Improving the ethics of pharma research is an important part of preventing tragedies like the Adam Lanza case - in my opinion . The news about this senseless killings the past week saddens me, as it should sadden most reasonable people.
Pundits from various sides of various issues like gun control and psychiatric medication compliance will try to make this story fit their own point of view, but first of all folks- it's just plain sad. LITTLE kids were the victims. sad.
We also may never know for sure what meds Adam was actually on at the time he did the violence. Also withdrawing too quickly from any psych med can produce results that are 'off the charts' in human behaviour. This is not the behaviour the person would exhibit on the med, or if he was titrated slowly off of it, and med free, or on a different med that worked better for him.
Where can you find the federal standards that govern the ethics of psychiatric medical research ? (especially wrt children, adolescents, the elderly, minorities and other vulnerable populations)
The Belmont Report
http://en.wikipedia.org/wiki/Belmont_Report
http://www.brynmawr.edu/ceo/students/ethics/belmontreport.html
Sorry to echo information from a previous post of mine, but the occasion calls for it
Surprisingly, none of the platitudes expressed in the Belmont Report are federal law, making it, in effect, a toothless federal policy.
It is hard for reform to get through congress, since many congress persons rely on donations from pharma- friendly PACs and lobbies
It is difficult for university researchers today to follow the hypothesis and data analysis steps of the scientific method in an unbiased manner, since there is a lot of pressure on them to produce results that the pharma company sponsors want.
Only public outrage IN THE RIGHT DIRECTION can reform psych research. It happened once before, after the Tuskeegee tragedy that spawned the Belmont Report in the 1970s
What are the consequences for a society where some university researchers think more about profits, accolades and their own giant egos than seeking scientific truth ?
Monday, December 17, 2012
Thursday, June 21, 2012
A brief update
I apologize for not posting anything recently. Google recently made it difficult to have multiple accounts. Out of respect for my son's privacy, I was maintaining this blog with an account that had LESS personal info about me and my family, other than the medication issue.
JT's current diagnosis is in the Aspbergers / autism spectrum with some ADD and of course 'a mixed diagnosis that includes issues in the affective spectrum too'. He takes Clozaril now, and I am really troubled by that. He also takes a small amt of stimulant in the AM. Probably another 'bipolar' med too.
But there is good news . Ok.. I'm a parent.. I'll take good news ! He is 21. He graduated from high school. He is taking a scaled back community college program which should lead to a certificate and then possibly an AA in computer technology. JT loves computers ! He loves to fish too. No regular job yet.
Thanks for your comments and for reading this blog. And Stephanie, thanks for all the good info over the years.. you are like the rock of Gibraltar ! I guess Phil Dawdy has stopped 'furious seasons' and needs to come off the blog roll. Some other blogs that have popped up in the last year or two need to go on the blogroll.
Congress and a democratic president didn't make any significant dents in Pharma lobbying and NIH/ academia conflicts of interest in the last 4 years. I am not too surprised. Senators and congresspeople have unlimited terms.. maybe this has something to do with the current stagnation. At least there is that one Republican senator who keeps asking for academic honesty in pharma research. One light in the storm.. oh well
"So it goes" ( I think that's from Kurt Vonnegut.. but I forget which book)
If I move to another blog host-er I will definitely leave a fwd'ing link.
JT's current diagnosis is in the Aspbergers / autism spectrum with some ADD and of course 'a mixed diagnosis that includes issues in the affective spectrum too'. He takes Clozaril now, and I am really troubled by that. He also takes a small amt of stimulant in the AM. Probably another 'bipolar' med too.
But there is good news . Ok.. I'm a parent.. I'll take good news ! He is 21. He graduated from high school. He is taking a scaled back community college program which should lead to a certificate and then possibly an AA in computer technology. JT loves computers ! He loves to fish too. No regular job yet.
Thanks for your comments and for reading this blog. And Stephanie, thanks for all the good info over the years.. you are like the rock of Gibraltar ! I guess Phil Dawdy has stopped 'furious seasons' and needs to come off the blog roll. Some other blogs that have popped up in the last year or two need to go on the blogroll.
Congress and a democratic president didn't make any significant dents in Pharma lobbying and NIH/ academia conflicts of interest in the last 4 years. I am not too surprised. Senators and congresspeople have unlimited terms.. maybe this has something to do with the current stagnation. At least there is that one Republican senator who keeps asking for academic honesty in pharma research. One light in the storm.. oh well
"So it goes" ( I think that's from Kurt Vonnegut.. but I forget which book)
If I move to another blog host-er I will definitely leave a fwd'ing link.
Thursday, October 01, 2009
Tantalizing scientific evidence on the role of mid-brain mechanisms in fear response
Evidence That Altered Amygdala Activity in Schizophrenia Is Related to Clinical State [ie the drugs someone is taking] and Not Genetic Risk
Roberta Rasetti, M.D., Venkata S. Mattay, M.D., Lisa M. Wiedholz, B.A., Bhaskar S. Kolachana, Ph.D., Ahmad R. Hariri, Ph.D., Joseph H. Callicott, M.D., Andreas Meyer-Lindenberg, M.D., Ph.D., and Daniel R. Weinberger, M.D.
http://ajp.psychiatryonline.org/cgi/content/abstract/166/2/216
OBJECTIVE: Although amygdala dysfunction is reported in schizophrenia, it is unknown whether this deficit represents a heritable phenotype that is related to risk for schizophrenia or whether it is related to disease state. The purpose of the present study was to examine amygdala response to threatening faces among healthy siblings of schizophrenia patients in whom a subtler heritable deficit might be observed. METHOD: Participants were 34 schizophrenia patients, 29 unaffected siblings, and 20 healthy comparison subjects. Blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) was conducted during an implicit facial information processing task.
The N-back working memory task, which has been shown to elicit prefrontal cortex abnormalities in unaffected siblings of schizophrenia patients, was employed as a positive experimental control. RESULTS:
Schizophrenia patients demonstrated a deficit in amygdala reactivity to negative face stimuli and an alteration, correlated with neuroleptic drug dosage, in the functional coupling between the amygdala and subgenual cingulate. In contrast, unaffected siblings showed a pattern that was not statistically different from that of healthy comparison subjects. ...
...
CONCLUSIONS: These data suggest that the pathophysiological mechanism underlying the inability of individuals with schizophrenia to normally engage the amygdala in processing fearful and angry facial representations is more likely a phenomenon related to the disease state, specifically to treatment. - snip [inline bolding is mine, the words are from the experimenters -padraic]
Roberta Rasetti, M.D., Venkata S. Mattay, M.D., Lisa M. Wiedholz, B.A., Bhaskar S. Kolachana, Ph.D., Ahmad R. Hariri, Ph.D., Joseph H. Callicott, M.D., Andreas Meyer-Lindenberg, M.D., Ph.D., and Daniel R. Weinberger, M.D.
http://ajp.psychiatryonline.org/cgi/content/abstract/166/2/216
OBJECTIVE: Although amygdala dysfunction is reported in schizophrenia, it is unknown whether this deficit represents a heritable phenotype that is related to risk for schizophrenia or whether it is related to disease state. The purpose of the present study was to examine amygdala response to threatening faces among healthy siblings of schizophrenia patients in whom a subtler heritable deficit might be observed. METHOD: Participants were 34 schizophrenia patients, 29 unaffected siblings, and 20 healthy comparison subjects. Blood-oxygen-level-dependent (BOLD) functional magnetic resonance imaging (fMRI) was conducted during an implicit facial information processing task.
The N-back working memory task, which has been shown to elicit prefrontal cortex abnormalities in unaffected siblings of schizophrenia patients, was employed as a positive experimental control. RESULTS:
Schizophrenia patients demonstrated a deficit in amygdala reactivity to negative face stimuli and an alteration, correlated with neuroleptic drug dosage, in the functional coupling between the amygdala and subgenual cingulate. In contrast, unaffected siblings showed a pattern that was not statistically different from that of healthy comparison subjects. ...
...
CONCLUSIONS: These data suggest that the pathophysiological mechanism underlying the inability of individuals with schizophrenia to normally engage the amygdala in processing fearful and angry facial representations is more likely a phenomenon related to the disease state, specifically to treatment. - snip [inline bolding is mine, the words are from the experimenters -padraic]
The Belmont Report- governs the ethics of medical research in USA
Where can you find the federal standards that govern the ethics of psychiatric med research ? (especially wrt children, adolescents, the elderly, minorities and other vulnerable populations)
The Belmont Report http://www.brynmawr.edu/ceo/students/ethics/belmontreport.html - this report was written as part of the response to the moral outrage over the Tuskeegee syphilis experiments, when that was discovered in the 1970s.
-updated link above 12-17-12
Also see
http://en.wikipedia.org/wiki/Belmont_Report
The Belmont Report http://www.brynmawr.edu/ceo/students/ethics/belmontreport.html - this report was written as part of the response to the moral outrage over the Tuskeegee syphilis experiments, when that was discovered in the 1970s.
-updated link above 12-17-12
Also see
http://en.wikipedia.org/wiki/Belmont_Report
Thursday, May 07, 2009
academics in psychiatry call for better research standards- letter to NEJM
link to article-
http://content.nejm.org/cgi/content/full/360/19/2035
Today, the field of psychiatry is perceived to have suffered a unique "crisis of credibility" with respect to the growing influence of pharmaceutical companies on organized psychiatry.1
The reaction of the organization that is increasingly in question, the American Psychiatric Association (APA), has ranged from calling for greater transparency — mandating that all members of task forces that produce its diagnostic guidelines (i.e., the Diagnostic and Statistical Manual of Mental Disorders [DSM]) complete financial-disclosure statements — to labeling critics' concerns about conflicts of interest as a "well documented antimedication bias."2 However, it is clear that transparency alone is not enough of a safeguard: approximately 68% of the members of the DSM-V task force reported having industry ties, which represents a relative increase of 20% over the proportion of DSM-IV task-force members with such ties. Also, of the 137 DSM-V panel members who have posted disclosure statements, 77 (56%) have reported having industry ties, such as holding stock in pharmaceutical companies, serving as consultants to industry, or serving on company boards3 — no improvement over the 56% of DSM-IV members who were found to have such industry relationships.4 If financial conflicts of interest are not reduced, private-sponsor bias in research will be exacerbated.
Moreover, both disclosure requirements and specific policies about the management of existing conflicts of interest are missing in the APA's clinical practice guidelines. This is an especially important omission because these guidelines are seen by many as the standard for evidence-based medicine in clinical psychiatry. The APA is in the process of revising both its diagnostic guidelines and some of its most influential clinical practice guidelines (e.g., for bipolar disorder and major depressive disorder). Thus, it would be both timely and prudent for the APA to take this opportunity to address the gaps in existing policies regarding transparency and the management of conflicts of interest. For example, unrestricted research grants were excluded from disclosure requirements, and currently, there are no policies for managing indirect financial ties, such as industry funds that are pooled and given to academic departments, hospitals, and medical schools. To strengthen its current conflict-of-interest policy and monitor the process for the development of unbiased diagnostic and treatment guidelines, the APA will need to substantially free itself from its extensive financial ties to pharmaceutical companies.
.. as of today I have 3 NEW heros - padraic
http://content.nejm.org/cgi/content/full/360/19/2035
Today, the field of psychiatry is perceived to have suffered a unique "crisis of credibility" with respect to the growing influence of pharmaceutical companies on organized psychiatry.1
The reaction of the organization that is increasingly in question, the American Psychiatric Association (APA), has ranged from calling for greater transparency — mandating that all members of task forces that produce its diagnostic guidelines (i.e., the Diagnostic and Statistical Manual of Mental Disorders [DSM]) complete financial-disclosure statements — to labeling critics' concerns about conflicts of interest as a "well documented antimedication bias."2 However, it is clear that transparency alone is not enough of a safeguard: approximately 68% of the members of the DSM-V task force reported having industry ties, which represents a relative increase of 20% over the proportion of DSM-IV task-force members with such ties. Also, of the 137 DSM-V panel members who have posted disclosure statements, 77 (56%) have reported having industry ties, such as holding stock in pharmaceutical companies, serving as consultants to industry, or serving on company boards3 — no improvement over the 56% of DSM-IV members who were found to have such industry relationships.4 If financial conflicts of interest are not reduced, private-sponsor bias in research will be exacerbated.
Moreover, both disclosure requirements and specific policies about the management of existing conflicts of interest are missing in the APA's clinical practice guidelines. This is an especially important omission because these guidelines are seen by many as the standard for evidence-based medicine in clinical psychiatry. The APA is in the process of revising both its diagnostic guidelines and some of its most influential clinical practice guidelines (e.g., for bipolar disorder and major depressive disorder). Thus, it would be both timely and prudent for the APA to take this opportunity to address the gaps in existing policies regarding transparency and the management of conflicts of interest. For example, unrestricted research grants were excluded from disclosure requirements, and currently, there are no policies for managing indirect financial ties, such as industry funds that are pooled and given to academic departments, hospitals, and medical schools. To strengthen its current conflict-of-interest policy and monitor the process for the development of unbiased diagnostic and treatment guidelines, the APA will need to substantially free itself from its extensive financial ties to pharmaceutical companies.
.. as of today I have 3 NEW heros - padraic
Tuesday, April 21, 2009
A timeline of my son's medication to date
3/1/2009 Depakote Geoden Concerta Welbutrin. Advent of JTs 18th bday (in February) and dorm change neccessitated by school re-org cause instability. JT convinced he can leave school since he is 18- partially true ! JT acts out violently against a therapist- claims fugue like symptoms and akathisia* he was experiencing preceded this un-premeditated attack. Note John's current diagnosis is more in the autism spectrum.
*akathisia while on Abilify- the event happened before he was put on Geoden.
2/3/2009 Depakote Abilify Concerta Welbutrin Inderal, Concerta 36 mg QAM; Abilify 5mg QAM/ 10 mg QAS; Depakote 500 mg QAM/ 1000 mg QAS; Inderal 240 mg QHS; Welbutrin 100 mg BID
1/1/2009 note JT's meds were pretty stable from 2007- 2009 though I kept up the questions to the docs about the purpose and efficacy of Abilify*. JT in out-of state residence- school- Sept 2007 thru Spring 2009 (that is 'the present' when doing this blog post) he is doing really well in this period when compared to the previous 2-3 years. Phone calls to him regulated to once-weekly after he acts out a lot on the phone about leaving school. Some or all of us up to see him every couple months. Several home visits too. Takes up guitar and fishing. I will probably always treasure memories of some of the happy days during this period that we spent with him.
* Why is JT prescribed antipsychotics ? He has never had a hallucination. He has never heard voices. UNBIASED research has never shown antipsychotics to be effective at reducing violence over the long term. There is a fair body of research literature that shows antipsychotics like Haldol increase violence, especially pointless, un- meditated violence. maybe the other ones do too, and unbiased research would show that. Meanwhile mental health workers are indoctrinated by Pharma-funded CME courses to believe that they are safer on the job if more patients take antipsychotics. When I ask this question, the docs usually answer with vague nice-ities such as : "It will help to clear up his thinking. " Huh ? Do they really believe that ? In what ways do a long -term doseage of antipsychotics clear up a non-schizophrenic individuals thinking ? How has that been measured ?
1/1/2007 Depakote Abilify Concerta Welbutrin Inderal Concerta 36 mg QAM; Abilify 5mg QAM/ 10 mg QAS; Depakote 500 mg QAM/ 1000 mg QAS; Inderal 240 mg QHS; Welbutrin 100 mg BID - Note- JT has been taking approx the same meds 2007- 2009. Welbutrin dosage may have varied slightly during this time.
11/15/2006 Tegretol Abilify Concerta Welbutrin (Bupropion) SR AND Depakote ! adding Zydis regular BID "Tegritol XR 200 MG at bedtime Depakote ER 750 MG AM-1000 MG PM Abilify 5 mg AM- 20 Mg PM Welbutrin 100 MG bid Concerta 27 mg one in AM Zyprexa 5 mg BID Inderal 60 Mg once a day."
12/1/2005 note Late 2005 they added Inderal 60 Mg 1 time a day
6/15/2005 some tweaking of dosages 2005-06. A bid by the treating doctor to put him on Haldol was dropped after Dad asked questions about Haldol and violence.
6/7/2005 note levothyroxine added for thyroid 0.05 mg at mid-day. Added B12 1000 mcg
6/7/2005 Tegretol Abilify Concerta Welbutrin (Bupropion) SR AND Depakote ! adding Zydis regular BID "Tegritol XR 400 BID and 200 BID and 100 BID so 700 in all 500 mg Depakote BID Abilify 15 mg Welbutrin 100 MG bid Concerta 27 mg one in AM Zyprexa 5 mg BID"
5/1/2005 Tegretol Abilify Concerta Welbutrin (Bupropion) SR adding Zydis as prn "Tegritol XR 400 BID and 200 BID and 100 BID so 700 in all. Abilify 15 mg Welbutrin 100 MG bid Concerta 27 mg one in AM"
5/1/2005 note increase of Tegritol in April- May 2005
4/26/2004 Tegretol Abilify Concerta Welbutrin (Bupropion) SR
2/1/2004 Straterra taken off after severe appetite loss- in 1 year JT goes from 85 lb here to back up to145 lbs ! The doc did not beieve at first that Staterra was the culprit.
9/10/2003 "Tegretol 600 AM & PM (7 am 6:30 PM)" Seroquel 150 AM & PM Welbutrin SR 150 AM & PM Straterra 60 MG AM , -- info is from VM team notes. DR MY
5/17/2003 5/17/03 5th hospitalization at SP _west. Seroquel titrated by 50 mg here
5/1/2003 "Tegritol XR 400 AM 600 PM" Seroquel 200 bid (400 daily total) Buspar Welbutrin 150 bid Eskalith 450 bid Straterra added _ for ADHD … titrating Buspar
4/8/2003 "Tegritol XR 400 AM 600 PM" Seroquel 200 bid Buspar 10 tid Welbutrin 150 bid Eskalith 450 bid, -- "4/8/03 4th hospitalization beginning (also had 1 day inpatient at G__C 4/7/03) after violent behavior towards family self- harm and property destruction"
3/23/2003 "Tegritol XR 400 AM 600 PM (at discharge)" Seroquel 200 bid (at discharge Buspar 10 tid Welbutrin 150 bid Eskalith 450 bid, -- 3/23 JT back in 3rd hospitalization SP after violent behavior towards family- Discharge 3/31/03
3/17/2003 Tegritol XR 400 bid Seroquel 100 tid Buspar 10 tid Welbutrin 150 bid Eskalith JT Discharge 3/17…
3/17/2003 note "After discharge Mom and Dad discuss possible titration of Tegritol (in favor of using Eskalith as the mood stabilizer… why have two major mood stabilizers along with all other meds and risk possible contraindications) unfortunately JT does not prove stabe enough to try any outpatient med changes"
3/11/2003 Tegritol XR Seroquel Buspar 10 tid Welbutrin 150 bid Eskalith "3/11 Dr. VM is repl Trileptal w another anti convulsant incr Seroquel."
3/7/2003 Trileptal Seroquel Buspar Welbutrin Eskalith added back in Another Hospitalization SP starting 3/7/03 (Friday)
2/25/2003 Trileptal Seroquel Buspar Welbutrin Hospitalized at SP adolescent unit for violent acting out towards Mom. - disch following Monday
1/22/2003 Eskalith Seroquel Buspar Welbutrin "Begin titrating Lithium- reason teacher (Ms. F) noted cognitive dulling also there are a few possible borderline thyroid readings in his recent history Dr H wants to try Trileptal add Trileptal. During this period dosages of Zydis( Zyprexa) were given as PRNs at Dr. H's direction."
1/20/2003 Eskalith 450 bid "Seroquel 100 bid 50 noon" Buspar Welbutrin Note 4 months with no hospitalizations !
9/14/2002 Eskalith 450 bid "Seroquel 100 bid 50 noon" Buspar Welbutrin "discharge post hosp seroquel- 100mg bid 50 mg noon buspar- eskalith- 450 mg bid welbutrin- (probably raised to 150 bid here) "
9/7/2002 Eskalith 450 bid "Seroquel 100 bid 50 noon" Buspar 7.5 tid Welbutrin 100 bid "pre hosp seroquel- 100mg bid 50 mg noon buspar- 7.5 mg tid eskalith- 450 mg bid welbutrin- 100 mg bid "
9/1/2002 Note 5+ months with no hospitalizations !
3/18/2002 Lithium Seroquel Buspar Welbutrin "Another hospitalization at SP. After addition of Welbutrin JT's self- harm statements became very rare virtually non- existent !"
2/1/2002 Lithium Seroquel Buspar Nortyptyline "JT readmitted SP for ~ 5 days another increase of Seroquel"
1/31/2002 Lithium Seroquel Buspar Nortyptyline "JT at SP - increase of Seroquel add Lithium"
9/1/2001 Depakote Seroquel Buspar Nortyptyline "JT is discharged from VM . The first month or two are pretty good a 'honeymoon period'"
9/30/2001 Depakote Seroquel Buspar Nortyptyline JT begins to have trouble with behavior at WO school. Mom is lobbying for his admission to full year program at (SP private) school
7/1/2001 Depakote Seroquel Buspar Nortyptyline JT vacation at beach with parents is overall pleasant
2/1/2001 Depakote Seroquel Buspar Nortyptyline "Titrated to 100 mg Seroquel again with no ill effects no overall increase in violent behavior."
11/1/2000 Depakote Seroquel Buspar Nortyptyline "Dr P begins to titrate off the Seroquel slowly from 150 to 125. JTs short term memory improves and he begins to talk more with his therapist"
7/1/2000 Depakote Seroquel Buspar add Nortyptyline "Dr P adds Nortryptyline since it is (at lease partially) an epinephrine antagonist and also an anti- depressant"
6/1/2000 Depakote Seroquel Buspar JT is home. Fairly sure at lease one hospitalization here. We re- apply for residential at VM
2/1/200 note Dad has a one time eonly consult with Dr Peter Breggin in Bethesda- who tells him he can do more good by staying with his family and asking intelligent questions about the meds. Good advice ! Dad pays for this out-of-pocket.
2/1/200 Depakote Seroquel Buspar "November 1999- February 2000 JT is in residential at SV residential. At some point here Zyprexa was replaced by Seroquel which was better for him since he didn’t gain as much weight (was getting grossly overweight on Zyprexa). Overall this is an unpleasant experience for the family. The staff at SV is not used to working with birth parents."
10/1/1999 Depakote Risperdol (removed and Zyprexa added ) "Continue Tenex add Effexor ? Antidepressant"
6/1/1999 Depakote Risperdol "remove Klonodine add Guaneficine Tenex) has similar anti-anxiety y properties"
5/1/1999 Depakote Risperedol Klonodine "250mg Depakote 2x day 0.5 mg Risperedol AM 1.5 Risperedol pm .05 Clonodine 2 x day"
5/1/1999 Depakote Risperedol Klonodine "Since addition of Klonodine and Risperedol JT is harder to wake up in AM but generally has a good AM. Behavior in school is still good unchanged. Still can keep awake at school. Some incidents of hitting his mother and sister at home. Overall affect at home in PM cycles with more ""dark"" periods. JT generally poops out at 7:30- 8:00 PM falling into a deep sleep. "
4/1/1999 Depakote Risperedol Klonodine "250mg Depakote 2x day 0.5 mg Risperedol AM 1.5 Risperedol pm .05 Clonodine 2 x da"
2/1/1999 Zoloft Depakote
1/1/1999 "Zoloft six day trial of Adorax" see comment >>> "JT tried on Adorax (anti-anxiety) for six days is taken off because of poor staff communication that he had a really bad weekend when it was just average problems. Dad feels trial of Adorax was not long enough"
12/1/1998 begin Zoloft (after ?) Adderall see comment >>> "JT is tried on Adderall (like Ritalin) - becomes very hyper and anxious also vomits at school- taken off after two days"
11/1/1998 No Meds
10/1/1998 Zoloft/ no meds no meds at all at VM !
9/1/1998 Zoloft Tegritol
8/1/1998 Zoloft Tegritol Neurontin Neurontin is titrated with no ill effects. Dad (with Mom's concurrence) request 'peeling off the layers of meds'
7/1/1998 Zoloft Tegritol Neurontin Risperedol "JT starts at local VM residence in July.
Risperdol is titrated with no ill effects. Mom and family visit at least twice a week. J is reading the Harry Potter books out thus far in 1998 I think 2 or 3"
5/1/1998 Zoloft Tegritol Neurontin Risperedol
3/1/1997 Nortryptyline "Depakote (briefly) then Tegritol" Neurontin "JT age 6 when psychoactive meds started- Dad objects to the meds Mom wants them. J's original diagnosis was Oppositional Defiant. The docs probably added a 'rule out something in the affective spectrum' after they started medicating him. Note here J is an early reader."
3/1/1997 note "After an anxious incident in his first day of a 'French Immersion Program ' full day kindergarten JT has a pretty normal year of kindergarten and attends regular Summer camp. Mom fights to get him in Special Ed over Dad's (and the regular school system's) objections"
3/1/1997 note "Mom and Dad disagree wrt whether JT presented any 'symptoms' of abnormality in toddler years. Dad agrees JT was a 'spirited child' who like riding bikes hiking playing ball and got into occasional mischief. The intent of this table is to show JTs meds not give his ENTIRE background which would create more contention from various stakeholders wrt the content."
11/18/1995 note JT's sister is born. Mom shows increasing signs of being unable to sleep while breastfeeding
2/9/1991 note JT is born
*akathisia while on Abilify- the event happened before he was put on Geoden.
2/3/2009 Depakote Abilify Concerta Welbutrin Inderal, Concerta 36 mg QAM; Abilify 5mg QAM/ 10 mg QAS; Depakote 500 mg QAM/ 1000 mg QAS; Inderal 240 mg QHS; Welbutrin 100 mg BID
1/1/2009 note JT's meds were pretty stable from 2007- 2009 though I kept up the questions to the docs about the purpose and efficacy of Abilify*. JT in out-of state residence- school- Sept 2007 thru Spring 2009 (that is 'the present' when doing this blog post) he is doing really well in this period when compared to the previous 2-3 years. Phone calls to him regulated to once-weekly after he acts out a lot on the phone about leaving school. Some or all of us up to see him every couple months. Several home visits too. Takes up guitar and fishing. I will probably always treasure memories of some of the happy days during this period that we spent with him.
* Why is JT prescribed antipsychotics ? He has never had a hallucination. He has never heard voices. UNBIASED research has never shown antipsychotics to be effective at reducing violence over the long term. There is a fair body of research literature that shows antipsychotics like Haldol increase violence, especially pointless, un- meditated violence. maybe the other ones do too, and unbiased research would show that. Meanwhile mental health workers are indoctrinated by Pharma-funded CME courses to believe that they are safer on the job if more patients take antipsychotics. When I ask this question, the docs usually answer with vague nice-ities such as : "It will help to clear up his thinking. " Huh ? Do they really believe that ? In what ways do a long -term doseage of antipsychotics clear up a non-schizophrenic individuals thinking ? How has that been measured ?
1/1/2007 Depakote Abilify Concerta Welbutrin Inderal Concerta 36 mg QAM; Abilify 5mg QAM/ 10 mg QAS; Depakote 500 mg QAM/ 1000 mg QAS; Inderal 240 mg QHS; Welbutrin 100 mg BID - Note- JT has been taking approx the same meds 2007- 2009. Welbutrin dosage may have varied slightly during this time.
11/15/2006 Tegretol Abilify Concerta Welbutrin (Bupropion) SR AND Depakote ! adding Zydis regular BID "Tegritol XR 200 MG at bedtime Depakote ER 750 MG AM-1000 MG PM Abilify 5 mg AM- 20 Mg PM Welbutrin 100 MG bid Concerta 27 mg one in AM Zyprexa 5 mg BID Inderal 60 Mg once a day."
12/1/2005 note Late 2005 they added Inderal 60 Mg 1 time a day
6/15/2005 some tweaking of dosages 2005-06. A bid by the treating doctor to put him on Haldol was dropped after Dad asked questions about Haldol and violence.
6/7/2005 note levothyroxine added for thyroid 0.05 mg at mid-day. Added B12 1000 mcg
6/7/2005 Tegretol Abilify Concerta Welbutrin (Bupropion) SR AND Depakote ! adding Zydis regular BID "Tegritol XR 400 BID and 200 BID and 100 BID so 700 in all 500 mg Depakote BID Abilify 15 mg Welbutrin 100 MG bid Concerta 27 mg one in AM Zyprexa 5 mg BID"
5/1/2005 Tegretol Abilify Concerta Welbutrin (Bupropion) SR adding Zydis as prn "Tegritol XR 400 BID and 200 BID and 100 BID so 700 in all. Abilify 15 mg Welbutrin 100 MG bid Concerta 27 mg one in AM"
5/1/2005 note increase of Tegritol in April- May 2005
4/26/2004 Tegretol Abilify Concerta Welbutrin (Bupropion) SR
2/1/2004 Straterra taken off after severe appetite loss- in 1 year JT goes from 85 lb here to back up to145 lbs ! The doc did not beieve at first that Staterra was the culprit.
9/10/2003 "Tegretol 600 AM & PM (7 am 6:30 PM)" Seroquel 150 AM & PM Welbutrin SR 150 AM & PM Straterra 60 MG AM , -- info is from VM team notes. DR MY
5/17/2003 5/17/03 5th hospitalization at SP _west. Seroquel titrated by 50 mg here
5/1/2003 "Tegritol XR 400 AM 600 PM" Seroquel 200 bid (400 daily total) Buspar Welbutrin 150 bid Eskalith 450 bid Straterra added _ for ADHD … titrating Buspar
4/8/2003 "Tegritol XR 400 AM 600 PM" Seroquel 200 bid Buspar 10 tid Welbutrin 150 bid Eskalith 450 bid, -- "4/8/03 4th hospitalization beginning (also had 1 day inpatient at G__C 4/7/03) after violent behavior towards family self- harm and property destruction"
3/23/2003 "Tegritol XR 400 AM 600 PM (at discharge)" Seroquel 200 bid (at discharge Buspar 10 tid Welbutrin 150 bid Eskalith 450 bid, -- 3/23 JT back in 3rd hospitalization SP after violent behavior towards family- Discharge 3/31/03
3/17/2003 Tegritol XR 400 bid Seroquel 100 tid Buspar 10 tid Welbutrin 150 bid Eskalith JT Discharge 3/17…
3/17/2003 note "After discharge Mom and Dad discuss possible titration of Tegritol (in favor of using Eskalith as the mood stabilizer… why have two major mood stabilizers along with all other meds and risk possible contraindications) unfortunately JT does not prove stabe enough to try any outpatient med changes"
3/11/2003 Tegritol XR Seroquel Buspar 10 tid Welbutrin 150 bid Eskalith "3/11 Dr. VM is repl Trileptal w another anti convulsant incr Seroquel."
3/7/2003 Trileptal Seroquel Buspar Welbutrin Eskalith added back in Another Hospitalization SP starting 3/7/03 (Friday)
2/25/2003 Trileptal Seroquel Buspar Welbutrin Hospitalized at SP adolescent unit for violent acting out towards Mom. - disch following Monday
1/22/2003 Eskalith Seroquel Buspar Welbutrin "Begin titrating Lithium- reason teacher (Ms. F) noted cognitive dulling also there are a few possible borderline thyroid readings in his recent history Dr H wants to try Trileptal add Trileptal. During this period dosages of Zydis( Zyprexa) were given as PRNs at Dr. H's direction."
1/20/2003 Eskalith 450 bid "Seroquel 100 bid 50 noon" Buspar Welbutrin Note 4 months with no hospitalizations !
9/14/2002 Eskalith 450 bid "Seroquel 100 bid 50 noon" Buspar Welbutrin "discharge post hosp seroquel- 100mg bid 50 mg noon buspar- eskalith- 450 mg bid welbutrin- (probably raised to 150 bid here) "
9/7/2002 Eskalith 450 bid "Seroquel 100 bid 50 noon" Buspar 7.5 tid Welbutrin 100 bid "pre hosp seroquel- 100mg bid 50 mg noon buspar- 7.5 mg tid eskalith- 450 mg bid welbutrin- 100 mg bid "
9/1/2002 Note 5+ months with no hospitalizations !
3/18/2002 Lithium Seroquel Buspar Welbutrin "Another hospitalization at SP. After addition of Welbutrin JT's self- harm statements became very rare virtually non- existent !"
2/1/2002 Lithium Seroquel Buspar Nortyptyline "JT readmitted SP for ~ 5 days another increase of Seroquel"
1/31/2002 Lithium Seroquel Buspar Nortyptyline "JT at SP - increase of Seroquel add Lithium"
9/1/2001 Depakote Seroquel Buspar Nortyptyline "JT is discharged from VM . The first month or two are pretty good a 'honeymoon period'"
9/30/2001 Depakote Seroquel Buspar Nortyptyline JT begins to have trouble with behavior at WO school. Mom is lobbying for his admission to full year program at (SP private) school
7/1/2001 Depakote Seroquel Buspar Nortyptyline JT vacation at beach with parents is overall pleasant
2/1/2001 Depakote Seroquel Buspar Nortyptyline "Titrated to 100 mg Seroquel again with no ill effects no overall increase in violent behavior."
11/1/2000 Depakote Seroquel Buspar Nortyptyline "Dr P begins to titrate off the Seroquel slowly from 150 to 125. JTs short term memory improves and he begins to talk more with his therapist"
7/1/2000 Depakote Seroquel Buspar add Nortyptyline "Dr P adds Nortryptyline since it is (at lease partially) an epinephrine antagonist and also an anti- depressant"
6/1/2000 Depakote Seroquel Buspar JT is home. Fairly sure at lease one hospitalization here. We re- apply for residential at VM
2/1/200 note Dad has a one time eonly consult with Dr Peter Breggin in Bethesda- who tells him he can do more good by staying with his family and asking intelligent questions about the meds. Good advice ! Dad pays for this out-of-pocket.
2/1/200 Depakote Seroquel Buspar "November 1999- February 2000 JT is in residential at SV residential. At some point here Zyprexa was replaced by Seroquel which was better for him since he didn’t gain as much weight (was getting grossly overweight on Zyprexa). Overall this is an unpleasant experience for the family. The staff at SV is not used to working with birth parents."
10/1/1999 Depakote Risperdol (removed and Zyprexa added ) "Continue Tenex add Effexor ? Antidepressant"
6/1/1999 Depakote Risperdol "remove Klonodine add Guaneficine Tenex) has similar anti-anxiety y properties"
5/1/1999 Depakote Risperedol Klonodine "250mg Depakote 2x day 0.5 mg Risperedol AM 1.5 Risperedol pm .05 Clonodine 2 x day"
5/1/1999 Depakote Risperedol Klonodine "Since addition of Klonodine and Risperedol JT is harder to wake up in AM but generally has a good AM. Behavior in school is still good unchanged. Still can keep awake at school. Some incidents of hitting his mother and sister at home. Overall affect at home in PM cycles with more ""dark"" periods. JT generally poops out at 7:30- 8:00 PM falling into a deep sleep. "
4/1/1999 Depakote Risperedol Klonodine "250mg Depakote 2x day 0.5 mg Risperedol AM 1.5 Risperedol pm .05 Clonodine 2 x da"
2/1/1999 Zoloft Depakote
1/1/1999 "Zoloft six day trial of Adorax" see comment >>> "JT tried on Adorax (anti-anxiety) for six days is taken off because of poor staff communication that he had a really bad weekend when it was just average problems. Dad feels trial of Adorax was not long enough"
12/1/1998 begin Zoloft (after ?) Adderall see comment >>> "JT is tried on Adderall (like Ritalin) - becomes very hyper and anxious also vomits at school- taken off after two days"
11/1/1998 No Meds
10/1/1998 Zoloft/ no meds no meds at all at VM !
9/1/1998 Zoloft Tegritol
8/1/1998 Zoloft Tegritol Neurontin Neurontin is titrated with no ill effects. Dad (with Mom's concurrence) request 'peeling off the layers of meds'
7/1/1998 Zoloft Tegritol Neurontin Risperedol "JT starts at local VM residence in July.
Risperdol is titrated with no ill effects. Mom and family visit at least twice a week. J is reading the Harry Potter books out thus far in 1998 I think 2 or 3"
5/1/1998 Zoloft Tegritol Neurontin Risperedol
3/1/1997 Nortryptyline "Depakote (briefly) then Tegritol" Neurontin "JT age 6 when psychoactive meds started- Dad objects to the meds Mom wants them. J's original diagnosis was Oppositional Defiant. The docs probably added a 'rule out something in the affective spectrum' after they started medicating him. Note here J is an early reader."
3/1/1997 note "After an anxious incident in his first day of a 'French Immersion Program ' full day kindergarten JT has a pretty normal year of kindergarten and attends regular Summer camp. Mom fights to get him in Special Ed over Dad's (and the regular school system's) objections"
3/1/1997 note "Mom and Dad disagree wrt whether JT presented any 'symptoms' of abnormality in toddler years. Dad agrees JT was a 'spirited child' who like riding bikes hiking playing ball and got into occasional mischief. The intent of this table is to show JTs meds not give his ENTIRE background which would create more contention from various stakeholders wrt the content."
11/18/1995 note JT's sister is born. Mom shows increasing signs of being unable to sleep while breastfeeding
2/9/1991 note JT is born
going to my happy place for a few moments before blogging again
Its been a while since I blogged here. Every new event in the unfolding pharmaceutical research, 'black bag payoffs' & marketing scandals : Charles Nemeroff, the Seroquel 'sex for favorable drug research' scandal*, the Zyprexa settlements, the alleged misdeeds of Dr Joseph Biederman-- all these have caused me to believe that the way we as a society approach child and adolescent mental health treatment is going to change. When mental health treatments really change, when unbiased research on psych meds is really done, I am hoping my son will be one of the benefactors.
*Not as well known as the Nemeroff and Biederman fiascos - so I am posting a small additional blurb here.. 'lest we forget too quickly' and the other links get taken down
I remember Watergate. From my misty perspective here in 2009, seems like it only took a few months to round up the real culprits and serve justice, right ? Of course I know that's not true. deepthroat helped, so did the Post. John Dean cracked. Agnew flopped in his own mess. Incredibly, Tricky Dick gave us the tapes ! But it took over a year, even for the denouement.
So back to bloggery I go ! But first...
a cleansing breath
Om mani padme hummm... that's and old mantra my old friend Bill used to have on a record.
... will an angel of mercy ... look down on me .. and my family ?
In the 'happy place' I get to in meditation and dreams sometimes, I'm walking beside a robust creek on a warm May morning in the semi-Northern latitudes. The creek makes its own music, sings its own sagas on the stones beneath it. Dragonflies laze and skim. there is peace, and no particular place to go, since I am already there, with all my friends, safe inside the gates of eden, in the Dream-Time .
*Not as well known as the Nemeroff and Biederman fiascos - so I am posting a small additional blurb here.. 'lest we forget too quickly' and the other links get taken down
Former AstraZeneca U.S. medical director for Seroquel, Wayne MacFadden confessed
his multiple sexual affairs, and his offer of drugs to one of the women
he was sleeping with, to lawyers in December 2007.
The confessions include descriptions of sex in hotel rooms paid for by AstraZeneca, illicit distribution of Vicodin, and a kinky relationship in which one of his colleagues asked to be "punished" for looking at a study that had negative results for Seroquel.
MacFadden told that woman: "You will be punished (in the usual fashion!) when I see you ... but perhaps more harshly this time!!!"
He made the confession to the lawyers -- who are suing AstraZeneca for allegedly failing to warn patients that side effects of the drug include significant weight gain and diabetes -- as part of a deposition prior to the current litigation going on in Florida.
Between 2002 and 2006, MacFadden said he had slept with two executives who worked for AstraZeneca or its research agencies. He offered Vicodin to one of them. He also attempted to get confidential information about Bristol-Myers Squibb's FDA filing for a bipolar depression approval for rival drug Abilify, via a woman he was sleeping with.
MacFadden told that woman: "You will be punished (in the usual fashion!) when I see you ... but perhaps more harshly this time!!!"
He made the confession to the lawyers -- who are suing AstraZeneca for allegedly failing to warn patients that side effects of the drug include significant weight gain and diabetes -- as part of a deposition prior to the current litigation going on in Florida.
Between 2002 and 2006, MacFadden said he had slept with two executives who worked for AstraZeneca or its research agencies. He offered Vicodin to one of them. He also attempted to get confidential information about Bristol-Myers Squibb's FDA filing for a bipolar depression approval for rival drug Abilify, via a woman he was sleeping with.
Mr MacFadden- you make me want to puke !
Every week I still believe real change is 'right around the corner', so there will be no reason to dust off THIS blog. Plenty of other justly more famous bloggers are scooping me on each late breaking event in these scandals.I remember Watergate. From my misty perspective here in 2009, seems like it only took a few months to round up the real culprits and serve justice, right ? Of course I know that's not true. deepthroat helped, so did the Post. John Dean cracked. Agnew flopped in his own mess. Incredibly, Tricky Dick gave us the tapes ! But it took over a year, even for the denouement.
So back to bloggery I go ! But first...
a cleansing breath
Om mani padme hummm... that's and old mantra my old friend Bill used to have on a record.
... will an angel of mercy ... look down on me .. and my family ?
In the 'happy place' I get to in meditation and dreams sometimes, I'm walking beside a robust creek on a warm May morning in the semi-Northern latitudes. The creek makes its own music, sings its own sagas on the stones beneath it. Dragonflies laze and skim. there is peace, and no particular place to go, since I am already there, with all my friends, safe inside the gates of eden, in the Dream-Time .
Wednesday, September 24, 2008
In the news recently about kids and medical research on psych meds
As the concerned father of a 'bipolar child' who is now 17- and not doing too well- some recent news disturbs me...
Harvard-
A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators [what would happen to ME or you if we didn't report even 2 thousand bucks in income or consulting fees ?!? Something just doesn't seem right here. Spiro Agnew resigned the VP slot under Nixon for much less of an IRS affront- as I recall.]
By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants.
NY Times
Ohio
The University of Cincinnati will increase scrutiny on a psychiatry professor for not reporting all of the hundreds of thousands of dollars in corporate research money she received from a pharmaceutical giant during the last decade.
Melissa DelBello now has to review all of of her interactions with companies with her department chairman, UC vice president of research Sandra Degen said Friday.
DelBello's teaching and research haven't been restricted, but the fact that she didn't tell the university about some of her outside income has been detailed in her personnel file.
link to news source
Brown University in Rhode Island- [Professor] Keller has gained notoriety for authoring a controversial clinical study of the antidepressant drug paroxetine - marketed as Paxil in the United States - which concluded that the drug was safe and effective in adolescents. Keller and some of the study's co-authors have been accused by doctors, lawyers and journalists of having the 2001 study ghostwritten, earning large sums of money from Paxil's maker, GlaxoSmithKline. In addition, some say the researchers manipulated and suppressed data - including those showing increased suicidal tendencies in children taking the drug.Island
link to news source
Texas
According to [Senator] Grassley's research, Dr. Wagner, who is on the faculty at UTMB in Galveston, was paid more than $160,000 from GlaxoSmithKline between 2000 and 2005, though she reported just $600 to the university. In 2000 and 2001, she worked on a major study on the company's drug Paxil research that has been widely criticized for over-promoting positive findings while downplaying heightened suicidal thoughts and behavior in adolescents.
link to news source
Harvard-
A world-renowned Harvard child psychiatrist whose work has helped fuel an explosion in the use of powerful antipsychotic medicines in children earned at least $1.6 million in consulting fees from drug makers from 2000 to 2007 but for years did not report much of this income to university officials, according to information given Congressional investigators [what would happen to ME or you if we didn't report even 2 thousand bucks in income or consulting fees ?!? Something just doesn't seem right here. Spiro Agnew resigned the VP slot under Nixon for much less of an IRS affront- as I recall.]
By failing to report income, the psychiatrist, Dr. Joseph Biederman, and a colleague in the psychiatry department at Harvard Medical School, Dr. Timothy E. Wilens, may have violated federal and university research rules designed to police potential conflicts of interest, according to Senator Charles E. Grassley, Republican of Iowa. Some of their research is financed by government grants.
NY Times
Ohio
The University of Cincinnati will increase scrutiny on a psychiatry professor for not reporting all of the hundreds of thousands of dollars in corporate research money she received from a pharmaceutical giant during the last decade.
Melissa DelBello now has to review all of of her interactions with companies with her department chairman, UC vice president of research Sandra Degen said Friday.
DelBello's teaching and research haven't been restricted, but the fact that she didn't tell the university about some of her outside income has been detailed in her personnel file.
link to news source
Brown University in Rhode Island- [Professor] Keller has gained notoriety for authoring a controversial clinical study of the antidepressant drug paroxetine - marketed as Paxil in the United States - which concluded that the drug was safe and effective in adolescents. Keller and some of the study's co-authors have been accused by doctors, lawyers and journalists of having the 2001 study ghostwritten, earning large sums of money from Paxil's maker, GlaxoSmithKline. In addition, some say the researchers manipulated and suppressed data - including those showing increased suicidal tendencies in children taking the drug.Island
link to news source
Texas
According to [Senator] Grassley's research, Dr. Wagner, who is on the faculty at UTMB in Galveston, was paid more than $160,000 from GlaxoSmithKline between 2000 and 2005, though she reported just $600 to the university. In 2000 and 2001, she worked on a major study on the company's drug Paxil research that has been widely criticized for over-promoting positive findings while downplaying heightened suicidal thoughts and behavior in adolescents.
link to news source
I'm trying to decide how to vote in November
I'm trying to decide how to vote. I'm a lifelong Democrat and working man. Tonight I went to http://www.barackobama.com/issues/healthcare/ It seems to me that Barack has toned down his message about reforming the FDA and big Pharma since the primaries. Am I missing something ? Why is my biggest current hero in the fight to get unbiased medical research done on medicating children with psych meds a Republican senator from Iowa ? Because he is really doing something.
Tuesday, January 16, 2007
A significant study on neuroleptic drugs from NEJM
Here is a recent New England Journal of Medicine article on neuroleptics and Alzheimer's with respect to aggressive tendencies."A 42-site, double-blind, placebo-controlled trial, 421 outpatients with Alzheimer's disease and psychosis, aggression, or agitation " http://content.nejm.org/cgi/content/abstract/355/15/1525
The conclusion in the abstract : ' *Adverse effects offset advantages in the efficacy of atypical antipsychotic drugs for the treatment of psychosis, aggression, or agitation ' in this population of Alzheimers persons. *Adverse effects like sleepiness, cognitive dulling, frontal lobe atrophy, learning disabilities, tremors, akathisia and drug- induced dementia- to name a few. Note that this is a 42 WEEK study in comparison to many shorter studies that have been done to get FDA approval for using neuroleptics on various populations.
When will a long term study like this be done to determine whether neuroleptics are safe or harmful to the brains of pre- teen children, who are taking neuroleptics in exponentially increasing numbers for a variety of behaviour disorders ?
The conclusion in the abstract : ' *Adverse effects offset advantages in the efficacy of atypical antipsychotic drugs for the treatment of psychosis, aggression, or agitation ' in this population of Alzheimers persons. *Adverse effects like sleepiness, cognitive dulling, frontal lobe atrophy, learning disabilities, tremors, akathisia and drug- induced dementia- to name a few. Note that this is a 42 WEEK study in comparison to many shorter studies that have been done to get FDA approval for using neuroleptics on various populations.
When will a long term study like this be done to determine whether neuroleptics are safe or harmful to the brains of pre- teen children, who are taking neuroleptics in exponentially increasing numbers for a variety of behaviour disorders ?
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