Posts tagged ‘Depression’

FDA May Require Testing of Electroconvulsive “Therapy” Devices

You may remember a couple of posts I made last year at this time about the importance of speaking up when the FDA opened itself up to comments on the issue of reclassifying the as yet untested ECT (shock treatment) machines from a class III to a class II. The situation was simple — in all the years the machines have been in use, the industry has never had to prove that they are either safe or effective. For decades people have been having their frontal lobes assaulted by electricity in varying amounts from just plain dangerous to thoroughly destructive on machines with no standard of testing to ensure that they’re working as designed, much less designed to address any established clinical use at all. This is not only frightening but a terrible insult to the rights and safety of the approximately 100,000 people who face ECT each year in the US (by choice or force) and only serves those profiting from the shock industry. In essence, the hundreds of thousands of people who have undergone this so-called treatment are the experiment — the living test.

Well, the good news is that it seems that the FDA’s protection of the shock industry may be coming to an end…

Peter Breggin, MD for the Huffington Post:

Friday afternoon, January 28, 2011: The FDA’s panel for electroconvulsive therapy (ECT) voted to place ECT machines in Category III for all but one indication. If the FDA accepts the panel’s recommendation, the agency will require testing for all uses except “catatonia” which was recommended for Category II, requiring less stringent testing.

A tiebreaker by the chair was needed to propose putting ECT machines into Category III for depression. Given acute trauma caused by the treatment and the evidence for long-term memory and cognitive problems, it reflects poorly on the panel that the vote was so close.

Indeed. Despite the polarized response to the matter from proponents and opponents of giving ECT a pass, each side claiming history has proven their point, the fact of the matter is that the FDA is supposed to be ensuring our expectation of some level of safety. If an industry is unwilling or unable (or in this case both) to prove its product safe and effective given the established (and frankly, lax) channels, then that product has no business being passed off as a reasonable course of action in our nation’s hospitals. This shouldn’t have come off as a vote on ECT’s supposed merits but on its decades-long exemption from the system — and that shouldn’t be a close vote at all.

It’s a little early to cry victory as it remains to be seen whether the FDA will follow the panel’s recommendation, what result that will actually have and how much the overlapping psychiatric and shock industries will play off of the catatonia exemption.

If the diagnosis of catatonia is given this loophole, we will see more and more people diagnosed with this disorder…It’s similar to what happened to children: massively increasing the diagnosis of bipolar disorder to justify giving them adult mood stabilizers and antipsychotic drugs.

Unfortunately, the FDA is already waffling about whether or not it will in fact require the usual testing for Category III devices. In response to questions at the hearing, the agency staff said it was not certain whether a Category III designation for ECT would require the same rigorous testing routinely carried out for safety and efficacy. No one on the panel seemed to think the treatment should be phased out until safety and efficacy were proven.

Psychiatric reform moves ahead a step at a time, falters, and hopefully moves ahead again. The classification of ECT into Category III for most conditions, which at this point is only a recommendation, is a step forward and a somewhat positive sign to those of us who have called for this for decades. We hope the FDA will uphold its obligation to the public to thoroughly test such a dangerous device for safety and efficacy.

Since the psychiatric and shock industries have essentially shaken off the burden of responsibility for the safety of the consumer (certainly at the industry level the term is more fitting than patient) and the FDA is apparently questioning its convictions about the protection of the public, the burden rests on the people. As neither of those entities are wholeheartedly committed to moving forward of their own accord to ensure the safety and the efficacy of products on the market and ECT cannot prove itself under any honest scrutiny, the burden then falls on the people to pressure them toward forward momentum and to keep the scrutiny honest…but then, has there ever been a time when that wasn’t the case?


January 31, 2011 at 11:01 am 6 comments

iTherapy 2.0

Welcome to the future of reductionist psychiatry. You can now be diagnosed, labeled and treated without a doctor ever having to even look you in the eye or hear the stories that make you tick. Just click the boxes for your symptoms, fill out the questionnaire and the complexities of the human psyche can be unraveled as quickly as e-filing your taxes in the last hour of tax day. Never mind the subtle differences that define us or the experiences that got us here.

This is not some luddite rant about the technology takeover, though to some extent there is a worthwhile wariness in that discussion. I’m talking about the power of the DSM, which was never meant to be a stand-alone collection of boxes to check off in diagnosing, now essentially uploaded and online to be used in just that fashion.

From Australia’s The Age:

MENTALLY ill Australians are increasingly being diagnosed and treated online in virtual psychiatric clinics, without ever seeing a doctor.

Patients suffering from depression, anxiety and post-traumatic stress disorder are being assessed by computer and given ”e-prescriptions” for online counselling courses instead of medication or treatment sessions with a psychologist or psychiatrist…

With e-therapy, patients are clinically diagnosed after completing psychiatric reviews by answering online questions

“Assessed by computer”? It makes you wonder what we need all these psychiatrists for? Apparently all we really need are the DSM committee and a handful of tech guys to work out the interface and we’ll be well on our way to solving those pesky problems that keep cropping up and reminding us how hopelessly human we all are.

One positive point is that it presents a shift from medicine and toward some sort of counseling but I see that aspect of it as short lived. It seems likely to follow the trend of “real life” psychiatry and revert to drug based care, printing out its e-prescriptions for the latest in pharmaceuticals. Also, it makes you wonder — if these kinds of treatments are so effective, why do we need a computer to veer away from drugs? I can see computer based communication and the easy transfer of information as useful but only as a supplement to truly involved care from a living, breathing human – not a replacement. I question the quality of online counseling when compared to real counseling. Of course it’s limited to relatively minor difficulties like depression, anxiety and PTSD. They wouldn’t dare try to treat the as yet uncharted depths of serious mental illness — would they?

In Melbourne, David Austin, the co-director of the National eTherapy Centre’s Anxiety Online program, which is run from Swinburne University of Technology, said the service did not attempt to treat people with more serious conditions such as schizophrenia or bipolar disorder but there was scope for that in the future.

“Within five to 20 years we will have a proven e-therapy for most of the psychological conditions. Once you do that, you have 24-hours-a-day, seven-days-a-week low-cost access for everyone,” said Professor Austin.

Everyone. Oh good. At least they’re planning ahead. This is where the drugs are likely to come into play as most things perceived as serious mental illness are treated with drugs as a chemical problem in the brain not simply a coping, life handling or perception problem.

Patients log on anonymously to complete modules on cognitive behavioural therapy and breathing and relaxation techniques through videos, podcasts, online forums and interactive questionnaires.

Next month, courses will begin for people with eating disorders and gambling addiction.

I’m convinced computers can be of some benefit in a therapeutic setting whether it’s to impart information, the support found in many forums or supplemental counseling. The biggest problem, though isn’t in the counseling aspect of it but in the assessing. While the move to computer based diagnosis promises to extend mental health care to more people, we need to question the level of care and its potential to do more harm than good. We’re talking about diagnosing people online that we’ve never met. The internet has proven to be an unreliable way to get to know people. Something gets lost in translation between the keyboard at one end and the screen at the other. That’s why some people hide behind them, filtering and crafting their online persona and others with the best and most honest intentions just don’t come across as themselves. Many would argue that the computer isn’t even a good way to determine whether someone is dateable but somehow we think we can ascertain someone’s mental and emotional state and diagnose them which will have a huge and far reaching impact on the course of their lives.

We are all complex individuals to varying degrees. One can no more experience another’s state of mind through a computer’s screen than the fullness of a symphony through its crackling plastic speakers. I can’t imagine letting the care of someone’s mental well being hinge on that poor a translation.

June 13, 2010 at 1:07 pm

Seroquel XR’s New Ad

You may have seen the relatively new direct-to-consumer ad from Astra Zeneca for its long acting atypical antipsychotic, Seroquel XR. Creepy and pandering to say the least. I’ve heard a few people say that if you’re not depressed before watching it, you will be after — and isn’t that the point?  Like a carefully and corporately crafted emo/indie/whatever hit song, it’s made to strike a chord and sometimes it takes a panel of well payed analysts and some market research to find out how best to strike that chord in a way that shows that the company truly understands how you feel. Look at any one of the current pharmaceutical ads. The focus isn’t so much on selling you the drug as the disease. Once you’ve bought the idea of the disease, you’ll find the drug.

Here, they are positioning their Seroquel XR as a fix for “bipolar depression.” They show scene after dreary scene of miserable looking people who have half faded into the grays and browns of their equally dreary  environments, all while an instrumental from Badly Drawn Boy plays in the background. Oddly, one thing that separates this ad from a lot of the others is that it doesn’t switch to bright scenes of people laughing with friends at parties or rolling around in green, sun bathed fields. It stays pretty gray, though one woman does find the strength to get up off the couch. At least in that respect it’s a little closer to reality, considering a lot of people’s experience with this drug and others like it.

Another thing you can’t miss is that the health risk disclaimers take twice as much time as the first part of the ad telling you how great the drug is for treating “bipolar depression.” I’ll be the first to admit that a risk vs benefit scenario can’t be weighed out in seconds of air time but with such a vague diagnosis, based not on objective medical evidence but a nebulous cluster of feelings and behaviors laid out in a questionnaire, one has to wonder when the perceived benefits justify the very real risks. The question may now be more important than ever as we see these drugs being used in increasingly mild situations and in an ever broadening range of indications and demographics. Even with twice the time dedicated to the risks, the likelihood of those risks hasn’t fully been put forth and while they touch on metabolic symptoms and state the need for cholesterol and triglycerides to be checked, the reality is that only about ten percent of doctors prescribing these drugs are looking into metabolic responses by running those tests. With these companies downplaying, often even lying outright about the risks of these drugs to the FDA, prescribing doctors and now — via direct-to-consumer ads — the public, even with their FDA mandated obligations fulfilled, truth in advertising remains questionable at best.

Just as with the ad marketing Abilify as an add-on for “treatment resistent depression,” a viewer who sees this ad would have no reason to see Seroquel as anything but an antidepressant. It’s not an antidepressant though — far from it. It’s an antipsychotic designed to combat the cluster of “symptoms” associated with a diagnosis of schizophrenia — but then, when your product was designed for a perceived illness that affects only 1.1 percent of the population, you have to expand your market somehow.

January 28, 2010 at 10:40 am 2 comments

When I was Seventeen…

When I was 17, I visited a church where I met a lot of amazing people. There was one child that had an incredible voice. His name was Michelin. I don’t mean good for a kid or good for singing in church but the kind of voice that would stop you in your tracks. I remember thinking to myself that if he were born somewhere else his voice would be his meal ticket. He couldn’t possibly be passed over — even in a world where everyone is clamoring to be heard because they think their voice is their ticket to fame, which of course we all learned somewhere we so richly deserve. But he wasn’t born somewhere else. This church was in a small coastal village in Haiti.

I saw an impressive spirit in the people there. One can’t help but notice the contrast between our country and theirs. I think of how much we value stuff and status, about our connection to things and their connection to our happiness. We live in a country in which it’s  commonplace to diagnose ourselves as depressed or having any number of anxiety disorders over matters like career advancement and wealth management while elsewhere people are singing “alleluia” with bare feet, torn and ill-fitting clothes and empty stomachs. That’s not to say it’s all smiles in Haiti — that there’s a flood of joy amidst poverty. They are without question burdened and weary but for most, their burdens are different from ours. Our consuming has gone past need, past waste and into competition. We’re personally affected when our favorite restaurant closes. If we don’t know where our next meal is coming from, it’s because we can’t decide not because there is nothing to eat. The jobs we can’t stop complaining about afford us enough food to get fat. Then we complain about that.

I remember standing at the foot of a bed shared by several children in a hut made of discarded branches, old signs and scraps of whatever could be made useful. It was no bigger than my bedroom back home and 12 people lived there. Outside people drank from small streams of dirty water, had little to eat and their country was falling apart beneath them. Still they went to church on Sunday, sang, danced and praised God for what little they had and asked Him for enough to really get by — to just be okay.

Now some people have lost everything. People that had only meager scrap huts have lost them. People who had only missions for food and schools for purpose have lost them. People who literally had nothing but each other have lost even that. Port-au-Prince  was desperate when I saw it years ago and it was grand when compared to the villages. Now it is rubble.

I rode my bicycle home from work last night. Nearing home, I found myself looking up at all of the houses in my neighborhood — wondering what made someone buy one house over another. Was it the size, the style, the yard? Maybe they bought that house for its original woodwork and stained glass. The more I looked at the houses, the more they looked the same. They serve the same purpose, they offer the some protection and at night they all blur together and look more alike than different — and at least for one more night they are all still standing.

This child is in his New Missions school uniform, standing in front of what’s left of a classroom. I think it’s the one I stayed in but it’s hard to tell. They were built simply and probably fairly uniformly. I remember being thankful for the sturdiness of the shelter when the winds got strong.

• • •

You can donate to the Red Cross or Yele Haiti (founded by Wycleffe Jean) via their websites.

While text message donations are easiest and still useful, they apparently are also delayed by as much as 90 days due to billing cycles and technicalities. That’s an eternity in this situation but it’s better than nothing and it’s better than never. Text “YELE” to 501501 to donate $5 to Yele or “HAITI” to 90999 to donate $10 to the Red Cross.

January 16, 2010 at 10:50 am 2 comments


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