Category Archives: Medication

From the Global Financial Crisis Down To You

This movie is so good I watched it twice.

It just has a funny title – I Am <FishHead( – yes, really.

It’s partly good because it has Philip Zimbardo in it. I remember before the age of the internet, watching Phillip on his PBS Discovering Psychology series, and was delighted to discover useful psychology training available for free!

But more than that this movie is good because it hits on the core issues of the financial crisis we live in, and yet still comes down to daily realities and practical steps we can take.

All starting with the core concept of the “corporate psychopath”.

Coming from the Chinese proverb that says “a fish rots from the head”, let me invite you to watch – I am <FishHead(

“WHAT’S WRONG WITH OUR WORLD? THIS IS A FILM FOR PEOPLE WHO WANT TO KNOW.”

Effectiveness of Antipsychotics – Schizophrenia Vs Psychiatric Medicines

During my medical training I did three months of community psychiatry.

It was valuable time.

Among the most shocking experiences in that time was the visit I made to a share house for people with severe mental illness, often schizophrenia.

These were the type of people whom you could tell were mentally ill. They just looked the part.

Many had clear-cut cigarette stains on their fingers – even the younger ones.

They were listless with vacant stares. Some mumbled as they walked or sat.

But worst of all was their slow, staggering walking, and the regular twitches and twists of their faces and tongues.

It was this last sign that struck me the most, because this was not in fact a sign of mental illness, but rather a sign of being on anti-psychotic medication, often at high-dose, and long-term. A tragic, visible and socially awkward side-effect with the polite medical term, dystonia.

Many were on court-ordered injections of their anti-psychotic medication. They would never get off it.

Even those people that somehow came off this medication, would find that the dystonias would be permanent, marking them out as ‘different’ forever.

Now this was in the 1990s when there were new anti-psychotics coming out that were meant to cause less of these side-effects. Less, but not zero. They all had some sort of problems.

So in trying to come to grips with this iatrogenic (doctor-caused) damage I did ask myself the key question, “Did they need this medication, or could we reduce it or even stop it altogether?”

I can’t say I cut back their medication much at all.

However it set me to thinking and research, and the answers I found back then disturbed me. They were part of my deliberate decision to avoid psychiatry when I looked at becoming a counsellor.

So now in 2012 a friend sent me an article that brings these memories back to me and revives that question:

“Did those people need that anti-psychotic medication?”

Well here is an official answer:

The British Journal of Psychiatry (2012) 201: 83-84 doi: 10.1192/bjp.bp.112.112110

Recent evidence from systematic reviews and meta-analyses suggests that the efficacy and effectiveness of antipsychotics to produce clinically meaningful benefits for people with psychotic disorders have been overestimated. A meta-analysis showed that although there may be demonstrable effects of antipsychotics in comparison with placebo, the improvements over placebo are not as great as previously thought:1 the average change in symptoms rated with the Positive and Negative Syndrome Scale (PANSS) attributable to antipsychotics did not meet an empirically derived threshold for minimal clinical improvement,2 and only 17–22% experienced an important benefit (significant improvement or prevention of relapse) which could be attributed to the drugs rather than to placebo effects or natural recovery. A subsequent systematic review concluded that the improvements claimed for antipsychotics, old and new, are of questionable clinical relevance,3 with most trials failing to demonstrate even minimal improvement measured using the PANSS. There is also growing recognition that there is no discernible difference in effectiveness between first- and second-generation antipsychotics, supported by evidence from a recent meta-analysis.4 It is also relevant that there is evidence from double-blind trials in healthy volunteers that antipsychotic medication can result in secondary negative symptoms.5″

Or when put into non-medical jargon:

“Recent evidence from systematic reviews and meta-analyses suggests that the efficacy and effectiveness of antipsychotics to produce clinically meaningful benefits for people with psychotic disorders have been overestimated.”

Translation: Ooops. We goofed.

A meta-analysis showed that although there may be demonstrable effects of antipsychotics in comparison with placebo, the improvements over placebo are not as great as previously thought: …

Translation: These are not the ‘cures’ we claimed they were.

… the average change in symptoms rated with the Positive and Negative Syndrome Scale (PANSS) attributable to antipsychotics did not meet an empirically derived threshold for minimal clinical improvement …

Translation: The drugs are largely useless – but the research papers look good!

… and only 17–22% experienced an important benefit (significant improvement or prevention of relapse) which could be attributed to the drugs rather than to placebo effects or natural recovery.

Translation: 80% of people were wasting their time taking these.

A subsequent systematic review concluded that the improvements claimed for antipsychotics, old and new, are of questionable clinical relevance,3 with most trials failing to demonstrate even minimal improvement measured using the PANSS.

Translation: The fact that these drugs are close to useless is so important/surprising/horrifying, we had to find a way to say it again.

There is also growing recognition that there is no discernible difference in effectiveness between first- and second-generation antipsychotics, supported by evidence from a recent meta-analysis.

Translation: Forget the hype. The newer drugs are just as useless as the older ones.

It is also relevant that there is evidence from double-blind trials in healthy volunteers that antipsychotic medication can result in secondary negative symptoms.

Translation: The drugs can even CAUSE the same problems they were meant to treat!

I learned my psychiatry in the 1990s during what was called the “Decade of the Brain”: a big time for research into neurology, neurochemistry and putting psychiatry onto a proper medical footing.

Unfortunately what that decade should have taught us instead was … humility.

The Power Of Negative Thinking

This a quote from a subheading in one of my favorite books of all time, “The Peter Principle“.

But in fact this approach has a long and rich history.

I am just about to head overseas on a 2 month trip with my wife and 3 small kids – and leave my counselling practice unattended for all that time.

For many reasons, this was something I assumed I would NEVER be able to do.

With the Power of Negative thinking (done more informally than Tim suggests in his video below) I managed to do it.

Think of this as a farewell from me – til November anyway – and, an invitation to you to apply negative thinking in your life for your success.

-Dr Martin Russell

Phentermine For Weight Loss – My Story

As I was cleaning out some of my old medical files I came across a couple of letters from 1998 about the weight loss drug phentermine.

Back in 1998 I was reading the material of a medical organisation called MaLAM, which monitors and lobbies pharmaceutical companies on their advertising.

Always a fascinating read, but this time they had sent a letter to 3M Pharmaceuticals with questions about their Duromine brand of phentermine.

Phentermine has been around as a weight loss medication since the 1959, and is only recommended for short-term use eg 3 months at most.

The first question was the kicker…

“1. Does 3M have any evidence that the short-term of [sic] Duromine leads to long-term reduction in weight, total morbidity and total mortality?”

ie does Duromine work?

And 3M’s reply…

“…there is no evidence in the medical literature or from 3M studies suggesting that long term reduction in weight, total morbidity and total mortality can be expected from the use of short term adjunctive appetite suppression with phentermine.”

Hmm.

So did 3M just say phentermine is useless?

That’s how I read it.

This letter was the moment I stopped using the currently available medications for weight loss.

That left me with only lifestyle options to offer my patients and I’ve written before about my issues with exercise and dieting.

But today in 2009 maybe something has changed for phentermine in the past 10 years.

Nup.

Wikipedia still says, “Since the drug was approved in 1959 there have been almost no clinical studies performed. The most recent study was in 1990…” ie well before this 1998 letter.

Sad. Really sad.

Go read my Amazon review if you want an alternative.

-Dr Martin Russell

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The LAP-BAND Solution

No, this is not my line.

The LAP-BAND Solution: A Partnership in Weight Loss” is the title of a book by Australian surgeon Dr Paul O’Brien which I read with interest when one of my patients found it in a library and showed it to me.

Since the start of 2007 I have been doing public talks on the myths and facts about weight loss.

The key question I ask people at those talks is this…

What would you advise someone who wanted to lose a SIGNIFICANT amount of weight LONG-TERM?

By which I mean, what actually works to lose >10% of bodyweight for >5 years.

People will come back with all sorts of answers.

I’d love to be able to say it was some sort of psychological intervention, but I can’t (more on this later.)

The fact is that the only research-PROVEN answer is an operation.

There are a few types of stomach operations for weight loss, also known as bariatric surgery, but to my mind they fall into two camps; ones that irreversibly rearrange the gut in some way, and ones that leave your insides intact and put in some sort of stomach banding instead.

The commonest operation of the first type is called gastric bypass surgery, and it is popular in the US.

The most well-known of the gastric banding type is LAP-BANDing (TM), and it is the most popular in Australia.

In “The LAP-BAND SolutionDr Paul O’Brien is described as one of the originators of this device, and has extensive experience in academic, research, and professional areas of obesity and bariatric surgery.

The book therefore promised to be an authoratitive text, and also very pro-LAP BAND(TM). It was both of these.

It is also fairly readable which is a nice bonus too.

The best bit about finding people who have one solution to a problem, is to listen to what they say about other suggested solutions. They will tend to be scathing.

Here’s what Paul O’Brien says about drugs…

The long-term efficacy is poor and the long-term safety is unknown … the average weight loss after 1 year of orilistat [Xenical] is about 7 lb (3 kg) and for sibutramine [Meridia or Reductil] is 10 lb (4.5 kg) … these results are just not good enough.

Here’s what he has to say about weight loss by dieting and lifestyle modification…

The commercial weight-loss centers have made fortunes by promising excellent weight loss through various twists on the “lifestyle” methods, and their constant advertisements always show the classic “before and after” pictures. Invariably, the “äfter” picture is only a few months after. They do not show the “after” pictures at 5 years.

A recent comprehensive review of all the high-quality scientific studies of the options for weight control has found that there is no evidence of a durable effect from any current lifestyle intervention methods for obesity.

The only problem with this statement is that the review he refers to is in fact from 1997. Not exactly ‘recent’ in my opinion.

Still, the last 11 years haven’t proven any better studies that I am aware of either.

[The approach I recommend has not been proven in the research, and since there is no pill or expensive program, ie no money in it, I very much doubt the required multi-year studies will ever be done.]

However, my patient was already losing weight without surgery.

She gave the book to me for an entirely different reason.

She pointed out that the book talks about patients with a LAP-BAND(TM) learning to eat in an entirely different way – a way that mimics many (but not all) of the things I recommend in my non-surgical, non-dieting approach.

This is really interesting.

What if surgery is merely an extreme way to change someone’s eating behaviors?

I don’t think that is all of the effect, but I certainly think it is some of it, and maybe all of the long-term lasting results.

Why would I say this?

Because I have worked with people who lost weight with surgery, but then gained much of it back again. Their results didn’t last, and I then teach them the additional changes.

Every method of weight loss reports some successes.

Some of people even keep the weight off long-term.

A few become celebrities (eg Biggest Loser winners) and their new life then depends upon keeping the weight off. That might help as motivation.

But I think there are another group of people who discover a few other tips and habits that give them the success they need – effortlessly.

I think they discover, albeit accidentally, the non-dieting method that naturally thin people live unconsciously and automatically.

If you are over-weight enough to qualify for surgery, then it certainly is worth pursuing. In the US you might need to push to get access to LAP-BAND(TM) because apparently insurance companies are still trying to avoid paying for this, but I agree with Dr O’Brien that it is a better option than gastric surgery, if for no other reason than it is entirely reversible.

But also know that you can make many of the same changes without surgery, and all for free!

Here’s how.

Enter your name and email address for the blog notification list at the top of the page here, and you will be sent a complete audio of all the steps I suggest.

[If you are in my home town of Adelaide, then you can get the Adelaidean-only emails with the same audio here instead.]

-Dr Martin Russell

Lily The Pink

People say that your adult life is shaped by your childhood experiences.

Now I have my own young children I begin to recall all sorts of nursery rhymes, songs and tunes I haven’t heard for ages. What effect did they have on me I wonder?

I’m not sure that my mum singing “The Purple People-Eater” greatly influenced my future development, but just recently I’ve been getting a song stuck in my head called “Lily The Pink”.

So with a bit of hunting in Wikipedia I find that “Lily The Pink” is an English drinking song based on “Lydia Estes Pinkham (February 9, 1819 – May 17, 1883) who was an iconic concocter and shrewd marketer of a commercially successful herbal-alcoholic “women’s tonic” meant to relieve menstrual and menopausal pains.”

The traditional “Lily The Pink” has verses like these two…

Peter Whelan
He was sad
Because he only had one nut
Till he took some of Lydia’s compound
Now they grow in clusters ’round his butt.

And Uncle Paul
He was terribly small.
He was the shortest man in town.
So on his body he rubbed medicinal compound,
And now he’s six foot, underground.

I have a sanitized version stuck in my head, and this was a hit in the UK just before I was born.

Maybe this was the start of my upbringing to becoming a medical sceptic?

All I can say is that anytime someone tells me they have found a medicine or natural cure that seems to work on anything and everything, then this song pops into my head (the full original lyrics are below the video)


Chorus:
We’ll drink a drink a drink
To Lily the Pink the Pink the Pink
The saviour of the human race
For she invented medicinal compound
Most efficacious in every case.

Verses:
Mr. Frears
had sticky-out ears
and it made him awful shy
and so they gave him medicinal compound
and now he’s learning how to fly.

Brother Tony
Was notably bony
He would never eat his meals
And so they gave him medicinal compound
Now they move him round on wheels.

Old Ebeneezer
Thought he was Julius Caesar
And so they put him in a Home
where they gave him medicinal compound
and now he’s Emperor of Rome.

Johnny Hammer
Had a t-t-terrible s-s-stammer.
He could b-barely speak a word.
So they gave him medicinal compound,
And now he’s seen, but never heard.

Auntie Millie
Ran willy-nilly
When her legs, they did recede
And so they rubbed on medicinal compound
And now they call her Millipede.

Jennifer Eccles
had terrible freckles
and the boys all called her names
but she changed with medicinal compound
and now he joins in all their games.

Lily the Pink, she
Turned to drink, she
Filled up with paraffin inside
and despite her medicinal compound
Sadly Picca-Lily died.

Up to Heaven
Her soul ascended
All the church bells they did ring
She took with her medicinal compound
Hark the herald angels sing.

Oooooooooooooooo Weeeeeeeeeeeeeeee’ll drink a drink a drink
To Lily the Pink the Pink the Pink
The saviour of the human race
For she invented medicinal compound
Most efficacious in every case.

The original and complete vinyl recording is here;

http://www.youtube.com/embed/6ETDp6xzJko

-Dr Martin Russell

Antidepressant Ups And Downs

“There have now been six meta analyses in the last decade showing little difference between antidepressants and placebos, yet this is not commonly recognised in clinical practice.” – Medical Observer April 4 2008 pg 31

So says Professor Gordon Parker of the Black Dog Institute in Australia, who has long been a critic of “depression” as being too broad a label for what is going on in particular individuals. He is particular keen that treatment, including antidepressants, must be tailored much more specifically.

Professor Parker points out that the popularity of antidepressants was full of ups and downs even before the culture-shifting release of the antidepressant Prozac…

“The first antidepressant drug (the tricyclic drug Imipramine) was ‘discovered’ a little more than fifty years ago.

The manufacturers, Ciba-Geigy, did not wish to take that drug to market as their analyses indicated that there were insufficient depressed people in the world for the drug to return a profit, and it was only after strong protest advocacy in the United States (by consumers) that it was released [my emphasis].

When we consider the sales of antidepressants over the last decade, that judgment by Ciba-Geigy may seem inexplicable. But “depression” in the middle of the twentieth century essentially comprised severe expressions of “biological depression” (psychotic or melancholic depression) that resulted in a percentage of people being hospitalised, generally in asylums as few general hospital psychiatry units existed.”

The last 50 years of psychiatric thinking has been an enormous rollercoaster ride through society and the ride isn’t looking like ending any time soon.

All I can say is, hang on!

-Dr Martin Russell

Depression Solutions… Can You Help?

With the recent studies showing antidepressants to be far less effective than previously reported, this leaves a big gap in the field.

What can take the place of antidepressants?

What solutions are already out there for depression?

What books, courses, websites, resources of any type are there for “curing” people who have been given the label “Depression”?

I’d like to know of ones you think work, and any you don’t think work as well, with enough details for me to find the resource, and what thoughts you have about it.

Yes. Self promotion is allowed. If you’ve got something good enough then great!

It will be interesting to know whether there is anything that might fill the therapeutic vacuum.

You can put your thoughts as a comment below.

Much appreciated.

-Dr Martin Russell

How To Get Better Results From Treatment

Fake pills and treatments are such wonderful things.

They work roughly 30% of the time, on almost anything.

With the technical term of ‘placebos’ they are the gold standard treatment against which every other treatment is measured.

And the whole field is shrouded in mystery.

Why do blue placebos make people more sleepy, while red placebos keep people more awake?

How can fake pills work even when you know there is no active ingredient in them?

How can they work no matter what level of intelligence you do or don’t have?

Well it’s still largely guesswork, because we don’t know why or how they work but they certainly do. Study after study has shown the effectiveness of variations of placebos.

Here is one more thing that has been recently uncovered about placebos – they work better if they cost more!

Dr. Ariely, a behavioral economist at MIT’s Media Lab, and his colleagues had two groups of people receive electrical shocks to their wrists.

They were told this was for a research into a new painkiller called Velodone.

When they were given the medication one group was told the price of the medication was $2.50 a pill and others were told the cost was discounted to just 10 cents a pill.

Those who got the “more expensive” pill had significantly better pain reduction than those who thought they were getting the discounted version.

This is actually important.

Drug companies often bring out drugs that besides being new, are often more expensive too. How much of the patient’s results is simply based on the added expense, rather than having a better chemical.

Also, this effect may indeed make brand-name medications more powerful than generic brands.

So one way to get better results from your treatment is to pay more for it.

As a side note, Dr Dan Ariely has a book just published about these and other psycho-illogical phenomena. It’s called “Predictably Irrational: The Hidden Forces That Shape Our Decisions”.

My main thought is whether people who buy the more expensive hardcover version will rate the book better than those who buy the cheaper paperback.

It wouldn’t surprise me, or Dan I suspect, in the least.

-Dr Martin Russell