Tuesday, February 10, 2009
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Cyclothymia and pharmacological treatments: What is truth?
David Healy wrote in the New Scientist (see my previous post and translation in Courier International). : "labs, often with the enthusiastic support of psychiatrists, managed to embed deeper into the minds
the idea that these disorders (mood) require preventive treatment for life, not just when the onset of manic or depressive episodes. It can read on the site Bipolar Help Center Eli Lilly that is "vital to follow a long-term treatment. Without medication, the symptoms recur and the disease will worsen. "
(...) But there are a lot less evidence than is to support these assertions. And the few that are available do that the most severe form of the disease. [Bipolar disorders are classified into two categories: Type I and II, from the lowest to lighter, limits and shapes called cyclothymic disorder.] Data are lacking almost entirely on the type II or cyclothymia since Clinical trials have mostly been carried out on people with bipolar disorder type I. Yet they represent only one tenth of the cases.
This excerpt from the translation of the article by David Healy inspired me to do a little investigation so I spent part of my morning look at the results of scientific the BPII and cyclothymia PubMed (Over 650 entries for cyclothymia!).
A Canadian study of 2004 (Department of Psychiatry, University of British Columbia, Vancouver) caught my attention: "Pharmacotherapy of bipolar II disorder: a critical review of current evidence":
http://www.ncbi. nlm.nih.gov/pubmed/14996137
which concludes: "there is a paucity (lack) of sound evidence to help guide clinicians Treating BP II patients. Decisions about pharmacotherapy Should Be Made on a case-by-case BASIS; list overall, broad recommendations are based is available That Can not Be evidence adequately made. More Quality Research Needed to SI delineata Effective Treatment Strategies ".
Then I stumbled on this very serious U.S. study of 2007 (" Case Western Reserve University staffed by a specialist in BP II and cyclothymia, Dr. Calabrese) regarding the effectiveness of Divalproex Sodium (Depakote) in adolescents and cyclothymic BP II over a period of 5 years:
Double-blind, placebo-controlled trial of divalproex monotherapy in The Treatment of symptomatic youth at high risk for Developing bipolar disorder.
http: / / www.ncbi.nlm.nih.gov/pubmed/17503990?ordinalpos=5&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
which the conclusion is "no significant improvement with regard to the results": "These results Suggest That, although well Tolerated, divalproex sodium Does not Produce Clinically Meaningful Improvements in The Treatment of symptomatic Youths Suffering from bipolar NOS Either Gold Cyclothymia Who are at genetic risk for Developing bipolar disorder. "
To compare these tests with the University of Texas more conclusive but over a period of 8 weeks:
An open-label trial of divalproex in Children and Adolescents With Bipolar Disorder.
http://www.ncbi.nlm.nih.gov/pubmed/12364844?ordinalpos=15&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
which concluded that the Depakote is "safe" and effective for young people: "This study Provides Preliminary support for The Safety and Effectiveness of divalproex in The Treatment of Bipolar Disorder in Youth."
According to a psychiatrist with whom I had contact in Canada, a study will shortly be published on the efficacy of Seroquel (quetiapine) for adults BP II (but not cyclothymic).
Healy seems to be right when he says there is a lack of "evidence" for the results over the long term (I am not an expert but only studies over several years can provide guidance for prophylactic treatment) and laboratories on the right in general psychiatry (
http://pharmacritique.20minutes-blogs.fr/archive/2009/02/07/le-rapport-de-l-igas-nous-donne-une- idea-of-conflict-of-inte.html
# more) that have a vested interest in selling you the prophylactic treatment, "for life". We certainly understand that pharmacological treatments are necessary and vital for the episode (manic or hypo, mixed state or severe major depression). But after settling what to do? Say 1 year later? I do not quite agree with David Healy on the current trend of "Buypolar" as cyclothymia and BP II and cyclothymia are a reality and psychological suffering of attenuated bipolar is real except that one would wonder more and more to where to turn for treatment (and even for the diagnosis) because between the negation of the Bipolar Spectrum still very common and the excesses of " Buypolar "(abuse of drugs and sometimes as diagnostic for depression). Where is the Via Media?
Until there are no guidelines, protocols for specific treatments, it remains unclear and the subjectivity of the physician or psychiatrist.
us back to the main question: what about bipolarity does one and cyclothymia what? What criteria: Felt the patient or external criteria: suicidal thoughts or attempts, "" hospitalization "," substance abuse ", etc. ...?
It seems clear that many cyclothymic need treatment. Which? Psycho-education alone or with medications? And especially for how long?
Experts cite surveys, studies, tests? But what is the validity of these studies and can attest to that?
Regarding children and adolescents, caution is also needed especially when experts in child psychiatry at Harvard forget to declare their earnings from laboratories (
http://www.nytimes.com/2008/ 06/08/us/08conflict.html
), when a professor of neurology at the University of Florida warns against the effects of anticonvulsants on children: Judith Warner http://www.psychiatrictimes.com/display/article/10168/52286 or when concerned psychiatric medications that are given to children so-called "difficult" ... http://warner.blogs.nytimes.com/2008/11/20/tough-choices-for-tough-children/
Should we follow the advice of the Canadian study of 2004 pre-quoted? : "Broad recommendations are based is available That Can not Be evidence adequately made. More research quality IS Treatment Needed to delineata effective strategies." Where
ask for more explanations and evidence of the effectiveness of treatments, which have, let us recall, side effects are not negligible. It is true that lithium and Depakote have a marketing authorization in France and have long been used in psychiatry, but is there any data? And a sufficient basis for BP II and cyclothymic?
In Britain, the National Institute for Health and Clinical Excellence, which advises the National Health Service has published a "guideline" to mild depression. (
http://guidance.nice.org.uk/CG90/NICEGuidance/pdf/English
). This institute is independent (not funded by the labs) and it seems that the option des médicaments n'est pas la première ...Comme c'est étrange. (Bas de la P. 21) "Use of antidepressants" :
Antidepressants are not usually recommended
for people with mild depression. But they may
help you in certain circumstances – for example,
if your depression has lasted a long time, or if
you have had severe depression before and now
have milder symptoms.
La question est moins claire lorsque le guideline dit :
The severity of depression varies a great deal.
Some people have only a few symptoms, which
affect daily life in a limited way. This is called
mild depression. Other people may have more
symptoms That CAN make daily life very difficulty - This Is Called
severe depression.
What then? The tolerance for the suffering of each varies and as pointed out very wisely Charles Barber, which is important is not the degree of pathology of the disease but the resources with which the person faces. Again, what matters is mainly the external criteria and objectives: hospitalization, suicidal thoughts, inability to have a normal social life, etc. ... I will go further to say that personality is more than the temperament critical: a good person surrounded, which keeps morale, with values and principles, practice a sport that is feeding well and has every chance to control many features of cyclothymic. It is a long-term, difficult and sometimes resulting in human sacrifices, but grew up in spring and confidence and the sense of "temperament excessive" cyclothymic becomes a reality.
In my case, some psychologists told me I could do without drugs, others were recommended to me, others told me I could do what I wanted. Brief in doubt I abstained and I intend to abstain until I do not have significant episodes or as long as I do not really feel the need. I'm not opposed to taking drugs in principle but the decision must be considered and intervene in some cases ("case-by-case" as concluded in the Canadian team). Meanwhile, I am using my little creativity Kafkaesque reduction and it works so far (p.73 and 239 of Cyclothymia for the worse and best). I find it reasonable that if cyclothymia "Calvinist" or "horacienne" that requires us to be simple, humble, submissive to God or to nature and away from the temptations of ambition.
The patient tomorrow, if he wants to be free and critical, will be "the expert himself" and make their choice according to the psychiatrist, psychologist or social worker, who will act as "consultants".
Please give me some scientific information (BPI studies versus BP II and cyclothymia) on this or additional suggestions.
Thursday, February 5, 2009
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translation and critical introduction to the article of Professor David Healy: The Latest Mania: Selling Bipolar Disorder.
Following the request of some users, I propose the partial translation of the article by David Healy in the New Scientist (My post of January 7) ( http://www.newscientist. com / home.ns ) published in Courrier International May 2006. This translation is preceded by a critical commentary of Pierre Sidon SARPs http://forumdespsychiatres.org/ . Whatever the positions of each, we would like more debate and confrontation of experts as suggested by the association UP Act-for example in the field of AIDS (good point that had been made by psychiatrist Pierre Angel).
David Healy under the influence of the drug by Pierre Sidon
07-09-2006
Marketing Mental Health: Psychiatry in the grip of the labs, by David Healy
enthusiastic Several sources sent us the By David Healy (author of The Time of antidepressants published by the troublemakers to think in circles) in the New Scientist and translated in Mail international marketing for diseases by industry. A theme that makes fun! And here the author addresses the "bipolar". We are nonetheless surprised by the current extension of certain aspects of speech psychopharmacologist.
In particular, if we agree willingly to the unwarranted extension of the qualification statements called cyclothymic disorder, his criticism of the prescription (especially the prescription of antipsychotics) in the treatment of disorders mood, we were surprised. Launched on his critique, often relevant to the prescription of antidepressants David Healy warns about the increase in disease morbidity and suicide as well as the increase in hospitalizations for bipolar subjects treated versus control. For him, the benefit / risk ratio of drugs that compete for the indication "mood stabilizers", could be negative. This view calls for two comments from us.
Erasing the name of "psychosis" in the name "Manic Depressive" effectively permit, during the years 90-2000, extending the prescription of antidepressants in these disorders of mood. This experience has provided a massive accumulation of evidence in favor of an iatrogenic prescription antidepressants in some cases (PMD or other): suicide, mania, hallucinations, delusions, making rapid cyclers, unintended movement of stabilizers, among other symptoms ... Today show delivery (new) antipsychotic drugs on the commercial scene, claiming their share of mood disorders, it was nice challenging game of their legitimacy, because of the erasure of the name of psychosis and now also inherit the bad reputation of antidepressants. Healy then stalking the hidden side effect based not on the clinic, but on statistics. Gold Epidemiology in Mental Health, based on DSM is to believe that the multiplication of a diagnostic test, neither specific nor sensitive, produces a division of the uncertainty of the test by the number of the sample when it is a multiplication happens. So how the DSM has made it impossible to discriminate subjects at risk of developing adverse effects on antidepressants, he could now serve as a base for an epidemiology of adverse reactions to psychotropic drugs? So if Healy is supported by a meta-analysis of four studies, we expect a future meta-analysis or study to prove the opposite tomorrow if necessary.
On comparing the frequency higher today than a century ago hospitalizations in Wales, the process surprised by the absence of any comparison of medical supply and psychotherapy, social conditions, economic and education for a century interval: more often means more monitoring of hospitalization. Healy seems to think that the drug would be the only variable here is not constant. Moreover, the reasoning model of Kerkhoff, which clearly showed that the ratio [number of suicides in an active girl Monitoring number of suicides in the general population] was probably proportional to the level of mental health countries, it is not considered a pejorative used more care in the hospital if the patient's welfare is increased. At least consider hospitalization in all cases as a bad thing ...
But specifically on the drug, when Healy said: "The Olanzapine Eli Lilly has been cleared by the FDA for long-term treatment of bipolar disorder in January 2004 on the basis of a randomized controlled trial. But this trial only lasted one year and the most obvious relapses occurred only after patients had stopped taking the drug, suggesting they in fact suffering from withdrawal symptoms, "we are very surprised: the situation described, before being interpreted as" withdrawal "is a classic case (at least for clinicians) of relapse at the cessation of neuroleptics.
Finally, we are not very surprised by the statement: "the drug is useless." An inverted version, in short all-medicine! Healy But why does he not assume that In addition the drug is also the requirement that matters?
Pierre Sidon
Source: New Scientist - and translated by International Mail - No. 820 - July 20, 2006
The pharmaceutical industry invents Does she or overrides of diseases in order to sell more drugs? Psychiatrist David Healy is convinced, as more and more of his fellow doctors and researchers.
The first images of the TV spot shows a woman full of life that makes the party and dance all night. "Your doctor never sees you like this," says the voiceover. On the next shot, the same woman appears, the compacted body and the sad face: "He sees you like that." Immediately after we see her doing her shopping, full of vitality. "That why so many people who suffer from bipolar disorder receiving treatment against depression and are no better: the depression is only half the story. "The woman returns again, the downcast, bills to the hand. Then another plane shows her to paint her apartment with lots of energy. "The dynamic woman, able to party all night, talking quickly and reacts with a quarter turn is unlikely ever to the doctor "repeats the voice.
This advertisement aired on American television in 2002. Viewers were encouraged to visit Internet address, which leads to the site Bipolar Help Center. Looking at the bottom of the homepage, you learn that it is the pharmaceutical company Eli Lilly. There is a "questionnaire on mood disorders." The television advertisement showed a woman trying to complete this questionnaire, and viewers were encouraged to do so. "Take this test and bring it to your doctor, it can change your life. A correct diagnosis is the first step to treat bipolar disorder. Help your doctor help you."
can see the advertisement as a genuine effort to inform people who do not know they suffer from psychiatric illnesses most serious and disabling of all: the manic-depressive, listed among bipolar disorder. Those who are familiar with alternating periods of deep depression and episodes of elation or euphoria [called manic] just as extreme, which can destroy their lives. One can also see that spot as an example of disease mongering: the fact to invent a new disease for developing a new market and sell drugs. It pushes people to consider any fluctuation of mood as a symptom of a disease that requires treatment. No drug is mentioned on the website, but it insists on the importance of long-term drug treatment.
When broadcasting the commercial, olanzapine (Zyprexa), Eli Lilly Laboratory, had just been approved by the Food and Drug Administration (FDA), the U.S. Food Safety Agency, to treat manic episodes , and tests were underway to establish it as a "mood stabilizer" or "mood stabilizer", a term that hardly anyone had ever heard before 1995. [Mood, psychiatry, has a very strong sense, defined negatively: the mood disorders are all forms depression or mania. The word is synonymous with thyme, Greek thumos, the seat of the passions.] This authorization followed a campaign launched by the pharmaceutical industry on the theme of the need "to regulate mood. She had just started in 1995, the year the FDA approved Abbott Laboratories to use an AED, valproate sodium (Depakine) to treat manic episodes. In the U.S. the green light from the FDA allows laboratories to advertise for the uses it has authorized. In advertisements for doctors, Abbott has therefore been to describe sodium valproate as a "mood stabilizer", which probably prompted many practitioners to believe that the drug could not only treat manic episodes, but also other mood disorders.
Six years later, in 2001, the term "mood stabilizer" now applies also to antipsychotics. However, these drugs are primarily indicated for the treatment of schizophrenia. And articles from scientific journals say clearly that there is no consensus among psychiatrists about what exactly a "mood stabilizer".
is attended around the same time to another slip. For if one can accept the use of antipsychotic drugs to treat manic episodes, that is to say in the short term, there is not any consensus on the appropriateness of their use as long-term treatment of bipolar disorders. Yet since 2000, Eli Lilly, Janssen and AstraZeneca have pounced on this new field and have taken steps to make not only accept their antipsychotic for manic episodes, but also as "mood stabilizers" Long duration. Result: People with bipolar disorder see themselves now routinely prescribe a cocktail of drugs that are very expensive and must take permanently. Laboratories, often with the enthusiastic support of psychiatrists, managed to embed deeper into the minds the idea that these disorders require a preventive treatment for life, not just at the onset of manic or depressive episodes. So you read on the site Bipolar Help Center Eli Lilly that is "vital to follow a long-term treatment. Without medication, the symptoms recur and the disease will worsen." The information provided by Janssen, which markets under the name risperidone Risperdal, go to the same effect: "The drugs are crucial in the treatment bipolar disorder. Studies conducted over the past twenty years show conclusively that people who take the appropriate drugs are better in the long term than those who did not take. "
However, there are a lot less evidence than is to support these assertions. And the few that are available cover only the most severe form of the disease. [Bipolar disorders are classified into two categories: Type I and II, the most serious lighter and shapes limits called cyclothymic disorder.] Data are lacking almost entirely on the type II or cyclothymia as testing clinics have mostly been carried out on people with bipolar disorder type I. Yet they represent only one tenth of cases.
In fact, with the possible exception of lithium [the standard treatment for this disease, discovered there are several tens of years] for bipolar disorder type I, no randomized controlled trial did show that subjects with bipolar disorder who take drugs are better in the long term than those who do not. Olanzapine Eli Lilly has been cleared by the FDA for long-term treatment of bipolar disorder in January 2004 on the basis of a randomized trial controlled. But this trial has lasted a year and most obvious relapses occurred just after patients had stopped taking the drug, suggesting that they actually suffered withdrawal symptoms. Even the evidence to demonstrate the effectiveness of lithium are controversial. It is true that this lack of evidence is due to difficulties in conducting trials for more than a few weeks for such complex diseases as bipolar disorder. But the evidence of effectiveness should not overshadow their dangers. The potential toxicity of lithium is well documented, and many data indicate that the risk mortality is higher among people taking antipsychotics on a regular basis over the long term. This result as well as other known side effects of antipsychotics are not visible in the relatively short test designed to demonstrate the efficacy of treatment in psychiatry. Tests on the use of antipsychotics in schizophrenia also show that the suicide rate is significantly higher among those taking the drug than in the placebo group. Moreover, it is questionable whether the benefits purportedly shown in clinical trials actually occur in the therapeutic activity. A century ago, in North Wales, people with bipolar disorder type I were hospitalized on average four times per decade. Today, despite huge advances in medicine and pharmacology, patients with the same disease are hospitalized four times more often! This is not what happens when a treatment "works", but it's quite often what happens when it has side effects.
Those who "promote" bipolar disorder emphasize the frightening rate of suicide among sufferers. [It is estimated that 20% of patients with bipolar disorder type I or II died by suicide.] The issue is immense, but the controversy is too. [David Healy has recently shown that antidepressants, in some circumstances, increase the risk of suicide in depressed people. Healy said in 2002 that 25,000 people had committed suicide just because of Prozac.] Debate on the role of antidepressants in suicide has recently taken a new turn: the misdiagnosis. Antidepressants cause suicide if prescribed wrongly in the case of mood disorders. If the doctor saw the patient was bipolar, argues it does, it would not have made the mistake of prescribing an antidepressant. [Consider that bipolar disorder is under-diagnosed: up to 40% of depression could actually be manic-depressive and therefore are inappropriate treatment.]
Because of the risk of suicide, most psychiatrists would have no qualms about not prescribe medication to a patient with bipolar disorder. Yet the evidence suggests that drugs are useless. Jitschak Storosum and colleagues at the Netherlands Committee to Evaluate Drugs analyzed four randomized controlled double-blind efficacy of "mood stabilizers" in the prevention of recurrent manic-depressive, which have been submitted between 1997 and 2003. They compared the risk of suicide among patients taking various drugs and in the control group. Among the 943 subjects who took a drug, there were two suicides and eight suicide attempts. There have been only two attempts and no suicides among the 418 patients in the placebo group. If it is based on these figures, the suicidal acts are 2.2 times more common in people under "mood stabilizer" than among those taking placebo.
If the effectiveness of "mood stabilizers" is questionable and if they increase the risk of suicide, should logically be very cautious with regard their widespread use. Now we are currently witnessing in the United States to a sharp increase in diagnoses of bipolar disorder in children. Today, there are even of olanzapine and risperidone in preschool children. Yet, these children do not meet the usual criteria of bipolar disorder type I. Bipolar disorder in children are also not recognized outside the United States. The researchers even claimed recently that the manic-depressive illness appears only very rarely before adolescence. However, some specialists are now willing to consider early signs of disorders Bipolar in hyperactive behavior of the embryo in the uterus.
alone in adults, there is already a strong potential to create an "epidemic" of bipolar artificial because the diagnoses are based on subjective judgments, not on objective criteria such as hospitalization or a work stoppage a month. With children, this risk is even greater because the diagnosis is based primarily on the testimony of parents and because most clinical practices are very few cases the context in which parents raise their children. At a time when both parents often work long hours and where services Childcare reject "difficult" children, medication may be the easiest way to deal with a behavior problem.
Some studies in this area further aggravate the situation. Institutions known for their reliability, such as Massachusetts General Hospital in Boston [one of the most prestigious hospitals in the United States] have tested olanzapine and risperidone on children with a mean age of 4 years. The hospital had recruited participants by broadcasting television advertisements saying that aggressive behavior and difficult for children 4 years could be due to disorders bipolar. Whatever the decision that we can focus on the quality of such research, this ad did more than recruit children with behavior problems really: it suggested that small common disorders must be regarded as a disease.
The use of "mood stabilizers" in maintenance treatment and long-term bipolar disorder is based more on v complex substances? The only thing that is assured is the financial health of the pharmaceutical companies that produce these drugs. David Healy
New Scientist
Author
Professor at the Faculty of Medicine, Cardiff University, Wales, David Healy, 51, is a specialist highly controversial antidepressants. This Irish psychiatrist said that some of them generated a strong addiction. And most importantly, it showed that they could encourage suicide under certain conditions - that the laboratories are recognized after several years of denial (see No. 506 of 13 July 2000). He testified in that trial as an expert in several families who have objected to the pharmaceutical industry. He is the author of thirteen books, including The Time of antidepressants (ed. The troublemakers of thinking in circles, 2002).
"Disease mongering"
"You can make money by persuading healthy people they are sick. That's why pharmaceutical companies promote diseases and advertise to physicians and consumers" , could be read in 2002 in the British Medical Journal, one of the world references the medical press. The review was looking at the phenomenon of disease mongering, the fact to invent a disease to develop a new market and sell drugs, and denounced "the alliance of industry, doctors, patient groups and the media present common ailments as serious problems, personal problems as medical issues, risks as diseases .... "
2006 International Courier weeks of vacation I had the opportunity to read and reread some books of psychiatry dealing with cyclothymia and bipolar and I must say I find it more and more indigestible, like a contract insurance or pre-Reformation scholasticism, complex, obscure and sometimes vain desire to deceive or lull the reader honest. I'm back to my classical XIX and my creativity U.S. academic specialists.
My dear and esteemed William James stated in "Varieties of Religious Experience" that "a degenerated upper" (a great saint or religious leader, according to James!) Is simply a man "with a sensitivity in all directions which is harder than anyone to keep his spiritual house in order and the right path for his feelings and impulses are too fervent and conflicting with each other." That tells you something?
When I worked on creativity and cyclothymia Hantouche with Elijah, I am particularly interested in an academic from the University of Maine (U.S.), Colin Martindale, who explained how creative people are often hypersensitive and they have same time a thirst for novelty (Handbook of Creativity edited by Steinberg p.144). The cyclothymic-sponge can take so much water it ends drown. According to Martindale
, they are often overwhelmed by their environment (stress) because of their hypersensitivity and retreated in quiet places: Proust in his cork-covered part in which he labored for years or Vigny in his "Ivory Tower ". The tranquility and mentally stimulating, contrary to the true adventurers who need real excitement in real life - and then lead them to seek novelty (novelty craving). Martindale evokes the arousal levels of the brain but we can also think of cycles related to mood or season (if that Schumann composed in the summer and spring). For Marcel Proust, we imagine what genius "neurotic" surely Cyclothymic alternating phases of observation and those of socialization and withdrawal necessary for its literary creativity. 
This "model of Proust" may seem theoretical and applied only to artists but upon closer inspection, it can affect all cyclothymic and bipolar alternation in living sometimes dangerous because everyone does not the talent nor the means of Proust or Vigny. To think about anyway and I also have the opportunity to return citing the theories of Frankl and Eriksson applied to cyclothymia.
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