Still, it's puzzling to me that such a vast change could be going on in the treatment of a major mental illness and the very people who should be asking the hard questions are mute. Last month, actress Linda Hamilton was a guest on Larry King Live on CNN. She was discussing her "20 years of bipolar hell." At the top of the show, King announced that the Terminator star was also there representing Eli Lilly and their well-being approach—exercise and nutrition—for "people with serious and persistent mental illness." In other words, she was talking to me. Too bad I wasn't asking the questions.
King is of course no exemplar of journalistic inquisitiveness. He didn't ask her if maybe—just maybe—those side effects and all that weight gain that she was on television saying patients needed to address were, in fact, caused by products made by Eli Lilly—namely, Zyprexa and Prozac. He didn't ask how reasonable it was to expect someone taking Zyprexa (or Seroquel or Risperdal) in high doses to get out there and exercise and eat good food, as she was saying they must, when their weight, blood lipids, blood sugar levels, and cholesterol were shot to hell by Zyprexa. I guess looking to the media and advocates for cold-blooded honesty and accountability is naive. But someone ought to be asking serious questions because atypical antipsychotics have serious problems.
Karen Steichen
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The people who most need to be held to account here are not the pharma companies, however. They are acting much as you'd expect drug companies to behave—designing drugs, calling half-performance a victory for patients, and minting money.
It's doctors and researchers who must be held accountable. By dint of their medical degrees, they are supposed to be ethical actors. I am not convinced that it is ethical to ask millions of bipolars to take medications long term that work about as well at remitting symptoms as the old standby of a mood stabilizer plus antidepressant approach. Their proposed paradigm shift is doubly questionable given the side effects and hard-core nature of atypicals. Maybe I've become too much of a skeptic about psych meds, if by skeptical you understand that I actually expect meds to work and expect long-term treatments that don't dumb down active, intelligent humans.
I still take meds, however. They are a constant in my life and will be until I die. In fact, I still have a bottle of Seroquel in my medicine cabinet. It's there for short-term use when I cannot sleep and the edge dogs me once again, as it will. I'll take the Seroquel just like I once took Mellaril, for a day or two, here and there.
This is an awkward time for mental- health experts, researchers, and advocates. This month, a peer-reviewed academic paper was published on the Public Library of Science Web site pointing out that researchers still have not proved the serotonin-imbalance-in-the-brain hypothesis of depression. What proof there is, the authors claim, is mostly circumstantial. Two weeks ago, The Wall Street Journal ran an article covering the same points in relation to antidepressants. And a pesky reporter was calling around the country, asking questions about bipolar disorder and atypical antipsychotics that prominent researchers hadn't even asked themselves.
These are all matters that smart people should be willing to meet head-on.
The larger uncomfortable truth about the psychopharmacological revolution is that psychiatric medications are now part of mainstream American culture, but these meds do not consistently offer the kind of long-term benefits that many in the mental-health field claim. Nor do we fully understand the long-term consequences of their use. This is as true of antidepressants as it is of atypical antipsychotics.
That's a lousy deal for patients, regardless of their diagnosis. It's doubly lousy because there are no new classes of psych meds on the horizon. And any talk of gene-based cures and therapies is just talk, for now.
Meanwhile, patients have to live. They have to grapple with illnesses that are poorly understood scientifically, in an environment where medications can be as much of a problem as a solution, where incomplete evidence is the guiding light of long-term care in a revolution that's forgotten how to serve the patient first.
The hell with that.
pdawdy@seattleweekly.com
Atypical Antipsychotics
* A special FDA-required warning alerting consumers and doctors to known side effects of a drug, or class of drugs, owing to documented deaths or injury.
**Due to cases of toxicity, Clozaril (clozapine) is rarely prescribed.
