Crazy Talk

Psychiatry Needs Jargon

I read an article this week that compared diseases in psychiatry to diseases in other areas of medicine.  The article pointed out that other medical specialties have medical-sounding words to describe many of their conditions.  In other words, jargon.  In psychiatry we treat "depression" and "anxiety", words that have every day meaning that is related (but NOT equivalent to) the illness.  This creates a lot of confusion about what it means to be depressed versus suffering from Major Depressive Disorder as defined by the DSM IV. 

This problem has only been made worse by the increased coverage of mental health in the media.  Now people describe themselves as "having OCD"or "being ADD", or even "being Bipolar". 

It's great that there is a growing awareness of the existence of these various conditions.  The next step needs to be the recognition that these conditions are medical illnesses that are best treated by a doctor (and not the guy behind the counter at Vitamin Shoppe).

Want to learn about mental illness?

I know this posting is overdue and was intended to review exercise tips but I wanted to write a quick post to let people know about a series appearing on public television and available online that provides basic information about various mental illnesses.  I haven't watched the series yet myself but I'm hopeful that it provides impartial information that can be a starting point for understanding various mental conditions including autism, schizophrenia, bipolar disorder, depression, PTSD, obsessive-compulsive disorder, and others.  In short, it covers most major mental illness.  I hope that it takes a step toward demystifying and destigmatizing mental illnesses.

Here's the URL: http://www.wliw.org/productions/local/healthy-minds/season-two-overview/164/

It is on WLIW21 and channel 13 in NY.  The hours are early AM and later in the evening so perhaps best to watch online.

Recent News about Anti-depressants

Wow, I missed all of February.  I knew I was overdue but I did not realize that it had been that long, even with the extra day.

Anyway, today I just wanted to comment on some recent news reports about a recently published study that states that anti-depressants are not much more effective than placebo so should not be prescribed except perhaps in severe depression.

There has been discussion among psychiatrists about the methodology of the study (which wasn't great) and our universal experience that we have definitely seen anti-depressants benefit patients, in some cases in a profound and life-saving way.

I do understand that psychiatrists can be seen as biased here since prescribing medications is a large part of our livelihood.  So I have a different point to make.  Placebo is not really an option.  In the studies that show that anti-depressants are only somewhat more effective than placebo, the patients think that there is a chance that they are getting the active drug.  So the comparison to make is not between an anti-depressant and placebo, but between an anti-depressant and nothing.  With response rates as high as 60% or more, and with the devastating symptoms of depression, it certainly doesn't make sense to abandon anti-depressants.

Owen Wilson's Suicide Attempt

Several sources (including ABC news, link below) confirm that Owen Wilson

http://abcnews.go.com/Entertainment/story?id=3526977&page=1

made a suicide attempt on Sunday night.  I'm certainly sorry to hear that this happened and that Mr. Wilson may be suffering from depression.  What I find additionally lamentable is the possibility that such a high profile mental health situation may fail to bring people's attention to the importance of mental health treatment.  I fear that this too, along with Rush Limbaugh's struggle with addiction some years ago and Brooke Shield's episode of post-partum depression and many others, will be forgotten; forgotten in the sense that people will not learn from the struggles of these celebrities to avoid suffering similar experiences themselves.  We look to those in the spotlight to tell us what clothes to wear and what to buy.  I hope that knowing that even the rich and famous are susceptible to depression and even suicidal thoughts, will encourage people to seek consultations for treatment when things get tough.

Sports Psychology

There was an article on the front page of the NY Times today (Sunday the 5th) about young athletes seeing sports psychologists when they are having certain problems in their chosen sport.  The article was largely favorable and I think this is a great trend.  My agenda is to get people to recognize that psychology and professional psychological help is not something to be shunned or saved as a last resort.  It should be viewed as an available resource that should be considered in a variety of contexts.  It seems that young athletes and their families, at least as portrayed in this article, are doing just that.  Hopefully their experience will help normalize this kind of thing, not only to help young athletes perform better as athletes, but so that all people, young and old, need not suffer needlessly whatever their endeavor. (article URL below)

http://www.nytimes.com/2007/08/05/sports/05minds.html

Camps for the Children of Parents in Iraq

There is an article on the front page of the Metro section of the NY times today describing one to two week summer camps for the sons and daughters of parents in the military who are in Iraq.  I was impressed by the concept and it gratified me to know that a group (The National Military Family Association) was considering the impact of parents' absence on children.  It then dawned on me that part of the reason it gratified me is that this idea is in line with my own assertion that most people can benefit from mental health treatment.  That's what these camps are in a way, a kind of group therapy.  I'm not trying to pathologize the plight of these children.  Quite the opposite, I am trying to show that getting mental health treatment does not mean that you're crazy or that something is unhitched.  Most of time, mental health treatment helps individuals cope with stressors that are just part of life.  There is nothing wrong with getting help from others when life throws a lot at you.  For these kids, it's a camp with other kids going through the same thing.

Battling it Out in the News

Mental health is getting more and more coverage in the media, but, as with many things, the bad gets more press than the good.  Yesterday is an example of a "tie".  I was gratified to see the coverage of a recent study that shows that anti-depressant treatment in pregnant women DOES NOT pose a high risk of birth defects ( Antidepressants Not Big Risk for Defects)  The article also indicated that depression during pregnancy is common phenomenon and that treatment can be quite helpful.  Great, I thought, I finally do not have to fight an uphill battle in giving airtime to the benefits of mental health treatment.

Later I got a call from a friend and he asked me if I saw the article in the NY Times.  I was excited to talk about it until I realized that he was talking about a different article that I had missed, one that indicated that psychiatrists get more money from drug companies than any other kind of specialist ( Psychiatrists Top List in Drug Maker Gifts) I have no beef against the reporting of this fact (in fact, I wrote a blog about this very topic in May (NY Times Article about Psychiatrists and Drug Companies May 11, 2007)) but I was frustrated that of the two articles that day, the one that caught my friend's eye was the one that tends to make people more suspicious of mental health. 

Well, I knew the task was not going to be easy and hopefully I can work to have the media report the upside as much as the potential downside...
 

Personalized Depression Drugs

I think bloggers aren't supposed to take vacations, or at least not without their laptops.  Well, I did, but I'm back now and was happy to have an article in the New York Times pointed out to me.  Dr. Friedman wrote a nice piece about some advances in the treatment of depression that are in the works.  Here's the link:

http://www.nytimes.com/2007/06/19/health/psychology/19beha.html?_r=1&ref=science&oref=slogin

Those of us in the field have been aware of some of this work for quite some time and it's very exciting to think about improving our ability to treat depression and other illnesses.  Once concern I have is that people will use this as yet another excuse to put off seeking treatment and that would be a shame.  There are definitely things about depression treatment that can be improved but the treatments we have are actually pretty good.  Despite their shortcomings, the larger impediment to treatment is people not seeking treatment.  So while we can all look forward to the advances that are on the way, we shouldn't neglect using the treatments we have now while we wait.