Archives for Medication Management
How 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.
Lena Dunham, the 26-year-old force behind HBO's popular and much-discussed show Girls, hasn't grown famous through discretion. Part of the cringe-inducing delight of watching Girls is hearing Hannah say things and do things she knows she shouldn't. And part of what's refreshing about Dunham herself are her irreverent, indecorous comments and self-revelations, whether on Twitter, New Yorker essays, or interviews. So I was especially curious to hear what Dunham had to say about her obsessive-compulsive disorder and medication use in a just-released Rolling Stone cover story. Especially since it was titled Girl on Top: How Lena Dunham Turned a Life of Anxiety, Bad Sex, and Countless Psychiatric Meds into the Funniest Show on TV.
I've argued before that declaring American kids and teens to be "overmedicated" is something of a cop-out. How can people say what constitutes overmedication when they can't - or won't - specify what would constitute an acceptable number or percentage of kids taking psychiatric meds? Still, I do care about the numbers, because they can give us clues as to which kids and how many are getting appropriate treatment for emotional and behavioral problems. A recent and widely publicized study by researchers from The National Institute of Mental Health provides data on some -but not all - key measurements of youth medication use. Its main finding: Just one in seven teens with a diagnosable psychiatric conditions have recently taken medications to treat it.
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.
Most psychiatric drugs bear some version of the warning: "Do not drink alcoholic beverages when taking this medication." In reality, though, many people taking psych meds drink anyway. They have various reasons: not wanting to curtail their fun, not putting much stock in the warnings, or simply thinking it's easier to take a proffered drink than explain why they're turning it down. Doctors oftentimes don't bother to talk to patients about potential dangers. Or they tell patients not to drink, but don't explain why. To make matters worse, because of a lack of studies on the subject, patients inclined to do their own research will have a hard time just how risky it is to drink while taking various kinds of psychiatric medications (I've written elsewhere about this troubling lack of evidence). A widely publicized study that came out last month in the journal Neurology underscores the problem. The findings, which pooled data from 16 studies, showed that people taking SSRI antidepressants like Zoloft or Celexa were 40 percent more likely to suffer a type of stroke caused by bleeding in the brain and 50 percent more likely to suffer any bleeding in the skull.
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?
Today 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.
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.
Psychiatric medications have a lot of potential hidden costs. We don't know, for example, how taking them from a young age affects long-term brain and psychological development in kids. They have myriad of side effects, some serious, like diabetes, high cholesterol, neurological impairment and birth defects when taken in pregnancy. They carry stigma, both from others and self-imposed. But I'm not talking metaphorically about costs here. I'm talking straight-up financial outlays. Taking psychiatric medications can really add up, even for those who have health insurance, and even when they can take generic instead of brand-name drugs. One big reason is the so-called "medication merry-go-round."
New York, like much of the country, was mired in a massive heat wave for much of this week. Everyone was complaining that they could hardly stand to go outside - the heat index was 100 degrees. Once high temperatures set in, I began feeling particularly faint and achy, like I was getting sick. At first, I figured I was about to get a migraine, since I often feel like this before a particularly bad one. But no big headache arrived. Then I figured I was getting the flu. But I didn't have other symptoms, like a sore throat or an upset stomach. And then, I read an article online from the Philadelphia Inquirer about how heat and certain medications affect how well the body can regulate its own temperature, making people who take them more susceptible to extreme heat. I knew that people who take lithium as a mood stabilizer have to be careful in the heat. The drug has has a narrow therapeutic range and can reach toxic levels in your system if you get dehydrated, something that's much more likely to happen in hot weather. But it was news to me that other psychiatric drugs, including the antidepressants I take, could alter the body's ability to regulate its temperature.