Using Your Genes To Tailor Anti-Depressants. Will It End Hit-And-Miss Prescribing?

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(4-1-19)  About two years ago, I was approached by a sales representative who claimed his firm had developed a procedure that would help avoid the all too familiar practice of doctors prescribing a drug, deciding it wasn’t working, prescribing another, etc., until they finally hit one that worked.

Sometimes this hit-and-miss approach can cause real damage. One of my son’s psychiatrists prescribed a pill that made him much, much worse.

Washington Post Reporter Ilana Marcus has investigated the practice of using genes to better prescribe. While I don’t like to post already published articles, her story is worth your attention.  (Please share your stories on my Facebook page about having difficulty or success in finding the best meds that worked for you.) 

Can genetic testing help doctors better prescribe antidepressants? There’s quite a debate.

By Ilana Marcus  

The Washington Post

Grit alone got Linda Greene through her husband’s muscular dystrophy, her daughter’s traumatic brain injury, and her own mysterious illness that lasted for three years and left her vomiting daily before doctors identified the cause. But eventually, after too many days sitting at her desk at work crying, she went to see her doctor for help.

He prescribed an antidepressant and referred her to a psychiatrist. When the first medication didn’t help, the psychiatrist tried another — and another and another — hoping to find one that made her feel better. Instead, Greene felt like a zombie and sometimes she hallucinated and couldn’t sleep. In the worst moment, she found herself contemplating suicide.

“It was horrible,” she said. She never had suicidal thoughts before and was terrified. She went back her primary care doctor.

In the past, when Jeremy Bruce, Greene’s physician in Cincinnati, treated patients for depression, he followed the same steps for almost everyone: start the patient on one antidepressant and switch to another until something helped. Sometimes, before they found the right treatment, the patient would leave his practice to find a new doctor.

“They would usually be very angry,” Bruce said.

But about three years ago, Bruce tried a new approach.Click to continue…

Involuntary Commitment Debate Still Relevant: Who Is Playing Me?

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Watch this short clip from Minds on the Edge

(3-29-19) FROM MY FILES FRIDAY: Shortly after my book, CRAZY: A Father’s Search Through America’s Mental Health Madness, was published, I was asked to participate in a PBS special program about involuntary commitment.

It used a scenario inspired by what had happened to my son and me after we were refused treatment at a hospital emergency room and he ended up breaking into a stranger’s house to take a bubble bath.

MINDS ON THE EDGE  proved to be compelling television, so much so, that many local mental health groups began using it to discuss the “danger to self and others” standard.

I wrote this blog in 2010 about how one NAMI chapter had cleverly modified the show.

MINDS ON THE EDGE: Pete Earley Confronts Pete Earley

(2010) A funny thing happened recently. A man approached me after I delivered a speech and said: “Hi, I’m Pete Earley.”

I wasn’t certain what he was talking about until he explained that his local mental health group had used Minds on the Edge to discuss involuntary commitment. Members in his group had played the roles of those of us who actually were in the Fred Friendly Seminars broadcast.

He had been me — an angry and frustrated parent who couldn’t get help after his son became psychotic.

Because my “double” was familiar with conditions in his local community, he was able to tailor his comments to what actually happened in his own neighborhood when someone had a psychotic break. That made the issues surrounding commitment germane to him and local officials, and helped both see holes in the system.

I’d encourage you to watch Minds on the Edge . It affords you the opportunity to see and hear how a Nobel Prize laureate, a U.S. Supreme Court Justice, an ethicist, the father of Housing First, Author Elyn Saks, Judge Steven Liefman, Dr. Fred Frese, Dr. Tracey Skale, and other top mental health advocates grapple with a fictional scenario that remains all too familiar for many of us.

The program won awards from the National Alliance on Mental Illness and Mental Health America, and I doubt the discussion that it spotlights will be resolved anytime soon.

Sharing Your Stories: Books That Chronicle Mental Illnesses And Those Impacted By Them

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“Pat in 1988 before our world came undone.” Author Dede Ranahan’s first book

(3-26-19) I’ll be speaking April 2nd at the National Alliance on Mental Illness Dane County 2019 Awards Banquet and Gala in Madison, Wisconsin. Please support NAMI by attending if you live in the Madison area. 

The 2019 book season is upon us. Here’s a few that have caught my eye. If you have one that you’d like to recommend, please do so on my Facebook page.

Surviving Schizophrenia, 7th Edition, by Dr. E. Fuller Torrey.

Long considered the most comprehensive and authoritative book written about schizophrenia, an updated Surviving Schizophrenia is being released today. It was groundbreaking when it was first published in the early 1980s.  Here’s how my former colleague at the Washington Post, Peter Carlson, described the book’s impact in a 2001 article that documents how this important work helped NAMI become a national organization. If you have schizophrenia, know someone who does, or want to educate yourself about this serious mental illness, this is a must read.

When Laurie Flynn walked into the office of the National Alliance for the Mentally Ill for her first day as executive director in 1984, she found a pile of mailbags, each of them stuffed with letters. It was all because of E. Fuller Torrey. 

Torrey had just published “Surviving Schizophrenia,” a guide for patients and their families. When he appeared on Phil Donahue’s TV show to promote it, he urged people seeking help to contact the alliance, which was then a fledgling organization with fewer than 50,000 members, most of them the parents of mental patients. The result was this avalanche of mail.  

“Nobody had ever said the word schizophrenia on popular television, and people came out of the woodwork seeking help,” Flynn recalls. “For many years, mothers were told they were the cause of the problem, and here comes Fuller Torrey saying, ‘Wait a minute, this isn’t the family’s fault. These are brain diseases.’ Here was a psychiatrist saying, ‘I know what you’re going through because my sister has the problem.’ It’s hard to overemphasize what a hero he was back in the early days.” 

Torrey donated the royalties of “Surviving Schizophrenia” to the alliance and he hit the hustings to organize, helping to build the group into a powerful lobbying organization with more than 220,000 members.

“Weekend after weekend,” Flynn says, “he went out to states where members were organizing chapters and he rallied the troops. Nobody did it better.”

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Video About ‘Lack of Insight’ Still Stirs Heated Debate: Can Individuals Experiencing Psychosis Make Treatment Choices?

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(3-22-19) From My Files Friday – Nearly seven years ago, I posted a blog about whether anosognosia (commonly referred to as ‘lack of insight’ ) was applicable to serious mental illnesses.

I featured a video narrated by Dr. E. Fuller Torrey and produced by the Treatment Advocacy Center. Both argue that anosognosia explains why individuals who are in the midst of psychosis  often don’t believe they are ill or need help.

The four minute long video includes a snippet of a disturbing interview with Eugene Weston Jr., who entered the U.S. Capitol on July 24, 1998, and fatally shot two U.S. Capitol Police Officers: Jacob Chestnut and Detective John Gibson.

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Comments and Questions From Readers: Why Did You Write That? Community vs State Hospitals?

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(3-18-19) Reader comments and questions.

Dear Pete: Your photo essay on the state hospital in Georgia was well done and thoughtful. However, the dubious distinction of largest of its type actually goes to a facility that was near my home town in New York – according to Wikipedia.  See below.

Pilgrim Psychiatric Center, formerly known as Pilgrim State Hospital, is a state-run psychiatric hospital  located in Brentwood, New York. At the time it opened, it was the largest hospital of any kind in the world. At its peak in 1954 it had 13,875 patients. Its size has never been exceeded by any other facility, though it’s now far smaller than it once was. “Pilgrim Psychiatric Center”. 

We were also told, if we misbehaved as children that we would go to Pilgrim State. 

My reply:  My information also came from Wikipedia, which noted that Georgia’s Central State Hospital’s rival was Pilgrim State Hospital. I should’ve cited that too! Here’s that Wikipedia reference:

Central State Hospital. By the 1960s the facility had grown into the largest mental hospital in the world (contending with Pilgrim Psychiatric Center in New York). 

Pilgrim Psychiatric Center cir 1938.

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The World’s Largest Mental Asylum: From The Horrors Of The Back Wards To Today’s Jails and Prisons

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Photos by Pete Earley

(3-15-19) I recently spoke at a nursing symposium at Georgia College in Milledgeville. I took advantage of my trip to visit Central State Hospital on the edge of that community. During the 1960s, it was the largest state mental hospital in the world with more than 12,000 residents.

It is difficult to walk its largely deserted grounds and read its history without feeling an abiding sadness. While there were periodic efforts to treat patients humanely, the hospital never received sufficient state funding or had adequate staff to care for those confined there. Nor did its doctors know how to help most patients. Thousands died and were buried in unmarked graves. The state announced it would close the hospital in 2010, but instead now uses parts of it to house forensic patients.

The asylums are nearly gone, replaced by jails and prisons. Is this progress?

 

 

MILLEDGEVILLE — The first patient came to Georgia’s first insane asylum on Dec. 15, 1842, chained to a horse-drawn wagon. Tilman Barnett, described as violent and destructive, diagnosed as a “lunatic, ” never left. Barnett, a 30-year-old farmer from Bibb County, died six months later of a malady termed “maniacal exhaustion.”  –Alan Judd, writing in The Atlanta News

Parts of the majestic Powell Building stood when General Sherman’s troops camped on the grounds en route from Atlanta to the sea. Once the center housed administrators, with patients in two giant wings. Today only a fraction of the building is in use, accommodating state staff and employees of a redevelopment authority. – Doug Monroe, Atlantic Magazine

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