Recently, a patient’s widow called to cancel a routine assessment because the patient suddenly died. There had been no freak heart attack and it had not been one of those undiagnosed cancers. He just “died, suddenly, in his sleep, I guess,” she said. That got me thinking.
The first class of drugs I think about, when I think of sudden death, are the stimulants. I remember when someone decided that everyone who was going to get stimulants needed to have a “cardiocentric” examination first. Doctors asked a lot of questions about chest pain, and administered an electrocardiogram. These precautions were especially interesting because they were – of course – used before prescribing Ritalin. Many child psychiatrists had laughed at me when I cautioned usage of this job, claiming it was the safest medication ever invented. Once – at the peak of my massive weight — an endocrinologist offered me a prescription of Meridia, to get rid of my excess weight. He did not think the fact that there had been a “few” reports of sudden death should get in the way of my using it. Read more on Sudden Death in Psych Patients — From Medicine…
Filed under depression, Diagnosis, End Of Life, medicine, prescription drugs by on Aug 19th, 2011. Comment. 
The next person to see me made a dramatic entrance. First, she had gotten a head start on her crying in the waiting room. But more than the sound of her crying and sobbing, she could barely make it through the waiting room door. I am no good at guessing someone’s weight. She later admitted to being 380 pounds. I took her word, as our clinic’s scale only went to 300. Her general appearance was that she was swollen with water – a human sponge. The edema bloated every part of her body, and her crying eyes were nearly swollen shut. I started by asking her when her problems began. She was now 42, and said she had thought everything was okay until age 15, when she had been raped by a “friend of the family.” This man was not really a friend, he was a person who went to the same church. Moreover, he was a Sunday school teacher. You would think that by now everyone would know that being a Sunday school teacher does not make someone a saint. But this family had not yet figured it out. In many such cases, this type of person is shielded by the religious community, and even the victim’s parents are often in denial. This woman was lucky. Her parents told her that they were going to prosecute this sinner to the extent of the law.
There was a trial, and she had testified. She thought everything had turned out great, and so did her parents. The rapist was convicted and sent to jail. Again, those who are experienced in these things know that this type of trauma is never over quite so easily. The woman went on with her life and ended up in a really abusive relationship — the kind where someone locks you up and won’t let you leave the house and beats you if you look out the window. By the time she got the courage to escape this living hell and seek a shelter, had a peck of kids. They lived in this shelter for over a year before she found that she had what it takes to start over. She went to school, gained some clerical skills, and started over. She was actually doing pretty well until something happened that triggered a demon she didn’t know had possessed her. She was called for jury duty and went, with pride, wanting to do her civic duty. She couldn’t. She had a panic attack as soon as she entered the courtroom. She ran to the ladies’ room, threw up, and tried to enter the courtroom again – and it was even worse. People thought she was having a heart attack, and they sent an ambulance for her. I do not recommend this means of getting out of jury duty, although it sure worked for her. Read more on Murphy’s Law Of Medicine At Work…
Filed under depression, Diagnosis, Doctors, prescription drugs by on Aug 17th, 2011. Comment.
I had a patient once, long ago and far away, who was the worst “Caffeine Fiend” – properly known as “caffeinism” in medical lingo — I had ever heard of.
He was only 27 but depression and obesity added ten or fifteen years to his appearance. He was single and did not have much of a social life, but he did not much care. He was one of the earlier generation of people to build himself a career doing something with computers, with some sort of techie abilities which I could not understand at all. That enabled him to work from home at least part of the time, and only occasionally would he have to make a mad run to and from his employers’ office. This was in rural northern California, somewhat removed from the Silicon Valley mainstream of this type of activity.
The “from” part was important, as he did not much like to hang around with other humans, much preferring the company of his computer. Read more on Tale Of A Caffeine Fiend…
Filed under depression, Diagnosis, eating disorders, Stimulants, weight by on Jun 16th, 2011. Comment.
Who should be worried about bath salts abuse?
I mean, what’s the worst that could happen? You should start smelling great? Believe me, I’ve had some people in my office that could use some abusive bathing.
But on a serious note, there have been some street drugs that are sold as bath salts and those can cause a lot of problems.
As far as the FDA is concerned, soap, bath oil, and legitimate bath salts aren’t regulated. As for the Fair Trade Commission, there are some labeling requirements for products that make a claim (such as moisturizing the skin).
But the bath salts that have the feds worried now are a legal high – and they want to make all “highs” illegal. Read more on Stimulating Bath Salts — Avoid At All Costs…
Filed under depression, News, Stimulants by on May 3rd, 2011. Comment.
If this is the first time you’re reading my blog – Welcome!
If not, you know that I’m … ummm … mature and that I’ve been restless enough to study many branches of medicine.
My current credential is in psychiatry, and like Rodney Dangerfield, we shrinks “Don’t get no respect.” Read more on Researchers Are Short-Sighted When Looking At Data…
Filed under depression, Diagnosis, Research by on Mar 25th, 2011. Comment.
I could not believe it when the patient asked me about ketamine. I had just seen an episode of “House, MD” on one of those cable super-stations the night before and it dealt with this weird drug. I told my husband about my experiences with it during my surgical career. Then, the next day, this patient brought up the same rare drug. When I looked at him closer, it became believable. He was old enough — in his sixties — that in the swinging sixties he had surely been one of those “knowledgeable” druggies who pride themselves on knowing all about everything that could give one a buzz.
Hugh Laurie as TV's Dr. House
This type of person is a sort of lay-pharmacologist — someone who knows not only how each drug made someone feel, but sometimes even about class of drug and mechanism of action. Of course, this type of expert would seldom know terribly much about what the FDA thought or felt about these drugs. “I heard it works pretty well and faster than anything on depression,” he said, “and I am kind of depressed and the standard antidepressants, the crap like Prozac and Zoloft aren’t worth taking and don’t do anything. But they say that stuff works fast on depression.”
Yes, he knew his stuff so well that he may even have read some kind of FDA reports or something. Still, ketamine is not the kind of thing you can dish out in a county clinic in Noplace, California. If you want something exotic, try a university psychiatry or pharmacology department, or call or email the National Institutes of Health. I could offer the standard stuff, but not ketamine. Not me, not there.
Filed under depression by on Dec 24th, 2010. Comment.
“I wants me some of them-there antidepressant pills.”
He was a 47 year old good old boy of the sort I had treated in Oklahoma and other rural parts west –a real cowboy. He had herded animals and done the rodeo and all of that.
No, he had never seen a psychiatrist before, ever. He had been out crying on the front porch, and it was a next door neighbor who had somehow convinced him that there were medications and he did not have to tell his whole life story to get pills. Well, maybe that would work with a general practitioner, but he was not only disappointed but also angry that it was plainly NOT going to work with me. Figuring he had been had, he broke down and told me the story. I could understand at once why he had been reluctant to get into this, for we went through half a box of Kleenex while he gave me a plot that was worthy of a tear-jerky country song. Read more on A Cowboy’s Lesson — Antidepressants Won’t Work Well With Alcohol…
Filed under depression, Diagnosis, medicine, prescription drugs by on Dec 22nd, 2010. Comment.
Eli Lilly gets credit for being economically savvy and the first out of the chute.
Cymbalta (duloxetine) is a much awaited antidepressant that is supposed to be effective especially on the bodily aspects of depression. Those pesky aches and pains that are associated with depression in one form or another.
They seem to have secured “back pain” as an indication for Cymbalta. Read more on Cymbalta For Back Pain…
Filed under depression, medicine, prescription drugs by on Nov 29th, 2010. Comment.
People may look at the complex before they look at the obvious — which is a faster answer and closer to the truth. I happened to be talking and I found three more yesterday. Women. Young, intelligent, and attractive women, who did not have and did not want boyfriends. All three were part of the mental health treatment establishment.
Men are losing interest in sex
The first time I discovered one of those was some years ago, a few cities ago, and she was a very clever and very talented psychiatric nurse. She loved her profession, and took good care of people. She loved nature and animals and plants. I believe her to have been quite attractive. She had been turning down dates because she would rather go to her gardening clubs or whatever.
She had also said, without tears or depression, that she expected she would always be alone, would move into the home for old nurses when she was old enough, and die there. She had been on Prozac for about three years. There were a few problems with this. First, nobody had ever talked to her about getting OFF Prozac. They said she might as well stay on it, since life was that good.
Actually, I have looked at data for depressed folks of varying ages. Sure, there is a risk of side effects, but nobody seems to care. I cannot remember, off the top of my head, seeing data about the recurrence of depression that suggested anybody needed to stay on antidepressants permanently.
Certainly, nobody under, say, 55 or so. And she was plenty under. I mean, there are things you can do to lessen the chance of recurrent depression — psychotherapy, even reading books. And there is the whole question of getting someone off SSRIs. I have had patients who claim it is impossible. I’ve had people come to me because the withdrawal effects were horrendous. Yet I have taken people off easily and (reasonably) quickly with natural substance regimens. It’s not impossible – you just have to know how.
That eliminates many of my colleagues. Or perhaps they keep their patients on prescription drugs to insure their return and a steady cash-flow. Naw – doctors wouldn’t do THAT!
There is another problem. There are drug side effects we know little about or may find hard to measure. I remember from my days doing clinical trials that at one time, shortly before I left the business, someone adopted a “uniform” side effect reporting system. The trouble with that was trying to fill in the blanks for the questions on the form when the patient is saying things that do not fit in the blanks.
Every one of these mental health professional women had been put on Prozac when it came out, because of the safety and efficacy. I remember, collecting data, one of the first people I gave Prozac to during clinical trials before that drug was on the market. She told me that she “felt like a zombie” and that she missed having the full amplitude of emotional expression. She missed crying at the movies, something she had genuinely enjoyed. Said she had a feeling of euphoria afterwards — a feeling of euphoria she really enjoyed. Try fitting that one on a uniform side-effects reporting system.
The three women I met yesterday are unlikely to get off their Prozac. They stood in wide-eyed disbelief of my assertions. Of course, they had just met me and know little about who I really am. Besides, people seem to have trouble taking advice for which they aren’t paying. I just reminded them as I remind patients that taking any medication is a choice, and reporting what is going on to a doctor is always a good idea.
If any of these intelligent and well-insured women had gone to a therapist, they could have ended up with some kind of verbally analytic procedure, which obviously would not help. Or maybe they would be referred for some hormone supplementation, which has biologic risks of its own. Big ones, like — cancer.
Worse yet, I’ve met two psychiatrists in my 30 years of practice who gave everybody electric shock treatment. Everybody! The first person in whom I suspected a real lack of sex interest had changed her life — the psychiatric nurse — did finally get off her Prozac. If she had any recurrent depression problems, I do not know about them.
She had a date within two weeks, and last I heard, was dating many interesting men, looking for a best boyfriend.
I am convinced that we are looking at a Prozac side effect that the system has made it impossible to measure. We probably have at least a little of the same side effect with similar drugs in the same class – such as Paxil and Zoloft. Maybe others, too.
The psychiatric nurse easily agreed her general quality of life had been diminished while she was on Prozac. She was too undepressed to notice. When she got off the drug, she suddenly noticed.
Getting a drug past the FDA takes some studies on how it gets into the body and the like. Nobody ever seems very worried about getting off a psychiatric drug. That’s been the focus of my private practice for at least the past five or six years.
For the individual, the effect is pretty evident even though I only have one clear cut example. What about the species? Is this just one of several steps driving humans to …. extinction? People change as time passes. What affected you in the past may have gone away – as many illnesses seem to do.
Spending your lifetime on a drug when you no longer need it is tragic. Or having your quality of life changed because of the way a drug reacts in your body – instead of seeking alternatives to control your problems.
I think it is worthwhile for anybody on a psychotropic drug to ask how their life has changed since they have been on a prescription medicine. We researchers have been limited to collecting information on side effects that the FDA and/or drug companies “let” us.
So don’t look toward the government or the drug companies for help.
Filed under depression by on Nov 23rd, 2010. Comment.
She was 28 and pretty and sweet and came in for depression. It was only systematic questioning that confirmed she was manic-depressive. Actually her next-door neighbor had seen a television show on manic-depression and had made the diagnosis a couple of years before, long before this woman had ever seen a psychiatrist. Her episodes had curiously enough been regarded more as amusing than as dangerous, so nobody had ever done anything about treatment.
By the time I knew anything about her, she had already had one child, and was pregnant with her second.I always believe in coordinating forces with the obstetrician/gynecologist when caring for a pregnant woman.I rarely get phone calls returned, but this is the way it should be, especially if someone has brought up the question of psychotropic drugs. She had never seen a doctor; her first child, and this one, had been delivered by a nurse practitioner midwife. The one thing I am absolutely sure this woman did better than any physician (except me) is answer phone calls. She was obviously thumbing through the old chart on the other end of the line when she told me: “After the birth of her last child she ran after her husband with a kitchen knife. She destroyed a bunch of stuff in the house. We did not know whether or not to believe the husband. After all, he had a serious history of drug abuse. They were sent to counseling; there is nothing more in the notes.”
It took all I had to keep from yelling into the phone at the top of my lungs. Read more on “Postpartum Psychosis”…
Filed under depression, Diagnosis by on Nov 9th, 2010. Comment.