Time to Change the Meds Again

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This Is Your Brain in Politics

In today’s NY Times: Psychiatrists Revise the Book of Human Troubles

The American Psychiatric Association is working on the DSM-V.

Is compulsive shopping a mental problem? Do children who continually recoil from sights and sounds suffer from sensory problems — or just need extra attention? Should a fetish be considered a mental disorder, as many now are?

Panels of psychiatrists are hashing out just such questions, and their answers — to be published in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders — will have consequences for insurance reimbursement, research and individuals’ psychological identity for years to come.

The American Psychiatric Association, who publishes the book, made contributors sign a non-disclosure agreement and put a $10,000 per year limit on the income they can receive from pharmaceutical companies.

Some groups want to have their cake and eat it too:

Transgender people are themselves divided about their place in the manual. Some transgender men and women want nothing to do with psychiatry and demand that the diagnosis be dropped. Others prefer that it remain, in some form, because a doctor’s written diagnosis is needed to obtain insurance coverage for treatment or surgery.

Some want to be special:

The same team is likely to make a recommendation on so-called sensory processing disorder, a vague label for a poorly understood but disabling childhood behavior. Parent groups and some researchers want recognition in the manual in order to help raise money for research and obtain insurance coverage of expensive treatments.

Others just want to make money:

Industry influence was questioned after a surge in diagnoses of bipolar disorder in young children. Once thought to affect only adults and adolescents, the disorder in children was recently promoted by psychiatrists on drug makers’ payrolls.

It is absolutely astonishing to see just how much influence politics, special-interest groups, and pharmaceutical companies have these days in medicine. I wonder how many more new diagnoses the fifth edition will have than the last.

Ritalin Kitteh

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Better Days, I’m Having Them

I feel horrible today, but that’s ok because it just means that I’ve been doing well for a while. The bupropion (Wellbutrin) is working well, and it seems my body is adjusting to it, so that I have to take a Xanax or Klonopin only once every 3 or 4 days. And I’m still on lithium and lamotrigine (Lamictal). I feel crappy today because I missed the Wellbutrin yesterday.

I’ve been busy tending my other blogs and washing the mountain of dishes that had been piling up on the counter top for several months (no, I’m not kidding). I’m almost done; I can even see the counter top. Now I have only to keep up with the dirty dishes. My husband is scheming against me—he keeps cooking and using the damned things.

Drugs Make You Stupid, M’kay

Every time I have tried to stay on an antidepressant lately, I just get all hypomanic. But, Mister Doctor wants me to take them, and I agree. Now, if take anti-anxiety drugs with the antidepressant, all is hunky-dory, except that I can’t think.

That whole thought process is pretty fuzzy, I stumble over myself, and I completely forget words (i.e. no recall). This makes me crazy. I can either live my life staying up two days at a time and being unbearably agitated and being so all over the place that I can’t get anything done, or I can be stupid—able to live with myself—but stupid. This in itself is very frustrating, but I’m also about to start trying to get a job. What the hell am I going to do then?

And this is not an isolated incident—it doesn’t matter which antidepressant (although some are worse than others) or which anti-anxiety med (benzos). Although, I am hoping that I can convince Mr. Doctor to let me try Buspar again. We shall see.

And yes, I am on mood stabilizers—lithium and Lamictal.

Pediatric Bipolar (or, Children on Drugs)

Round-up:

November 19, 2008
FIRST THEY’RE DRUGGING OUR DRINKING WATER, NOW OUR KIDS? WHAT NEXT?
From an M.D. and professor of psychiatry.

We also have the specter of two year olds being diagnosed with bipolar disorder and treated with these medications.

Stop giving antipsychotics to kids who don’t have the diagnosis of childhood schizophrenia.

November 18, 2008
Use of Antipsychotics in Children Is Criticized
The latest installment in the on-going saga.

June 8, 2008
Researchers Fail to Reveal Full Drug Pay
“Researchers” being the foremost advocates of pediatric bipolar disorder.

The Harvard group’s consulting arrangements with drug makers were already controversial because of the researchers’ advocacy of unapproved uses of psychiatric medicines in children.

Dr. Biederman is one of the most influential researchers in child psychiatry and is widely admired for focusing the field’s attention on its most troubled young patients. Although many of his studies are small and often financed by drug makers, his work helped to fuel a controversial 40-fold increase from 1994 to 2003 in the diagnosis of pediatric bipolar disorder, which is characterized by severe mood swings, and a rapid rise in the use of antipsychotic medicines in children. The Grassley investigation did not address research quality.

September 4, 2007
Bipolar Illness Soars as a Diagnosis for the Young
I made some comments on this one a while back.

August, 23, 2007
A Neuroscientist’s take on the issue.
Wear your flame retardant suit for this one. Although, I do have to say that when I was on Seroquel, I might as well have been lobotomized. It was not pleasant. I couldn’t concentrate long enough to string a few words into a coherent sentence, when, that is, I could stay awake.

And when they say pediatric bipolar disorder, they’re talking pre-adolescent.

One issue I have with all of this is that pediatric bipolar disorder is not like grown-up bipolar—different manifestations, different symptoms. So if it’s in kids, it doesn’t look like bipolar disorder in adults, and is similar enough to ADHD/ADD to be “misdiagnosed” as such, maybe it needs its own name.

As far as continuity into adulthood, the only study of its kind that I have found states,

Over eight years of follow-up, 44.4% of children with bipolar disorder displayed manic episodes after age 18, reported Barbara Geller, M.D., of Washington University in St. Louis here, and colleagues in the October issue of Archives of General Psychiatry.

This rate was 13 to 44 times higher than population prevalences, which strongly supported continuity into adulthood and the credibility of diagnosis in childhood, they wrote.

The researchers conclude that 44% of children in the study were correctly diagnosed as having bipolar disorder. My question is, what about the other 56%?

And I’m still not even going to get into giving these powerful psychotropic drugs to children. I just can’t imagine what they must do to a growing brain.

I, Pythia

You know, I read somewhere recently that the better your mental health is, the less you start your sentences with “I.”  From experience, this seems to be true. For quite a while now the posts here have been “I” posts. And yes, right now I’m avoiding starting with “I,” but putting adverbial phrases or conversational fluff first, while technically removing the “I” from its initial place, is not a semantically valid negation of the self-absorbed mind-set that it indicates. Whew, that was tough.

So, anyway, today is a doctor day. (I’m still very self-conscious about this “I” thing, so if I sound awkward, please bear with me.) If you’ve been following the exciting exploits of Pythia and the doctors, you’ll remember that my psychologist is now managing my meds. Well, he prescribed Paxil the last time I saw him, and said to start it when the nausea subsided. Well, the nausea subsided, but I never started the Paxil. I’m too scared to. I know I need an antidepressant, and know that I tolerate Paxil and that it to some extent works, but I’m afraid both of it dulling my mind (which is already dull right now) and the possibility it’ll make me (even more) irritable as hell and miserable. And, I have to say, I’m really not looking forward to the possibility of being lectured for non-compliance. 

What’s an oracle to do? 

Hypothyroidism, I Hope

Got the thyroid tested the other day. My psychologist, who is now handling my meds, sent me to the internist. I’m feeling much, much better now that I’m not being doped up like a patient in the psych ward, but am having problems with nausea and fatigue, both of which, apparently (I didn’t know about the nausea) could be attributed to hypothyroidism or side-effects of the meds that that I’m still on. I’m betting it’s the thyroid. I’m on such low dosages of psych meds as to be considered sub-therapeutic. The psychologist prescribed Paxil in addition to the lithium and Lamictal I’m already taking, but wants me to wait until the nausea subsides before starting on it. Well, the nausea is gone (thanks to a suggestion I found on the internet), but I don’t want to start the Paxil until the bloodwork comes back. I want everything straight before adding more to the mix.

The past few days have been good, but I suspect that I have no business not being on an antidepressant. I’m also having minor anxiety problems, panic attacks as I am falling asleep. It doesn’t help that I know something is wrong, but not what. And having chest pains at bedtime isn’t really helping. The doc said that the pains are probably from the hypothyroidism–I had a EKG done the last time I went, and it was fine. So, it looks like the doc thinks the thyroid is the culprit.

Bad Doctors

When All Else Fails, Blaming the Patient Often Comes Next

“Lots of patients elude doctors’ clinical skill and therapeutic cleverness. That’s often when the trouble starts.”

New Doctor, Again

I asked my psychologist to start managing my meds, to which he agreed, as long as I’m fairly stable (i.e. not crazy manic suicidal). He agreed with my assessment that I’ve been too drugged up, and has no problem taking me off of benzos–imagine that–and is putting me back on Paxil as soon as the nausea from the too much Lamictal wears off. See, the thing is, I seem to be hypersentitive to drugs in general. I manage quite well on what are considered subtheraputic dosages (as long as I’m not crazy manic suicidal), but my regular psychiatrist puts me on drugs that knock me out even at minimal doses, even when I’m stable (just not functional–though that may be a result of the meds themselves).

I have to say that I am feeling pretty optimistic about this, primarily because the psychologist listens to what I say, while the psychiatrist just asks questions.