside the photographer’s Boys, Guns, Etc? exhibition of near-naked photos of toddlers holding toy guns.

O’Carroll said the boys were ”very enthusiastic” about appearing in the photos. ”It’s the parent who needed lots of time and discussion and attention. The kids were like, ‘Oh, cool, I’m an animal in the cage,’ or ‘The baddies have caught me,”’ he told The Sun-Herald.

The Melbourne photographer said he had deliberately made the images confronting. ”In a sense I’m utilising the current hysteria around nudity to make my point about something far more dire.”

Figures from Medicare show that more than 57,000 children were on ADHD drugs, in 2009, including about 23,000 children from NSW.

O’Carroll’s strong views are shared by the West Australian Labor politician Martin Whitely, who describes Ritalin as a ”chemical cage” and has called for an end to federal government subsidising of Ritalin. ”Currently we’re subsidising misery,” he said.

Professor Jon Jureidini, head of the department of psychological medicine at Adelaide Women’s and Children’s Hospital, said there was increasing evidence of Ritalin’s long-term detrimental affects on the brain, particularly for children whose brains were in a ”state of flux”.

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