Drowned in a Stream of Prescriptions

By ALAN SCHWARZ
The New York Times
Published: February 2, 2013

Every morning on her way to work, Kathy Fee holds her breath as she drives past the squat brick building that houses Dominion Psychiatric Associates.

It was there that her son, Richard, visited a doctor and received prescriptions for Adderall, an amphetamine-based medication for attention deficit hyperactivity disorder. It was in the parking lot that she insisted to Richard that he did not have A.D.H.D., not as a child and not now as a 24-year-old college graduate, and that he was getting dangerously addicted to the medication. It was inside the building that her husband, Rick, implored Richard’s doctor to stop prescribing him Adderall, warning, “You’re going to kill him.”

It was where, after becoming violently delusional and spending a week in a psychiatric hospital in 2011, Richard met with his doctor and received prescriptions for 90 more days of Adderall. He hanged himself in his bedroom closet two weeks after they expired.

The story of Richard Fee, an athletic, personable college class president and aspiring medical student, highlights widespread failings in the system through which five million Americans take medication for A.D.H.D., doctors and other experts said.

Medications like Adderall can markedly improve the lives of children and others with the disorder. But the tunnel-like focus the medicines provide has led growing numbers of teenagers and young adults to fake symptoms to obtain steady prescriptions for highly addictive medications that carry serious psychological dangers. These efforts are facilitated by a segment of doctors who skip established diagnostic procedures, renew prescriptions reflexively and spend too little time with patients to accurately monitor side effects.

Richard Fee’s experience included it all. Conversations with friends and family members and a review of detailed medical records depict an intelligent and articulate young man lying to doctor after doctor, physicians issuing hasty diagnoses, and psychiatrists continuing to prescribe medication — even increasing dosages — despite evidence of his growing addiction and psychiatric breakdown.

The entire story is here.

Military's increased use of medications under fire

Army has seen eightfold increase since 2005
by Kim Murphy
The Los Angeles Times
Originally published April 8, 2012

U.S. Air Force pilot Patrick Burke’s day started in the cockpit of a B-1B bomber near the Persian Gulf and proceeded across nine time zones as he ferried the aircraft home to South Dakota.

Every four hours during the 19-hour flight, Burke swallowed a tablet of Dexedrine, the prescribed amphetamine known as “go pills.” After landing, he went out for dinner and drinks with a fellow crewman. They were driving back to Ellsworth Air Force Base when Burke began striking his friend in the head.

“Jack Bauer told me this was going to happen – you guys are trying to kidnap me!” he yelled, as if he were a character in the TV show “24.”

When the woman giving them a lift pulled the car over, Burke leaped on her and wrestled her to the ground. “Me and my platoon are looking for terrorists,” he told her before grabbing her keys, driving away and crashing into a guardrail.

Burke was charged with auto theft, drunken driving and two counts of assault. But in October, a court-martial judge found the young lieutenant not guilty “by reason of lack of mental responsibility” – the almost unprecedented equivalent, at least in modern-day military courts, of an insanity acquittal.

The entire story is here.

Ritalin Gone Wrong

By L. ALAN SROUFE

The New York Times

Opinion

Published: January 28, 2012

The molecular model of Ritalin

THREE million children in this country take drugs for problems in focusing. Toward the end of last year, many of their parents were deeply alarmed because there was a shortage ofdrugs like Ritalin and Adderall that they considered absolutely essential to their children’s functioning.

But are these drugs really helping children? Should we really keep expanding the number of prescriptions filled?

In 30 years there has been a twentyfold increase in the consumption of drugs for attention-deficit disorder.

As a psychologist who has been studying the development of troubled children for more than 40 years, I believe we should be asking why we rely so heavily on these drugs.

Attention-deficit drugs increase concentration in the short term, which is why they work so well for college students cramming for exams. But when given to children over long periods of time, they neither improve school achievement nor reduce behavior problems. The drugs can also have serious side effects, including stunting growth.

Sadly, few physicians and parents seem to be aware of what we have been learning about the lack of effectiveness of these drugs.

What gets publicized are short-term results and studies on brain differences among children. Indeed, there are a number of incontrovertible facts that seem at first glance to support medication. It is because of this partial foundation in reality that the problem with the current approach to treating children has been so difficult to see.

Back in the 1960s I, like most psychologists, believed that children with difficulty concentrating were suffering from a brain problem of genetic or otherwise inborn origin. Just as Type I diabetics need insulin to correct problems with their inborn biochemistry, these children were believed to require attention-deficit drugs to correct theirs. It turns out, however, that there is little to no evidence to support this theory.

The entire story is here.

Report: 1 in 5 of US adults on behavioral meds

NEW YORK (AP) — More than 20 percent of American adults took at least one drug for conditions like anxiety and depression in 2010, according to an analysis of prescription data, including more than one in four women.

The report, released Wednesday by pharmacy benefits manager Medco Health Solutions Inc., found that use of drugs for psychiatric and behavioral disorders rose 22 percent from 2001. The medications are most often prescribed to women aged 45 and older, but their use among men and in younger adults climbed sharply. In adults 20 to 44, use of antipsychotic drugs and treatments for attention deficit hyperactivity disorder more than tripled, and use of anti-anxiety drugs like Xanax, Valium and Ativan rose 30 percent from a decade ago.

The statistics were taken from Medco's database of prescriptions and is based on 2.5 million patients with 24 months of continuous prescription drug insurance and eligibility.

The entire story is here.

Are Psychiatric Medications Making Us Sicker?

By John Horgan

The Chronicle of Higher Education

Three years ago, I was reminded in dramatic fashion of the chasm between psychiatry and more-effective branches of medicine. My 14-year-old son, Mac, while playing lacrosse, emerged from a collision with his right arm askew. I drove him to a local hospital, where an orthopedic surgeon on duty immediately diagnosed the injury: dislocated elbow. He gave Mac an oral and local anesthetic and put him in a portable X-ray machine that showed Mac's elbow joint on a screen, in real time. Watching the screen, the doctor quickly snapped Mac's elbow back into place.

Overcome with gratitude to the doctor, I was leading my groggy son out of the hospital when my cellphone rang. An old friend, whom I'll call Phil, was on the line. He was in the psychiatric ward of a New York hospital, to which his 16-year-old son had been committed. The boy, who was taking antidepressants for depression, had threatened to commit suicide, not for the first time. The doctors were recommending electroconvulsive therapy, or ECT. Knowing that I had written about shock therapy and other psychiatric treatments, Phil asked my opinion. The fact that Phil had called me, a mere journalist, for advice in such a dire situation spoke volumes about the troubles of modern psychiatry.

I first took a close look at treatments for mental illness 15 years ago while researching an article for Scientific American. At the time, sales of a new class of antidepressants, selective serotonin reuptake inhibitors, or SSRI's, were booming. The first SSRI, Prozac, had quickly become the most widely prescribed drug in the world. Many psychiatrists, notably Peter D. Kramer, author of the best seller Listening to Prozac, touted SSRI's as a revolutionary advance in the treatment of mental illness. Prozac, Kramer said in a phrase that I hope now haunts him, could make patients "better than well."

Clinical trials told a different story. SSRI's are no more effective than two older classes of antidepressants, tricyclics and monoamine oxidase inhibitors. What was even more surprising to me—given the rave reviews Prozac had received from Kramer and others—was that antidepressants as a whole were not more effective than so-called talking cures, whether cognitive behavioral therapy or even old-fashioned Freudian psychoanalysis. According to some investigators, treatments for depression and other common ailments work—if they do work—by harnessing the placebo effect, the tendency of a patient's expectation of improvement to become self-fulfilling. I titled my article "Why Freud Isn't Dead." Far from defending psychoanalysis, my point was that psychiatry has made disturbingly little progress since the heyday of Freudian theory.

The entire story can be read here.

Antipsychotics overprescribed in nursing homes

By M. Price

The Monitor on Psychology

September 2011, Volume 42, No. 8

Print Version: Page 11

Physicians are widely prescribing antipsychotics to people in nursing homes for off-label conditions such as dementia, and Medicare is largely picking up the bill, even though Medicare guidelines don't allow for off-label prescription reimbursements, according to an audit released in May by the U.S. Department of Health and Human Services Office of the Inspector General.

The findings underscore the fact that antipsychotics are often used when behavioral treatments would be more effective, psychologists say.

The office reviewed Medicare claims of people age 65 and older living in nursing homes in 2007—the most recent data at the time the study began—and found that 51 percent of all claims contained errors, resulting $116 million worth of antipsychotics such as Abilify, Risperdal and Zyprexa being charged to Medicare by people whose conditions didn't match the drugs' intended uses. Among the audit's findings are:

• 14 percent of the 2.1 million elderly people living in nursing homes use Medicare to pay for at least one antipsychotic prescription.
• 83 percent of all Medicare claims for antipsychotics are, based on medical reviews, prescribed for off-label conditions, specifically dementia.
• 22 percent of the claims for antipsychotics do not comply with the Centers for Medicare and Medicaid Services' guidelines outlining how drugs should be administered, including those guidelines stating that nursing home residents should not receive excessive doses and doses over excessive periods of time.

The report suggests that Medicare overseers reassess their nursing home certification processes and develop methods besides medical review to confirm that medications are prescribed for appropriate conditions.

Why such high rates of overprescription for antipsychotics? HHS Inspector General Daniel Levinson argued in the report that pharmaceutical companies' marketing tactics are often to blame for antipsychotics' overprescribing. Victor Molinari, PhD, a geropsychologist at the University of South Florida in Tampa, says that another important issue is the dearth of psychologists trained to provide behavioral interventions to people in nursing homes. While he agrees that people in nursing homes are taking too much antipsychotic medication, he believes nursing home physicians are often responding to a lack of options.

Many nursing home administrators are quite savvy in their mental health knowledge and would prefer to offer their residents the option of behavioral treatments, Molinari says, but when residents need immediate calming, physicians will turn to antipsychotic medication because it's quick and available. Additionally, he says, many nursing home staff aren't educated enough about nonmedical options, so they go straight for the antipsychotics.

"It follows the saying, 'If your only tool is a hammer, everything is a nail,'" he says. "Nursing homes are not just straitjacketing residents with medications as a matter of course, but because there are a host of barriers to giving them optimal care."

Time to concentrate on human factors in mental illness

Sami Timimi consultant child and adolescent psychiatrist

NHS Lincolnshire, Lincoln, UK

BMJ 2011;343:d4377

Drug companies losing interest in psychiatry is great news for psychiatry and mental health services but most of all for patients.¹ Other research funding sources may also recognize that a focus on the brain is not a credible, evidence based choice likely to contribute to better care for those who have mental distress. Drug companies have found mental health highly lucrative, with multibillion pound blockbuster drugs such as the misnamed (for marketing purposes) antidepressants and antipsychotics. Sooner or later it would become apparent that the evidence based cupboard was empty—that all of the drugs were of dubious effectiveness, had varying degrees of neurotoxicity, created abnormal mental states (which can be lifesaving for some at certain points in their distress) rather than corrected them, and were different from illicit drugs only through who provides them and how they are subsequently used rather than because of discoveries of some particular therapeutic potency.

In biological psychiatry a reliance on psychotropic drugs has encouraged some remarkable developments such as an increase in the numbers and a worsening of the long term prognosis for those categorised as mentally ill,² and an increase in stigma that is associated with the model that mental illness is “an illness like any other illness.”³ Freed from the corrupting shackles of the pharmaceutical industry we can put money into better understanding the factors that have the biggest effects on outcome: social factors outside of treatment and the therapeutic relationship within treatment.⁴

Competing interests: None declared.

¹ Wise J. Research into treatments for mental illness is under threat. BMJ 2011;342:d3747. (14 June.)

² Whitaker R. Anatomy of an epidemic . Crown, 2010.

³ Read J, Haslam N, Sayce L, Davies E. Prejudice and schizophrenia: a review of the

‘mental illness is an illness like any other’ approach. Acta Psychiatr Scand 2006;114:303-18.

⁴ Timimi S. Campaign to Abolish Psychiatric Diagnostic Systems such as ICD and DSM (CAPSID). 2011. Available at: www.criticalpsychiatry.net/?p=527.

Loughner forced medication OKd by judge

From the San Francisco Chronicle

A judge ruled Wednesday that prison officials can forcibly give the man accused of the Tucson shooting rampage antipsychotic drugs in a bid to make him mentally fit for trial.

U.S. District Judge Larry Burns' decision came after Jared Lee Loughner's attorneys filed an emergency request last week to prevent any forced medication of their client without approval from a judge. The judge said he did not want to second guess doctors at the federal prison in Springfield, Mo., who determined that Loughner was a danger.

"I have no reason to disagree with the doctors here," Burns said. "They labor in this vineyard every day."

Loughner, who was not at the hearing in San Diego, has been at the Missouri facility since May 28 after the judge concluded he was mentally unfit to stand trial and help in his legal defense.

Mental health experts had determined the 22-year-old college dropout suffers from schizophrenia and will try to make him psychologically fit to stand trial. He will spend up to four months at the facility.

Prosecutors have argued that Loughner should be given antipsychotic drugs because he has been diagnosed as schizophrenic and poses a danger to others.

"This is a person who is a ticking time bomb," prosecutor Wallace Kleindienst said Wednesday.

In a filing Tuesday, prosecutors cited an April 4 incident where Loughner spit on his own attorney, lunged at her and had to be restrained by prison staff. They also cited an outburst during a March 28 interview with a mental health expert in which Loughner became enraged, cursed at her and threw a plastic chair at her twice.

Loughner has pleaded not guilty to 49 charges stemming from the Jan. 8 shooting that injured Rep. Gabrielle Giffords and 12 others and killed six people, including John Roll, the chief federal judge for Arizona.

If Loughner is later determined to be competent enough to understand the case against him and assist his lawyers, the court proceedings will resume.