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How Lena Dunham’s real-life OCD made it onto Girls

Monday, April 8th, 2013

Girls_logoHow closely does a writer’s work mimic her life experiences? It’s a perennial question made all the more irresistible as it pertains to Lena Dunham,  the 26-year-old creator of one of TV’s most talked-about shows, and her recently-revealed history of  Obsessive-Compulsive Disorder.

In the first season of HBO’s Girls, Dunham stirred up debate by, among other things, repeatedly revealing her less-than-perfect body while playing the show’s main character, Hannah Horvath. What got people talking as the second season progressed, though, was how serious the show seemed to be getting, especially with its depiction of Hannah coping with a resurgence of her OCD symptoms.

Critics, fans, mental illness activists and patients have largely praised the Girls’ depiction of OCD, which they’ve hailed as convincing and nuanced, but agonizing to watch. One hollywood.com writer and self-described former OCD patient called it “some of the darkest, most difficult material with which Girls has wrestled to date,” lauding the show for avoiding the temptation to turn OCD into a mere joke.

The fact that Dunham revealed in a March cover story for Rolling Stone that she’s struggled with OCD since childhood – and taken medication for it on and off – gave the topic more buzz. (I discussed what she revealed-and what she didn’t-here).

In a HBO behind-the-scenes look at one of the episodes, Dunham disclosed a little more about the connection between her experience and the show’s representation of Hannah’s OCD – though she didn’t go into specifics.

For those looking for a more direct comparison, here’s a look about what Dunham has said about her own experiences with OCD symptoms and treatment – and how they compare to Hannah’s.


Too Early To Link Sandy Hook Shooting With Psych Meds

Tuesday, December 18th, 2012

Tragedies like the one at Sandy Hook Elementary aren’t just agonizing and heart-wrenching for millions of people – they’re frustrating.

We keep asking ourselves “how?” and “why?” And, with authorities still trying to piece together evidence, the public has to make do with limited – and often incorrect – information.

First came reports that the shooter, Adam Lanza, might have Asperger’s. To my knowledge, no authoritative source has yet confirmed Lanza had a formal diagnosis of that or any other emotional, behavioral or developmental condition.

But that lack of evidence – as well as expert consensus that Asperger’s was extremely unlike to have triggered a shooting rampage – didn’t stop an army of commentators from weighing in.

Now, comes the speculation about whether Lanza might have a history of taking mood or behavior-altering medication.

Don’t get me wrong, here. I’m not blaming journalists, bloggers, pundits, Twitter users, and the general public from wondering if Lanza might be taking psychiatric meds.

In fact, it’s one of the first questions that came to my mind – even before I heard the reports of his possible Asperger’s.


The Challenge: Tracking Your Medication History

Tuesday, November 27th, 2012

Ever have a hard time remembering to take your meds regularly? Now try tallying up all the psychiatric meds you’ve ever taken, their dosages and side effects. It’s harder than you might assume – especially as time goes on.

When I was interviewing my peers for my book about growing up taking psychiatric meds, I started with what I thought was a basic question: Can you give me your medication history – which meds you’ve taken in the past, and for how long?

I was shocked at how many people couldn’t answer the question with any confidence.


Study Finds Autistic Kids With Psychiatric Disorders More Likely To Be Medicated

Monday, November 19th, 2012

Many children with autism spectrum disorders (ASD) take psychotropic medications to treat associated symptoms of their conditions, such as irritability and anxiety. Usage has increased in recent years, and some recent studies have questioned the evidence base supporting the drugs’ effectiveness in young people with ASD.

A new study, published in a supplement to the November issue of Pediatrics, suggests that coexisting psychiatric conditions and problem behaviors might account for much of that prescribing.

The study, which examined children and teens ages 2 and 17 with autism spectrum disorders, found that 80 percent of children with a comorbid psychiatric condition were taking medication, compared to just 15 percent without any psychiatric comorbidity.

Depending on the condition in question, those with a comorbid disorder were between 5 and 17 times more likely to be taking a psychotropic medication as those without the additional disorder.

The study included 2853 children enrolled in a registry run by the Autism Treatment Network, a consortium of 17 academic medical centers in the United States and Canada that is associated with the advocacy group Autism Speaks.

The registry used DSM-IV-TR criteria and the Autism Diagnostic Observation Schedule to diagnose autistic disorder, Asperger syndrome, or pervasive developmental disorder not otherwise specified. It relied on parent reports for information about comorbid psychiatric diagnoses and medication use.

Some metaanalyses have questioned the effectiveness of treating ASD with psychiatric medications, though they have not always taken psychiatric comorbidity into account. Comorbidity is very common in autism spectrum disorders, with studies finding that between 70% and 95% percent qualify for at least one additional psychiatric diagnosis. Other researchers, however, have said these high rates partly reflect overlapping symptoms and problems with diagnostic criteria.

The Pediatrics study didn’t collect information about why the children and teens had been prescribed medication – that is, whether the meds were to treat the comorbid condition, symptoms of the ASD, or both.

However, it found that current psychotropic use was also correlated with high scores on the Child Behavior Checklist, a measure of overall problem behavior. That …


Can You Be Too Attuned to Symptoms and Side Effects?

Sunday, October 28th, 2012

Doctors and mental health professionals have long encouraged patients to keep track of their moods and behaviors to gauge how they respond to psychiatric treatment.

With the explosion of mobile apps and websites such as PatientsLikeMe, which help people chart symptoms, medications and side effects, we’ve entered a new era of unprecedented medical self-monitoring.

Is this a good thing when it comes to psychiatric medications and mental health?


Can Meds Transform Mental Illness Into Mental Health?

Wednesday, October 10th, 2012

I blog for World Mental Health DayToday is World Mental Health Day, and I’ve been thinking a lot about the terms “mental health” and “mental illness” ever since reading a recent post post on the topic by blogger Natasha Tracy.

Natasha contends that using the politically-correct, cheerier-sounding term “mental health” trivializes psychiatric disorders and ends up shortchanging those who suffer from mental illness. That got me thinking again about a question I’ve often pondered: Can long-term, maintenance treatment with psychiatric medication take someone with a “mental illness” and restore him or her to “mental health?”

The answer isn’t as obvious as it might seem.


Youth Suicide and Medications – What’s the Link?

Monday, September 10th, 2012

Youth Suicide and Medications - What's the Link?To recognize World Suicide Prevention Day, I wanted to post again about the topic of medications, suicide and young people.

First, the sad statistics: Worldwide, suicide is the second-leading cause of death among young people ages 15 to 19. In the United States, according to the CDC, suicide was the third-leading cause of death in 2009 for people ages 10-14, 15-19 and 20-24. It was the second-leading cause of death for people ages 25 to 34.

The vast majority of people
who commit suicide have a mental illness. But for nearly a decade doctors and researchers have been debating whether certain classes of medications used to treat mental illness increase or decrease the risk of suicide – as well as suicidal thoughts and behaviors – in young people.

In 2004, the FDA placed a black-box warning on all antidepressants, warning that they increase the risk of suicidal thinking and behavior (called “suicidality”) in children and teens.

An FDA analysis had found that one type of antidepressants in particular, the SSRIs, which include Prozac, Zoloft, Paxil, Lexapro and others, doubled the risk of suicidality in young people from 2% to 4%. But it found no completed suicides in the studies it looked at, which included some 2,200 children.

In 2005, the European medications regulatory authority urged European countries to put strong warnings about using either SSRI antidepressants, or SNRI antidepressants, such as Effexor and Cymbalta, for children or teens. The warning was based on the drugs’ potential to induce suicidality and hostile or aggressive behavior.

Also in 2005, the UK’s National Health Service issued guidelines urging doctors to avoid prescribing antidepressants to kids under 18 unless other therapies for depression didn’t work.

In 2007, the FDA expanded its black box warning on antidepressants to include all young people under age 25. The risk is greatest in the first month or two of treatment, the FDA warned.

After the U.S. and European warnings went into effect, prescribing of antidepressants to children and teens decreased. At the same time, some …


Waiting Until You’re “Old Enough” for Antidepressants

Sunday, September 9th, 2012

What’s it like to suffer from severe depression for as long as you can remember – and to be too scared to ask for help until age 18?

Today I’m featuring the story of Allie, a 21-year-old college senior in Wisconsin who was ultimately diagnosed with bipolar disorder. Allie kept her unhappiness a secret and didn’t begin taking medication when she was old enough to ask for it without her parents finding out.

Allie’s story is interesting, because it shows how kids can suffer from severe depression from a very young age. It also shows how in a culture where psychiatric drugs seem ubiquitous kids can come to focus on medication as a source of salvation.


Medicating Class Cut-Ups But Overlooking the Rest

Monday, August 20th, 2012

This weekend a mother published a New York Times column about how her son came to be diagnosed with ADHD and became a member of the ballooning “Ritalin Generation.”

“Just a little medication,” the teacher told the boy’s mother, “could really turn things around” for the boy, who was having trouble focusing on class worksheets and lining up quietly for transitions between classes.

When the mother firmly responded that she and her husband weren’t going to medicate their son, the teacher backtracked, sounding mock-horrified.

She wasn’t explicitly suggesting medication, she said. The law prohibited such a thing. She just didn’t want him to fall through the cracks – and thus was was merely suggesting the boy’s parents have him evaluated by a psychologist.

The boy was evaluated, and sure enough, he ended up on Ritalin for a short-time, though he quit it on his own a year later, matured out of his former inattentiveness, and eventually ended up a well-adjusted, school-loving honor-roll student – and medication-free.

Such stories are commonly invoked as cautionary tales about the alleged over-diagnosis of ADHD and other behavior disorders and over-prescribing of drugs like Ritalin to keep children’s behavior in check. Teachers recommending meds for disruptive students often feature prominently. In fact, the debate over school involvement in medicating disruptive children showed up as early as the early 1970s.


How Psych Drug Studies Shortchange Kids

Thursday, July 26th, 2012

For years, researchers and health policy experts have been charging that psychiatric medications aren’t adequately tested in children – and a new study gives some powerful ammunition to that critique.

The study, from Pediatrics, looked at clinical drug trials between 2006 and 2011, involving five conditions that cause the greatest “disease burden” for children, as measured by a rating that counts the total years of healthy life lost to disability.

In high-income countries like the United States, three of the five conditions with the highest disease burden among kids were psychiatric disorders: depression, bipolar disorder and schizophrenia.

But of the drug studies to treat those conditions, disproportionately few involved children.

The lack of trials is troubling because children and adults don’t necessarily respond to medication in the same way. With psychiatric drugs, that’s a potential problem both for physical reasons – and for psychological and developmental ones.


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