Category Archives: Medication

National Sleep Awareness Week 2008… Yes Really!

This week March 3-8 the National Sleep Foundation (NSF) is holding National Sleep Awareness Week (NSAW, but SNAW would have sounded so much better.)

Had you hear about this week?

Each year it seems to be getting bigger so eventually you might.

Let me quote from the NSF’s “Sleep in America Poll 2008 – Summary of Findings”

“Long work days that often extend late into the night are causing Americans to doze on the job, at the wheel, and on their spouses, according to NSF’s 2008 Sleep in America poll. Among the poll respondents, 29% fell asleep or became very sleepy at work in the past month, 36% have fallen asleep or nodded off while driving in the past year, and 20% have lost interest in sex because they are too sleepy.”

Okay let me get straight to the point.

The Gold Sponsors of this event are:

  • Boehringer Ingelheim – makers of pramipexole known by the names Mirapexin®, Sifrol®, Pexola®, Mirapex®, which is a treatment for a sleeping disorder called Restless Legs Syndrome
  • Sanofi Aventis: makers of zolpidem known by the names Ambien®, Ambien CR®, Stilnox®, Myslee®, which is one of the world’s most popular sleeping medications.

The promotion of sleep awareness means the promotion of the awareness of sleep disorders, and of course, their treatments. It is hardly surprising that these companies are footing a big chunk of the bill.

It is hard for me to assess such an arrangement and it’s effects.

At least the evidence is that sleeping medication is more effective than anti-depressants at doing the job they are named for.

Except you need to consider whether they are effective long-term.

Certainly sleeping medication is not authorized for long-term use, even though that is how many, many people end up using them.

So how much is “awareness” based on marketing and “disease-mongering”, and how much on community benefit.

The NSF has a similar paradox to the one I find myself in when I talk about the system I have for helping people use sleeping pills safely and for as little time as possible.

http://www.SelfHelpSleepingPills.com

By making sleeping pills safer to take, am I encouraging more people to take sleeping pills rather than fear them?

Am I contributing to the over-medicalization of something that is simply a part of being human?

Maybe.

Overall I hope I am contributing to your ability to make your own choice. After all that’s what self-help is all about.

-Dr Martin Russell

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Shake-up Or Wake-Up

The commotion over the study that said anti-depressants are a waste of time for all but the most severely depressed people, has continued to escalate.

It hit the middle editorial pages of my local city’s newspaper, and that means the story is big!

Much of the criticism that I have read of this study has been badly unscientific. A number of medical authorities seem to have come out with rather rash and half-baked defenses of their position.

Meanwhile there is a small debate building around the actual study itself which was published online in a format that allows comments.

For reference you can find the original study here:

Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration

This is an excerpt from my comments on the site:

It is interesting to see the commotion this study has caused, and rightly so.

Even more interesting has been the media reporting. They have been talking about the biological description of depression (eg biochemical imbalance in the brain) even as they are reporting that the drugs don’t work to anywhere near the level previously promoted.

The media is brainwashed to parrot what it has been told, even when there is a gaping hole in the theory.

Brain chemistry is not like insulin for diabetics.

It is also interesting to hear people who have received anti-depressants, and clinicians who prescribed them, somehow thinking they could not be responding to a placebo.

“All this evidence I have seen with my own eyes can’t be wrong” had been the catch-cry of quacks and the quasi-scientific, but it seems it is just the same here. Too many doctors, and patients, are not going about this scientifically.

If this paper is right then it says these drugs should not have gotten onto the market in the first place…

… We can’t offer talk therapy to all of the 5-15% of the western world that is supposedly “depressed”, but it’s no value overstating the benefits of medication either.

Far from being a step backwards I would like to see medicine, and psychiatry in particular, take this as a giant wake-up call for the 21st Century.

Hey, well I’m a wishful thinker 🙂

You can find all the direct comments on this landmark study here.

-Dr Martin Russell

The End Of The Anti-Depressant Era?

Good to see the recent spate of publicity for a study that hacks the legs out from under the antidepressant medication industry.

Currently the most viewed health article from the Washington Post website is about this study: “Only Severely Depressed Benefit From Antidepressants: Study“, and if you search Google News for the study’s author, Irving Kirsch, you find dozens of stories in the last 48 hours. It’s gone hot, and rightly so.

The whole 50 years of the Serotonin hypothesis that justifies these medications is a minefield of dressed-up science and warped philosophy.

It’s just over 20 years since the wonder drug Prozac came onto the market, and the field has just kept expanding with new variations on the theme.

All this was meant to be backed up by highly rigorous and validated science.

Well it was only last month that a study into the reporting of those research findings showed that the benefits of antidepressants was universally less than claimed. In some cases more than half of the reported benefit of a particular anti-depressant was shown to be due to selective reporting of the available research.

The current study goes even further and questions whether there is any benefit at all in anti-depressant except in severe cases of depression, and even in these cases there was very little effect.

As disheartening as this is for people who are depressed, I hope this study really starts to clear the air on this topic.

But a note…

What if you are currently taking ‘anti-depressants’? – or whatever these drugs should now be named instead.

Keep taking them for the moment at least.

Discuss with the person who prescribed them for you, and make sure you have alternative plans for managing your mood, and that you understand the process for weaning off the medication.

If you think there is nothing else that can help your depression, you might find new choices with this:

http://www.SelfHelpMeeting.com

-Dr Martin Russell

Heath’s Death

A friend of mine suggested I should write about Heath Ledger’s unexpected death.

In fact he suggested I should do some media publicity about the material I have about taking sleeping pills safely since Heath was found with sleeping pills and anti-anxiety pills in the room.

Well I wasn’t up for a media campaign, and I wasn’t even going to write about this subject on this blog. A little too raw, the story is still a little unclear, and it’s always awkward for readers of this blog who might find death a personal topic of interest. This is where the disclaimer comes in.

However there was one post I found to be worth a read from a self help perspective:

http://www.fourhourworkweek.com/blog/2008/01/23/depression-how-you-label-determines-how-you-feel/

Also, if you are taking sleeping pills, or considering doing so, then I urge you to check these videos out for your own safety:

http://www.selfhelpsleepingpills.com/

-Dr Martin Russell

The Gambler’s Delusion And Anti-Depressants

The first time I ever remember hearing about gambling was when I was given a Christmas present bought from a year’s worth of horse race winnings.

Later my parents explained to me that they were going along with the gift to please the person who gave it, but that the “winnings” weren’t actually that.

Basically there was a bank account specifically for the winnings, but any loses were not taken out, and neither were the original stakes.

So every Christmas it seemed like there had been a successful year.

Even “professional” gamblers don’t like to answer the question of how much money (or time and effort) it took to get the winnings they talk about.

However this bias doesn’t just apply to gambling.

It applies in scientific research as well.

The most recent publication from the prestigious New England Journal of Medicine (NJEM) includes a paper titled: “Selective Publication of Antidepressant Trials and Its Influence on Apparent Efficacy”

The idea is that pharmaceutical companies are finding ways to hide or ignore research that doesn’t show their drugs are great.

This is nothing new.

Promote the good studies, downplay the bad ones.

Tobacco companies have been repeatedly accused of this type of publication bias. If they don’t like the results of a study, then it can be simpler to just never publish it.

The public is none the wiser.

However researchers have been honing in on this problem over the past few years.

This particular piece of research from the NEJM is very nice.

The researchers found that 37 out of 38 positive studies were published, but pf another 36 negative studies, 22 were not published, and at least 11 of the remaining 14 presented a negative study as a positive one.

All of the 12 different anti-depressants drugs from 7 different drug companies were helped by this positive bias.

Some of the drugs seem to be over 200% better than they would be if the negative studies had been included. This is not a trivial error.

The evidence suggests massive and systematic bias, but is it self-delusion like a gambler, or cynical manipulation?

Either way I don’t suggest anyone rely on anti-depressants to create their happiness.

This research paper even triggered a well-written article in The Wall Street Journal so I’m sure there will be much more to come on this issue.

-Dr Martin Russell

Claiming The Title

There are so many people claiming the titles of Depression, or Bi-Polar these days.

There are certainly companies who spend a lot of time and money telling us that every possible emotion, other than a sort of flat-lined acceptance of inevitability is an illicit symptom of a pathology.

If your life seems dull and pointless, and you can’t think of anything to get excited about, you are depressed, it could be Depression and need to get yourself dosed with some new, but legal, drug.  If you are particularly happy, and your mind is clicking away coming up with amazing idea after amazing idea, you are just in a “Manic phase,” and in addition, though it feels good, it will soon be over.

These medical “titles” have escaped from the narrow confines of the psychiatric world into public and commercial use, and they are running havoc.

This is a trend and at least partly a marketing-driven trend at that.

Nobody makes any medication sales if you are not self-diagnosing as “ill” to get you to go see a “medical professional” in the first place.

Once you are in their office it is easy for most medical professionals to fit your situation into the idea that they have something on the shelf that can bring your emotional state back to being more appropriate.

Once you are taking something, it can often lead to you taking more, whether by increasing the original dose, or adding something to treat side-effects of the original pill, or because you are seeing a health professional who is helpful enough to find a title for something else you have.

Then what happens if you want to stop the pills?

Anarchy will ensue, of course.

Or will it?

The only way you can find out is to stop the pills “under medical supervision”.

Isn’t that an interesting Catch-22.

-Dr Martin Russell

Headaches Are Caused By…

When people come to me and complain about headaches, they usually are quick to suspect their headaches are caused by stress or some psychological worry.

After all if they thought their headaches were caused by something physical, that a physiotherapist could fix for example, they wouldn’t be seeing a psychological self help guy in the first place now would they.

However not every headache is caused by something physical or even something psychological, some are caused by…

“Aspirin-Deficiency Syndrome”.

Yes that’s right.

Perhaps you haven’t heard of Aspirin-Deficiency Syndrome before, however it is obvious that this is a cause of headaches, because rectifying the problem is a well known cure.

Simply take aspirin and more often than not your headache disappears, and that of course is because you are treating the fundamental cause of the headache ie aspirin-deficiency.

Unfortunately aspirin washes out of the body quickly so you need to keep taking it for the deficiency to be properly addressed.

Aspirin is a naturally occurring substance, although often deficient in the diet of many people in the world. For people who require a supplementation to their diet it can be conveniently found in the form of a tablet.

However aspirin-deficiency syndrome is not just a cause of headaches.

No. It is also a cause of all types of aches and pains, and even fevers and chills.

Aspirin-deficiency syndrome is a known factor in bowel cancer, heart disease, and even blood clotting disorders. It may even be an important factor in causing Alzheimer’s.

Here is short list of deficiency syndromes that can cause headaches:
– top of the list is Aspirin-deficiency Syndrome,
– Tylenol-deficiency syndrome,
– codeine-deficiency syndrome (sometimes confused as being withdrawal rebound headaches),
– caffiene-deficiency syndrome (also confused with withdrawal symptoms),
– manual-therapist-deficiency syndrome,
– bed-rest-deficiency syndrome…

Heck, ask your pharmacist to tell you what deficiency syndrome you have. Almost guaranteed, your headaches are caused by a deficiency of something they have on their shelves, and the cure follows from the diagnosis.

At least that’s the way alot of our society treats it. So hop on board.

-Dr Martin Russell

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Self Help For Sleeping Pills – The Campaign

I want to change the world, or at least a bit of it.

So I’m giving some stuff away for free, and I’m wanting your help.

If you agree that people are popping too many pills in this world, or you just have an interest in helping people improve their lives then read on…

Working as a family doctor, and now as a counselor, one common issue people have is trouble sleeping.

They can’t get a good night’s rest.

They come to me and I offer them stress reduction, sleep hygiene, hypnosis, meditation among other self help methods.

But like it or not, many people want to pop a pill.

It turns out that sleeping pills are in fact a growth industry. Over the past decade the sales of prescription sedatives, much of which is sleeping pills, has doubled to $4 Billion in 2006 in the US alone.

The prediction is for an explosion to $5 Billion in the US by 2010. The rest of the world is following this frightening trend.

Even worse, remember that this is just on prescription pills. The dollar amounts are WAAYY bigger if you add in all the non-prescription sleeping pills, potions, sprays, etc, etc.

Most people worry about the side effects, but here is the real issue.

These pills are not recommended to be used longer than 2-4 weeks!

Yet whether prescription medication, natural, herbal, alternative or whatever, people end up taking them for months, years, and sometimes the rest of their lives!

This is unforgivably horrendous.

But what can be done?

It’s easy to just say “Don’t take the pills”, but that message won’t stop this pill-popping avalanche.

People take sleeping pills because they want sleep and the pills work.

If they used them short-term it would be okay, but people don’t.

Many people end up taking them long-term. They don’t want to, but if they simply follow the instructions on the packet and pop a pill each night for 2-4 weeks they find that when they stop the pills, more often than not, their sleeping problems come straight back.

They don’t even have to be physically addicted to the drugs, it’s just that they haven’t broken their habit of poor sleep.

So they go back on the sleeping pills again.

They are caught!

This recurring Sleeping Pill Catch-22 can be avoided!

Back when I was a family doctor, I began suggesting a 3-step system for my patients to help them take sleeping medication in the smallest effective dose, for as little time as possible, and without risking getting addicted.

I’ve recommended it in my counseling practice too.

It even helps people who are already taking sleeping pills, prescription and otherwise.

As far as I’m concerned they should stuff instructions for this 3-step system into every packet sold.

If you haven’t guessed by now I’m passionate about this.

My big dream is to stop the sleeping pill market in it’s tracks, and reverse it into steady decline, simply by having people take the pills they way they were meant to be used – short-term.

One thing is guaranteed. I can’t do this campaign alone.

So here is where you come in.

I originally made this as a product to sell. I would now prefer this information just gets out to people.

You may want this information on the link below for your own sleep. If so great. It’s all there for you. There is nothing left out and no extra product you need. It’s all yours.

However, even if it’s not for you personally I’d appreciate your help in making this known to as many people as possible. Sleeping problems are a not a common topic of conversation so you won’t know all of your family, friends, and colleagues who really want and need this system.

This is the page where I open up all the details for the 3-step system.

http://www.SelfHelpSleepingPills.com

I appreciate you leaving your opinions, ideas, feedback, suggestions for how to get this message out there etc as a comment below.

-Dr Martin Russell

Influencing Doctors

Survey after survey of doctors says that they don’t think that gifts influence their behavior.

Study after study says they are totally wrong.

The big pharmaceutical companies spend millions upon billions on advertising and promoting to doctors and one of the biggest ways they do so is by using gifts of all types.

Sometimes it’s pens, sometimes it’s meals and nights out, sometimes it’s travel and accommodation, there are various rules and guidelines in place but historically it can be almost anything.

The evidence is overwhelming that this sort of practice is highly effective at altering doctor’s behavior.

The most obvious evidence is that so much money is spent on it. Drug companies do have ways of monitoring the effect of their marketing to doctors. They have been able to study the results for themselves inside their own companies, and they clearly just want to do more of it.

Some of the research is done outside drug companies and therefore is available for us to analyze, and this research too comes up showing that doctors become more willing to prescribe drugs rather than non-drug treatments, pay less attention to the scientific evidence, and bias to favor a particular company’s drug.

That would be much less of a problem if it wasn’t for the perception that is widely held by doctor’s themselves that they are somehow “immune” to this influence, and that they are “too clever” to be swayed.

This self-delusion is wrong, and dangerous.

It’s easy for me. I’m in the luxurious position of not prescribing much at all these days, so I can accept as many gifts as I like for a new medication and my prescriptions still are zero.

I don’t get as many invitations or gifts these days.

Back when I did prescribe a lot more and did get more gifts I looked into this.

In my time I’ve come across a few doctors who do in fact acknowledge the influence of gifts in their own practice, and one in particular got taken to task by my local newspaper.

One of the most senior surgeons at my city’s biggest hospital wrote a book on how to prepare for surgery.

A tiny piece in the book suggested that patients should give a gift, like an expensive bottle of brandy, to their surgeon before they had an operation.

Among all his recommendations, this “bribe” got the attention.

The outcry was huge.

“Doctor’s are already rich enough, and now they are asking you to give them bribes too!”

“You can buy off your doctor with booze!”

Well, the newspaper didn’t quite go that far, but that was the impression they were giving. I bet it sold a few newspapers and demonstrated a lot about what influences them. But that’s not my field so I won’t go into that.

I was working as a volunteer with a local radio station at the time and I took the chance to interview this surgeon.

He was bemused as to what all the fuss was about. He openly acknowledged that surgeons get influenced by gifts, and he put it something like this…

“When you yourself need surgery and you are being wheeled into the operating theater, do you want your surgeon to think of you as the Xth case of Y operation for that day?

Or do you want to be thought of as ‘the patient who gave me ……’?

Surgeons are human too and it DOES influence how they handle you and your surgery.”

Unfortunately I’ve never seen this particular technique studied, so this is one piece of self help that I simply recommend from my own experience with doctors and other human beings.

-Dr Martin Russell