Psychiatrist J. Douglas Bremner has weighed in on the Melanie Blocker Stokes MOTHERS Act, an effort to provide voluntary screenings to pregnant women to help identify postpartum depression before it becomes overwhelming. I’ll let Bremner speak for himself:
The problem with this is the attitude that being a mother is a risk factor for a psychiatric disorder. First of all, there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum depression. So to screen all moms as if giving birth is a risk factor for depression is ridiculous.
My BS alert goes off whenever someone tries to change the argument from a reasonable effort to help increase education and information about a stigmatized mental health issue, to hyperbole, suggesting that a piece of legislation is trying to turn motherhood into a psychiatric disorder. It goes off again when a professional makes an extraordinary claim like, “there is no evidence that women without a prior history of anxiety and depression have any increased risk of getting post partum [sic] depression.” Really? Absolutely no evidence? That’s quite a strong statement, and easily proven false with a literature review.
Where shall we begin? (I have limited space and you have a limited attention span, so I’ll just highlight a few studies…)
Ross & Dennis (2009), for instance, in a literature review found that both substance use and current or past experiences of abuse are associated with increased risk for postpartum depression (PPD).
In urban South African women, Ramchandani and colleagues (2009) found the strongest predictors of postnatal depression were exposure to extreme societal stressors (e.g., witnessing a violent crime/danger of being killed) and reporting difficulties with their partner.
Robertson et al. (2004), in a large meta-analysis of research to-date, found that a previous history of depression and anxiety (not just during pregnancy) was predictive of postpartum depression. But they also found that simply experiencing a stressful life event during pregnancy or low levels of social support (e.g., not having any emotional support from your friends or family) could also lead to postpartum depression.
Beck’s (2001) meta-analysis of 84 studies found:
13 significant predictors of postpartum depression: prenatal depression, self-esteem, childcare stress, prenatal anxiety, life stress, social support, marital relationships, depression history, infant temperament, maternity blues, marital status, SES, and unplanned/unwanted pregnancy. 10 of the 13 risk factors had moderate effect sizes while 3 predictors had small effect sizes.
Look at all of those factors which are not depression or anxiety — I count 9. Even if 3 of those are small-effect size factors, that still leaves 6 factors which are not depression or anxiety.
What about the argument that if depressed women are the most at-risk, we should simply focus on them?
Ingram & Taylor (2007) found it wasn’t just a woman’s pre-birth depression severity that was important — poor emotional support and women who had more negative descriptions of their own childhood were additional risk factors that played a role in increased risk for postpartum depression. Who’s going to screen for these things, the obstetrician?
Well, no, because the obstetrician is already not doing a good job at screening for postpartum depression, even in high-risk women. Hatton et al. (2007) found that, among high-risk women, obstetric care providers may be overlooking up to one fifth of women with current major depression. Not exactly great numbers there. If obstetric care providers can’t deal with the obvious cases, I can only imagine how well they do with the more complex or less obvious ones.
Monk et al. (2008) sums the state of our knowledge on PPD:
Depression is relatively common during the perinatal period (Gavin et al. 2005; Ross and McLean 2006). Approximately 8.5 — 11% of women experience either a major or minor depression during pregnancy (Gaynes et al. 2005). Nearly 20% of women have a minor or major depression in the first 3 months following delivery (Gavin et al. 2005).
So up to 1 in 5 women have depression after giving birth, and this isn’t something worth noting or screening for? (For comparison’s sake, 1 in 10 men and women in the general population might have depression at any given time.) Giving birth doubles your risk of depression, and this isn’t an issue? Amazing.
But don’t just take my word for it. Zajicek-Farber’s (2009) study conducted on high-risk women for postpartum depression concluded that:
These findings provide additional supportive evidence that more efforts are needed to identify and assess women’s depressive symptoms to promote health and safety of young children.
These are objective researchers calling for more screenings. Not politicians. And not people (or professionals) with a political agenda.
Now, I understand Bremner’s point — let’s not medicalize and catastrophize ordinary motherhood. I agree. And of course a woman’s pre-birth depression or anxiety is strongly correlated to postpartum depression. But not exclusively, as Bremner claims.
Bremner claims, with no evidence, that all mental health screenings are simply pharmaceutical sales tactics to help increase prescriptions. That’s ridiculous. When I worked in community mental health, we ran annual mental health screenings in the clinic — with no funding from any pharmaceutical company — because it reduces stigma, decreases misinformation and increases education about mental health issues in the general population.
Sorry, but most people don’t have time to keep up with a dozen blogs or read monthly journals on the latest research in mental health. Most people know what they know about mental health largely through mainstream media, or their own first-hand experiences with an issue. How is the promotion of more information and education about mental health issues a bad thing?
Bremner uses teens as an example of screening gone wrong, but conveniently fails to mention the facts about teenagers and mental health. Teens are an “at-risk” population, hence the reason they are sometimes targeted for screenings. Teens are notorious for being limited in their treatment options (especially in the U.S., where their treatment may be covered by their family’s health insurance, meaning a talk with their parents about their mental health issues), and for peer pressure limiting their ability to accept or seek help. (Yes, sorry, if you’re seeing a therapist for depression as a teen, you’re typically not seen as a “cool” kid.)
Sadly, whether people want to admit it or not, mothers are another “at risk” population. Why? Because society has told mothers time and time again that giving birth is supposed to be a joyous, happy occasion. If you’re depressed after giving birth to a child, there must be something wrong with you. Don’t draw attention to yourself or your problems. Just try and deal with it, try and take care of the baby, and make it through each day. Mothers don’t know they might have something recognized as postpartum depression, much less that they can talk to someone about these feelings or that there’s treatment — psychotherapy or medication — readily available for it.
So respectfully, I disagree with Bremner’s assessment of the MOTHERS act and its need in today’s society. And if you’re not going to bother to do the legwork and just make general (false) pronouncements about what the research actually shows (or worse, suggest the all research that disagrees with you must be in pharma’s pocket), then that’s a lazy person’s argument. There are too many logical fallacies at work here to list, so I’ll just suggest that I expect more reasoned and professional arguments –based upon the actual research — about such important legislation.
Psych Central continues to support the Melanie Blocker Stokes MOTHERS Act because the research shows it would help in the efforts to increase education and correct mis-information about postpartum depression.
References:
Beck, C.T. (2001). Predictors of postpartum depression: An update. Nursing Research, 50(5), 275-285.
Hatton, D. C., Harrison-Hohner, J., Matarazzo, J., E.P., Lewy, A. & Davis .L. (2007). Missed antenatal depression among high risk women: A secondary analysis. Archives of Women’s Mental Health, 10(3), 121-123.
Ingram, J. & Taylor, J. (2007). Predictors of postnatal depression: Using an antenatal needs assessment discussion tool. Journal of Reproductive and Infant Psychology, 25(3), 210-222.
Monk, C., Leight, K.L. & Fang, Y. (2008). The relationship between women’s attachment style and perinatal mood disturbance: Implications for screening and treatment. Archives of Women’s Mental Health, 11(2), 117-129.
Ramchandani, P.G., Richter, L.M., Stein, A. & Norris, S.A. (2009). Predictors of postnatal depression in an urban South African cohort. Journal of Affective Disorders, 113(3), 279-284.
Robertson, E., Grace, S., Wallington, T., Stewart, D.E. (2004). Antenatal risk factors for postpartum depression: a synthesis of recent literature. General Hospital Psychiatry, 26(4), 289-295.
Ross, L. E. & Dennis, C-L. (2009). The prevalence of postpartum depression among women with substance use, an abuse history, or chronic illness: A systematic review (PDF). Journal of Women’s Health, 18(4), 475-486.
Zajicek-Farber, M.L. (2009). Postnatal depression and infant health practices among high-risk women. Journal of Child and Family Studies, 18(2), 236-245.
202 comments
Dr Grohol, does your cite not allow links to other stories. Im curious as to if this is why my post is awaiting moderation. google ssristories.
Amy Philo – If you keep twisting around another’s words and argument, I guess that indeed you could find yourself making many fine points against your opponent. But you’re not arguing with anything I ever said.
I never said anything about:
I guess if in your mind educating mothers about postpartum depression and asking them to take a screening quiz equates to “giving out medication,” then it’s no wonder we’re arguing without hearing the other side.
I think a person’s treatment choices, if they are properly diagnosed with PPD, is that person’s choice. I never said any differently, and this law will not change that.
I’ve also noticed that nobody has answered why PPD is different than health screenings for cancer. Or other mental health screenings that the government has promoted for decades (such as those for depression).
I also don’t see how a discussion about a government funded education and screening law is a legitimate place to talk about forced treatment and such. As anyone who has bothered to read the first thing about me knows, I’m generally against forced treatment and organizations like TAC.
But I also understand some people’s personal experiences are extremely negative and respect that. That’s an important voice to hear in this discussion. But so is the research data, and I fear the research data gets swept under the rug when people appeal to emotional arguments (e.g., hypothetically, “I had a horrible PPD experience and it ruined my life”). Hopefully we don’t make policy decisions based solely upon our emotional reactions; I hope we also make it based upon a reasoned and objective measure of the data.
Lisa – Some comments are automatically flagged by Akismet spam software for moderation. We have no control over that and approve comments throughout the day when we see them in the queue.
skills – I don’t disagree that, in general, this is a complex issue.
But I don’t think professionals bring any clarity to it by weighing in with a very one-sided and biased view of the research data, and suggesting that’s the whole story. That’s the main reason I wrote this entry because it’s a pet peeve of mine when I see professionals do that.
If my entry points to anything, it’s that the PPD is a complex issue that is misunderstood and often not diagnosed by professionals who could do so. Even in high risk cases, as I pointed out, it’s missed in 1 in 5 cases. Imagine how often it may be missed in populations that aren’t identified as high risk?
The government has funded dozens of screening programs and initiatives over the decades. Why is this particular one so darned polarizing?
I know moms (yes, more than one) who didn’t know they had PPD and suffered because of it. Their families suffered from it. And when they learned that it could be PPD, read up more on it, and then talked to their respective doctors about it, they felt better. They got help (no, neither one took a medication for it). So from a personal experience, I see what access to information can do. It can help end needless suffering.
The thing is, that a lot of the supporters are using their horrible stories of PPD as an argument FOR the Mother’s Act, Dr. Grohol.
The argument is being played on both sides, but we get labeled with paranoia and anosognosia. What a great bunch of advocates for mental illness, these folks are.
I have been checking back to read the latest comments in this debate off and on all day.
But I really did not feel the need to spend time responding to any of them.
However, Grohol’s comment directed at Amy, which stated in part: “We don’t allow ad hominem or personal attacks here. So I suggest that if you want to engage in such, you go elsewhere for your enjoyment,” really made me angry.
This from a someone who has allowed people to posted snide remarks and inuendoes to discredit Amy, or anyone else with an opposing view, who has been diagnosed with a mental disorder, rightfully or wrongfully, all over the internet, including here.
For instance, John Smith wrote on this site: “Check out Ms. Philo’s connection with the Scientology front’s ‘Natural News.'”
“As if it’s not obvious she’s mentally unstable,” he wrote.
“The idea that Time magazine would give her a platform is ridiculous, as if she represents the “other side†of the issue,” Smith said.
“She sings straight from the Scientology songbook: off-key.”
Over on Katherine Stone’s website, John posted the following comments:
“You know Time is abjectly derelict in its duty when it offers, as the “opposing side,” a person who seems to be an obvious Scientology sympathizer, Amy Philo.”
“Did they do no research at all? Do they not understand the importance of vetting sources?” Smith wrote.
“Do they not realize that mentally ill people don’t always have a grip on reality?”
The use of an association with Scientology, or the Citizens Commission on Human Rights, in attempt to discredit people who oppose the Mothers Act is really getting old.
The Citizens Commission is but one of more than 50 groups joined together in the coalition against the Mothers Act. Other prominent member organizations include: AbleChild, the International Center for the Study of Psychiatry and Psychology; Alliance for Human Research Protection; International Coalition For Drug Awareness; Law Project for Psychiatric Rights, and Mindfreedom International.
By now, it’s actually rather amusing to watch these people try to use Scientology as a smokescreen, at least for me.
I am not a fan of any organized religion, or the practices of many, but I fail to see what religious beliefs have to do with opposing the Mothers Act.
No other religions are ever used this way.
The list of supporters of the Act includes Planned Parenthood, a group that encourages the use of birth control and counsels women on abortion.
This endorsement might well upset Catholics, being that Catholic women are not permitted to use birth control or have abortions.
Then you have Gina Pera writing the following blog over on Bremner’s website:
“We cannot make public-policy decisions based on the stories of people who have been diagnosed with mental health disorders and treated for them.”
“Sorry, but it’s true,” she added.
“Many mental health disorders limit objectivity,” Pera states, “so these people are just not the best judges of what has been done to them and why.”
“They can have their stories and they can share them,” she says. “But we can’t make policy on this kind of hearsay and paranoia.”
In a blog on this site, Pera wrote: “To those who contend that the mentally ill always know they are mentally ill, that flies entirely in the face of all that we know about anosognosia and the denial of illness.”
“Mental illness can — and often does — limit accurate perception of self and others,” she says. “It’s just a fact.”
These people verify everything I have warned about in my articles. Once a woman is tagged with a mental illness diagnosis via the Mothers Act, she will lose all credibility for life.
Think about it, when is the last time you heard somebody say, “so-and-so used to be mentally ill”?
Finally, I definitely disagree with this comment by Grohol: “We wouldn’t even be having this conversation if we were talking about cancer or some other health concern.”
If I found a large number of people were being charged $30,000 a year for drugs and therapy with serious side effects, to treat cancer and there was no proof that the cancer existed, or if the cancer was verified, but after years on end, the treatment didn’t stop the cancer, I’d be writing just as furiously about that as I have about multiple drug cocktails, with serious side effects, being prescribed for years on end to treat unverifiable mental disorders for people who never get “cured.”
Katherine Stone is a good example. For a simple diagnosis of postpartum OCD in 2001, she’s been taking drugs for 8 years,including 5 antidepressants and 2 antipsychotics.
She recently said she was still taking “meds” (plural). In June 2007 she was still calling Jeffrey Newport her psychiatrist in her blogs.
Even if she isn’t receiving regular therapy, some doctor is collecting office fees for prescribing the drugs.
Some of the drugs Katherine took cost over a grand a month on DrugStore.com. The Abilify advertised on this site, as an add-on with an antidepressant, for the treatment of depression, runs about $1,200.
Add Abilify to Cymbalta, at more than $300 a month, and your looking at yearly tab of over $18,000, not counting the fees for the prescribing doctor or any therapy sessions.
Are women really expected to accept that there are no therapists in this country competent enough to teach them how to change compulsive and obsessive thought processes without 8 years of drugs and therapy?
I suggest that they buy a book titled, “The Language of Letting Go,” and with minimal time and effort they should be able get off the drugs and couch in a matter of months.
Evelyn Pringle
The PPD Law isnt the only polarizing issue,.. Teenscreen was disputed quite aggressively, lawsuits emerged! I take it you havent payed much attention to the military suicides, and the VA’s PTSD screening. In the Military’s case, Marines and Soldiers are being screened, being medicated, and then they go onto attempting or committing suicide. Many marines returned home safely from the wars in Iraq and Afghanistan, and only than to be prescribed multiple psyche meds. These brave men came home to rest in their own beds, Their families could not awaken them, these young vibrant men died in their sleep.
I believe the government should start spending taxpayer dollars more wisely. It turns my stomach to know that my hard earned money is being used for the prescribing of antipsychotics to babies!!
THANK YOU Evelyn Pringle for the post that said everything I wanted to say. Of course, I’m unwelcome to participate in this discourse, as I am diagnosed mentally ill, and currently suffering from anosognosia, a symptom of my mental illness. It’s obvious that I am suffering from anosognosia because I disagree with the Mother’s Act, you see. Too bad this wasn’t up for debate prior to 2008, when I was not yet labeled mentally ill and had not yet been deemed irrelevant for life.
The MOTHER’S Act is merely a witch hunt; and as with all good witch hunts, you have to find witches to validate the hunt.
It’s impossible, as has been shown here to communicate reasonable sense with those that have a financial stake in the outcome.
WHY HAS DR.BREMNER BEEN BLOCKED FROM COMMENTING HERE?
I believe Dr. Bremner’s comments have been blocked since he began to make comments suggesting he was not capable of carrying on a dignified, respectful, and professional conversation.
As for the topic of conversation, the MOTHERS act is good in that it raises a real issue, can help educate consumers and treatment providers, and hopefully reduce stigma.
However, I see another side to making screenings mandatory. In my opinion, making such a screening mandatory may imply that health providers are not well trained to recognize the signs/symptoms of the illness or even the at-risk factors that may be present that would warrant a screening. Thus, the mandatory nature of the act may underscore a lack of confidence in the health field, which the public likely will pick up on.
As such, making certain screenings mandatory may do more harm to health professions than good, as the public may begin to lose confidence in their health care professionals’ ability to recognize what is, and is not, present.
Additionally, making “treatment” (in this case, screenings) mandatory, creates an almost cookie-cutter approach to health care. No longer would clinicians be able to use their clinical training to decide, rather the government says to do it for everyone, so we do it for everyone. Individualized care is loss and health care costs go up.
I’m curious also as to why my brother’s comments have been excluded from the conversation?
Thank you Lisa for reminding me of the TeenScreen program, another blatant drugging dragnet that I investigated and reported on extensively back in 2005.
Likely unknown to most people here, TeenScreen is named in a federal lawsuit by third-party payers against J&J, as being used as a tool in the off-label drug marketing scheme to increase profits through sales of Risperdal to kids.
The lawsuit points out that the leader of TeenScreen, Laurie Flynn, was the leader of NAMI for 16 years, before she was recruited to run TeenScreen.
The complaint also gives great details on the drug company money funneled through NAMI, a main supporter of the Mothers Act, to further the scheme.
Evelyn Pringle
Evelyn Pringle is totally correct on how inappropriate it is for people who present themselves as mental health authorities to criticize psychiatric drug survivors. It seems like the people who love these drugs most fervently are the drug dealer/ prescribers whose license to practice medicine, ONLY, keeps them out of jail very unlike a normal unlicensed person whose distribution of the same drugs is deemed illegal. Most psychiatric practioners have never been forced to consume these drugs for years except maybe as punishment for being labelled mentally ill. It’s quite cruel and callous to criticize survivors who have personally experienced what may feel like to them, permanent damage to the central nervous system that these drugs have been found to cause. These people were unfortunate enough to have been forced to take drugs for many years and are unable to get a second opinion from a licensed medical practioner who could very gradually and safely wean them off them. Those who haven’t experienced that pain shouldn’t criticize those who have. It’s just cruel and inhumane to infer that these people are worthless for being labelled (quite often falsely) as mentally ill and to all out try to convince everyone that the pain and physical damage these people experience, could ONLY be caused by the condition and not the drugs and that no matter how brutalized and beaten down by these drugs these people are or feel they have been, to tell everyone else they have actually been HELPED and that anyone so labelled will be helped rather then harmed. It’s just a money fueled BIG LIE that has to be continually laid down in the media.
I’m just curious how you can say that someone who is diagnosed with PPD is branded mentally ill for life.
I had very severe Postpartum Obsessive Compulsive Disorder. If it hadn’t been for the fact that I happened to live in an area where pretty much everyone I dealt with was knowledgeable in treating PPMD’s I would be dead. No one branded me. No one forced (or even suggested the possibility of medication until I had been in treatment for at least a month or two) medication or any other treatments on me. The fact that I was able to be victorious in the end gave me much more credibility than I ever could have imagined. The MOTHERS Act is something I support wholeheartedly because I’ve seen what an educated treatment team can provide.
I tried many things including talk therapy, light therapy, exercise, medication and yes, in the end even ETC. When I was given medication I was very clearly told the risks and to call immediately if I had any problems. When I went to the hospital it was because I realized that’s what I needed to keep my baby safe.
Now I talk about my experiences and moms often come up to me to tell me about theirs. They don’t think I’m a freak or worthless because of my PPMD. They are thankful for my openness and willingness to share. They are happy to have someone they can talk to who isn’t going to look at them funny when they aren’t feeling love toward their child.
On a side note, supporters of the MOTHERS Act are being caught in the SPAM blocker too…it’s nothing personal.
Bremner has not been blocked from commenting here; in fact, I was surprised both by his lack of response here and then his claim that his comment never appeared. His comment is not in our spam filters or awaiting moderation, so I can only assume it was a technical issue. (I like that Bremner calls me a “large entity” in his dig against losing his comment, instead of simply emailing or twittering me about the lost comment! There’s nothing I could’ve done other than to suggest to save a copy in case it happens in the future, or see if I could post it for him…) Folks, comments getting lost on a blog are nothing new and it happens to me at least once a week. But I guess when you’ve been blogging for a decade, you take it for granted everyone already knows this. I apologize for Bremner’s trouble in posting a comment (apparently his brother had no such trouble doing so).
Apparently Bremner has never bothered reading my blog either, so he has no idea who he’s talking about when he puts in the “pro-pharma” camp.
I can only say that after you get through his continuing discussion about his book, one is left with Bremner again backpedaling on the data — which is what I’ve been arguing all along.
First, Bremner says that only if you had a previous episode of depression or anxiety are you at higher risk for PPD.
I pointed out that that was patently false and gave him specific studies, one of which found at least 6 additional risk factors (which he has ignored).
Second, Bremner focused on arguing about one study. Fine, but then he again mis-spoke about the data, saying that abuse wasn’t a risk factor unless you were abused when you pregnant. To show he again wasn’t being entirely forthcoming about the data, I had to post the PDF of the article so others could see that in an analysis of the 8 abuse studies, only a few of them talked about abuse during pregnancy. What about the others?
Now Bremner says:
How can you control for depressive symptomatology when asking about abuse? Most women were assessed postpartum with a single time point questionnaire and depression measure after giving birth. What’s there to control at that point? I’d love to hear a clarification from Bremner about what he means by this comment.
Evelyn Pringle wrote:
Yet I was talking about what this law is talking about — education and screening for a mental health concern. Not treatment.
Would you be against screening and education for cancer?
Why are people so quick to discriminate against mental illness?
Grohol asks whether I would be against “screening and eduction for cancer?”
No, providing that the screening that showed I had cancer was verifiable and the treatment I was offered to slow or cure the cancer, did not continue for years on end, without any way to document that the treatment I was paying for did in fact slow or cure the cancer.
To feign ignorance of the fact that screening for mental illness leads to drug treatment is misleading at best, and dishonest at worst. You know as well as I do that it leads to massive drugging.
The drug companies would not be pouring millions of dollars into the online screening programs and mental illness screening days every year if they did not render major profits.
Here are a few paragraphs (not edited totally) from a new article that will be out shortly to evidence the money spent in this country on “mental illness,” and drugs are the standard treatment.
The May-June issue of Health Affair reports that prescriptions for psychiatric drugs increased by 73% among adults, and 50% with children, from 1996 to 2006. Another study in the same issue, found spending on mental health care grew more than 30% over the same 10-year period, with almost all of the increase due to psychiatric drug costs.
On December 22, 2008, the “National Survey on Drug Use and Health,” by the Federal Substance Abuse and Mental Health Services Administration, reported that in 2007, 10.9Â percent of adults aged 18 or older, or an estimated 24.3 million persons, had experienced serious psychological distress in the past year, and 44.6% had received mental health services.
Of those who received services, 87% were given prescription medication, and 34.6% received drugs only. In contrast, only 10.7% received outpatient treatment alone, without any drugs.
In 2004, overall sales of psychiatric drugs totaled $26.7 billion, according to NDC Health Corp, a health information firm. In 2008, drug makers had overall sales in the US of $14.6 billion from antipsychotics, $11.3 billion from antiseizure drugs, $9.6 billion for antidepressants, and $4.8 billion from the sale of ADHD drugs, for a total of $40.3 billion.
In 2008, “85 million prescriptions were filled for the top 20 benzodiazepines, an increase of 10 million over 2004, according to IMS Health, a health-care information company,” the Wall Street Journal reported on June 30, 2009.
Worldwide revenue for Xanax rose to $350 million in 2008, “up nearly 50 percent from 2003, according to pharmaceutical company Pfizer’s financial reports,” the Journal reported.
This paragraph is from a previous article:
On April 22, 2009, the Agency for Healthcare Research and Quality, which is part of the US Department of Health and Human Services, reported that in 2006, more money was spent on treating mental disorders in children aged 0 to 17 than for any other medical condition, with a total of $8.9 billion.
By comparison, the cost of treating trauma-related disorders, including fractures, sprains, burns, and other physical injuries from accidents or violence was only $6.1 billion.
So the question remain, if all these people are going without treatment and more screening is needed, who the hell is eating all these psych drugs?
And where are all the people who have recovered from mental illness as a result of ingesting billions of dollars of psych drugs every year, with the majority of costs billed to public health care programs?
More than 40% of births in this country in 2007 were to unwed mothers, meaning in large part, much of the money to be made off the drugging that will result from the Mothers Act disease mongering campaign will likely come from public health care programs.
Tax payers cannot afford to allow another screening dragnet to be set up targeting the more than 4 million women who give birth in the US each year.
Finally, the Mothers Act campaign does not limit itself to drugging women for postpartum “depression and “psyhosis”, as specified in the legislation.
A whole new industry has been developed using the bill as a vehicle, with specialties like “reproductive psychiatry” and “reproductive mental health”, with terms like “perinatal mood and anxiety disorders,” and extending throughout the cycle of childbearing years.
Any one interested, can check out the websites of the so-called “advocates,” such as Katherine Stone’s Postpartum Progress, to see what’s in store for women in this country if the legislation is passed.
Evelyn Pringle
Evelyn Pringle wrote:
Like many people, I know some cancer survivors. Successful treatment can take years. Sometimes it doesn’t even work, even after years of drug treatment, the cancer returns, and the person dies. Some cancers have no known cure. Yet doctors still recommend treatment anyway. Treatment helps ease the pain and may extend a person’s life by months or even years.
Yet somehow depression is different and it’s okay to discriminate against people who have this disorder and try and limit their treatment choices.
Even though the law isn’t about treatment (and yet it seems opponents can’t focus on anything but treatment, virtually ignoring the benefits of education and screening on its own), I’d have to defer to our personal freedoms and our freedom of choice. Such freedoms means leaving treatment decisions where they belong — between doctors and informed patients. Which this law does.
“Massive drugging?” Wow. Okay. I guess cancer treatment also leads to “massive drugging” using that logic. Yet some people seem to suggest that since a specific treatment option is offensive to them and their sensibilities, we should limit treatment choices. Some arguments seems to actually suggest we take away a person’s right to choose which treatment they have access to (not saying this is the case with this particular commenter).
I am for the rights and freedom of patients to choose their own type of treatment and not putting my own personal treatment preferences onto others. Sorry. I am also for increased education and screenings for PPD, which is what the proposed law directly addresses (not treatment).
Dr. Grohol,…
PPD Screening and Education is not yet a U.S. Law. It is just a “BILL”!!! If you where Ameican you would have known that.
Folks can provide all the studies and arguments they like in regards to this “BILL”,.. not, “LAW”
Through Katherine Stone’s, and Mary Jo Codey’s own admissions, they have been diagnosed and continue to be treated for Mental Illness, who have at times, been prescribed potentially lethal, life threatening, combination of medications.
Folks need to be reminded that these women are clearly mentally ill. So why in God’s name would I allow these individuals to make medical decisions on my behalf, or on the behalf of family members and the american public.
Our legislators, should first, allow the mentally ill to make medical decisions on the behalf of themselves, and their family members. If our legislators want to be “guinea pigs” then that is their perogative. Our legislators dont have the right to make “guinea pigs” out of american citizens.
The literature you review says nothing about the fact that people, whether male or female, are more likely to experience emotional distress.
Here’s an example the meta analysis you reference that lists:
“13 significant predictors of postpartum depression: prenatal depression, self-esteem, childcare stress, prenatal anxiety, life stress, social support, marital relationships, depression history, infant temperament, maternity blues, marital status, SES, and unplanned/unwanted pregnancy.”
Huh, aren’t these things indicators some one is going to be unhappy maybe to the point of being labeled depressed whether she has a child or not. And if one in five mothers suffers from PPD, it’s not a private genetic biological problem, it’s a societal problem and blaming the individual will only make things worse. It’s like with the nation’s unemployment rate today doing a study on whether depression causes unemployment, irrelevant and potentially very harmful.
Amy, It’s actually open knowledge that in 2008 I made that $5800, as I shared with you on your blog willingly. I have been doing my blog and advocacy for 5 years, and it is only for that single speaking series that I have been paid. Never before and never since.
Sara, You’re right. I did take the cocktail of drugs that my awful first psychiatrist gave me off of my blog. I did so because I realized that I hadn’t properly explained that that particular psychiatrist actually made me sicker with all that medication. He had no idea what he was doing. I finally realized what was up and switched to a psychiatrist who had specialized training in the treatment of PPD and she put me on one medication and I got better almost immediately. That is not to say, however, that medication should be the treatment of choice or that medication works for everyone. It shouldn’t and it doesn’t. For some, like Amy Philo, it can actually do more harm than good.
Evelyn: I have NOT been taking 5 drugs and 2 antipsychotics for 8 years. I find it appalling that you could suggest anything of the sort. As I said above, for about 8 months postpartum I had a doctor who didn’t know what he was doing who tried several different meds with me. At one point I was probably on about at least 4 together — all together the 7 or 8 as you mentioned which is true. That’s why I LEFT him. That’s why I think women should be informed.
I am now on a single antidepressant for a condition that has nothing to do with PPD, not that it’s any of your business. I’m not ashamed. I can understand that you don’t like me because I have a different view than you. That’s okay. But to be so inaccurate about someone is just completely inappropriate. You could have just asked me.
As far as what “John Smith” whoever he is said in a comment on my site about Amy, I generally don’t remove any comments from my site. You’ll notice I haven’t removed any of yours either. I let people have their say. You are welcome to comment back and let him know he is wrong about Amy.
As I write this our county hospital has just achieved a new milestone, 5,081 psychiatric admissions, which is an increase of 49% over FY 2005. This wasn’t supposed to happen. We were told that in the “Era of Recovery and Wellness”, well into the “Era of Evidence-based Practices”, that community services would result in declining hospital admissions. The reality was quite different from the promise where service availability remained largely constant in the face of an ever increasing service population.
While I don’t question the intent of those who support the Mother’s Act, I do wonder what consideration has been given to the nature, timing, and extent of services available in the community and the outcomes these services routinely engender? What efforts had been made to insure that mothers with PPD can readily access those services which can make a difference?
Katherine,
You stated that a particular Psychiatrist made you sicker… Did you report him to medical authorities? If not, why not? If you havent, you became a part of the problem.
Joe – Sorry I didn’t respond to your earlier comment, I missed it in the onslaught of good comments here. I will take a look for research that might provide some answers as to whether screenings result in more positive outcomes.
One study I did look at in a cursory search noted the impact and difficulties of trying to implement screenings in primary care:
In other words, even when primary care professionals are “on board” with screenings, many still don’t do them, and those that do, most ignore the results of the screening. Clearly, we still have a lot of education to do, even amongst primary care physicians.
I also agree with your point that all of this is meaningless if the services needed aren’t available to mothers who want to make use of them. Funding and providing greater access to services — especially affordable psychotherapy — I believe should be an emphasis in the new healthcare reform effort. Whether we see it happen or not, well, time will tell.
Wow. As I commented last time this issue came up, there can be so satisfactory resolution to this or to the many other phantom debates in psychiatry/psychology as long as we keep pretending we have a coherent theory of mental health and a truly objective process of scientific inquiry upon which to base conclusions.
Dr. Grohol, you have a knack for getting to the essential issue, i.e.: What’s the difference between “physical diseases” like cancer and “mental disorders” like depression? A lame answer to this question leads to lame educational materials and lame treatment options.
Worse, if the legitimacy of evidence-based information and treatment options has been compromised by the undue influence of the pharmaceutical industry (and it has been), it is quite reasonable to be concerned that this could lead to MIS-information and HARMFUL treatment options being offered to suffering people.
What good is freedom of choice under those conditions?
Of course, we all have to move forward and deal with suffering people right now, however crappy the situation. But we ignore the root issue at everyone’s peril.
Here’s hoping this comment does not get *lost*. I have responded to the previous comments here on my own site and have these additional comments.
The comment that people wouldn’t be this up in arms about cancer screening as much as they are for psych screening is in fact not a good one. If you follow the link to my site and then the link to the category “cancer” you can see how screening for prostate and breast cancer have not in fact been shown to reduce mortality from those disorders. Good journalists like Gary Schwitzer have written about the waste inherent in medical screening and testing in the US and how this leads to over-diagnosis, over treatment and unnecessary anxiety. The fact that the mainstream continues to accept without question the “war on cancer” and the need for expansion of screening (e.g. see legislation for expansion of breast screening contrary to the evidence) is beyond me. Similary good journalists like Evelyn Pringle have examined the fact that screening for mental health disorders is not grounded in evidence that it improves outcomes but rather is promoted by drug companies as a way of expanding their markets.
Katherine, I am actually very happy to hear that you are only taking one medication now. I hope some day you might consider trying to get off and that you will research carefully withdrawal so you know that a lot of what you may experience is withdrawal and rebound and not some “underlying condition.” Getting off a psych drug is not an easy process especially when someone has been on them for a long time. Medical professionals often underestimate the length of time it takes to get off and the very slow rate of taper required (often necessitating a liquid form of the drug to facilitate) and give up and just put people back on or leave them on indefinitely.
I admit to being a little surprised that you are fighting so hard for more education and awareness in the general public when your own experience with medical professionals started off so dismally. It seems to me that what’s needed more than a global campaign to increase awareness about PPD is a lot of research and education among academics and professionals about just what the effects of psych drugs really are and how to get off them safely and carefully. No one should commence a treatment with a drug that so often ends up being a lifelong therapy without fully understanding just what is involved in stopping the drug and what the effects of staying on indefinitely really are.
Dr. Grohol,
Thank you for your reply. Absent significant dedicated funding I see little chance that mother’s with PPD will get the very care they deserve (1). That said, it remains challenging to get any care for depression (2).
(1) The Relationship Between Quality and Outcomes in Routine Depression Care” [2001]. http://psychservices.psychiatryonline.org/cgi/content/full/52/1/56
“Only 29 percent of the patients received guideline-concordant treatment.”
(2) Depression Patients Lost to Follow-Up After Leaving Emergency Department [2009]. http://pn.psychiatryonline.org/cgi/content/full/44/7/8-a
“Only 1 in 10 callers posing as patients just released from hospital emergency departments and diagnosed with acute depression could get appointments for community-based follow-up care, regardless of insurance status.”
Perhaps the stars will align and mothers will be able to access psychotherapy but I doubt it unless they have the personal resources to access it. One of my county’s MH agencies serves 1,500 individuals in its outpatient cluster with 7,125 units of service. Approximately half of the total units of service are for medication management.
I do hope that you come across those studies which refute what I have found and fear.
Again I totally agree with Evelyn Pringle. If this were only about “education” the drug companies would not be involved because that would compromised paid for infomercial type education” where people are encouraged to let their doctor make the decision for them. And where anything not involving these dangerous drugs is always severely criticized, ignored, or persons questioning the drugging are degraded in verbally or in print as on this blog or they are ignored. That’s not education. That is pseudo education or a perverted idea of what education really is. Education or what passes for that becomes fraudulent once way too much money gets behind only one viewpoint on an issue.
Katherine Stone mentions that she had a “bad” doctor at first who she had trouble with even though she denys being put on multiple drugs. How many other women have had the same experience and not reported the doctor or psychiatrist so other women would be caught in the same situation? Is this part of the education? Pretty negative especially when women email the blog and are feeling bad from the side effects and are told to “stick with it”. They might feel they are being hurt by the drugs and are just being told to suffer through it by pro psych drug advocates like Katherine Stone. How responsible is that? So that’s part of the education?
In response to Katherine’s remarks, I will state that I am not inaccurate in my reporting.
After I wrote the first article on the Mothers Act, Katherine changed the wording on her website to include the line about the doctor who didn’t know what he was doing. She also removed the list of drugs she was prescribed.
Katherine has changed her story continuously over the past 5 years. And it would be none of my business, if not for the fact that she is misleading women into think they will need minimal treatment for mental disorders when she knows that is false.
In a webpage titled, “The Art of Psychiatric Medication,” posted with a date of June 8, 2006, Stone told readers:
Â
“I’ve taken many medications, including Effexor, Celexa, Seroquel, Risperdal, Wellbutrin, Luvox, Cymbalta, etc. Throughout all of them, I was on the road to recovery. Some just worked better than others at treating my symptoms.”
In the June 7, 2004 issue of Newsweek, in which she was promoting the Mothers Act, she described her treatment for OCD and wrote “in my case, that meant taking an antidepressant and going for weekly therapy sessions.â€
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Since my reporting on the Art of Medication page, Katherine removed the paragraph with the list of drugs and put in the line:
“My psychiatrist gave me seven different medications, partially because he didn’t know what he was doing and partially because some of them didn’t work for me. When I finally found a trained doctor, we developed a plan that worked, including one antidepressant and weekly therapy.”
Compare that to the story she told 5 years ago in Newsweek, when she wrote: “I took advantage of my company’s employee-assistance program and called the help line. God blessed me that day. They put me in touch with a wonderful therapist who saw me immediately and recognized what was wrong.”
“As it turns out, I had postpartum obsessive-compulsive disorder,” she stated.
“For a while I was convinced that I’d never be the same person again,” she said. “But I did everything my doctor told me to do, and I’m now back to the old me.”
There was no mention of changing doctors or trying seven different drugs in Newsweek in 2004.
In fact, Katherine specifically stated: “I tell the story so that women who are now going through what I did will know there is help,” leading women to believe they could get well by taking a single antidepressant and attending weekly therapy sessions briefly.
Women readers had no way of knowing that her statement of, “I’m now back to the old me” meant taking antidepressants during their next pregnancy and still being on “meds” 7 years later.
In the Art of Medication she wrote: “What you can expect is to get less sick over time until you get back to who you were before you got sick.”
“For some people that takes a couple of months, for some people longer,” she said.
Finally, Katherine also did not reveal the money she was paid from Zoloft-maker Pfizer, until after I exposed the payments in one of my articles.
I discovered the $20,000 grant in a Pfizer report and traced it back to the Mental Health America Georgia group’s website and found Katherine’s phone number and email address listed to schedule the 1-hour talks for a the program: “Project Healthy Moms: What You Need To Know About Perinatal Mood Disorders.â€
Nowhere on her website does she let it be known that she was paid money by a drug maker. The amount she says she received averages out to roughly $350 for an hour talk.
Her acknowledgment of receiving Pfizer money at all, was posted in a lone blog on Amy’s website, and again, only after it was widely exposed.
Katherine’s Postpartum Progress “has become the most widely-read blog in the United States on postpartum depression, postpartum OCD, antepartum depression, postpartum PTSD and postpartum psychosis,” according to her website.
I have a big problem with knowing that so many potentially vulnerable and naive women are receiving advice from a woman who simply makes things up as she goes along.
Evelyn Pringle
I do have to agree that a number of these avid Mothers’ Act supporters, including Melanie Blocker-Stokes’ own mother and probably Katherine herself, strike me as dangerously and hopelessly naive about what they are supporting. It is quite clear that few of them understand the issues surrounding psychiatric medication and the role the pharmaceutical industry is playing in pushing their use and concealing their risks. The pharmaceutical industry is a master manipulator of victims of their own products. It happens all the time with all kinds of “disorders.” I also weep when I see people latch on to their diagnoses with a steel clamp never to let go again when so many factors (not the least of which is seemingly benign treatment) influence the onset and exacerbation of symptoms. I’m all for peer support groups and I’m glad these mothers have found each other but give the label a rest — really. It’s not doing you one bit of good and all this legislation is going to do is make it more widespread than ever.
As I mentioned earlier in the comments, I would appreciate it if people remained on the topic I blogged about — the research data on risk factors for PPD — and not turn this into an argument about the players. Please keep your comments related to the blog entry and discontinue any personal attacks (or whatever you want to call them) against other commenters. Thank you.
Doug Bremner — Indeed, I know there’s some controversy in the cancer world about the benefits (versus risks) of regular screening for *some* types of cancer. But for other cancers, there is a lot less controversy. A cancer screening saved my brother’s life, so I’d have to say, I’m going to be on the side of the American Cancer Society, the National Cancer Institute, and the Cochrane Review (for some cancers, like colorectal and breast cancer).
But this isn’t a perfect comparison, of course, since the incidence of death from PPD is likely pretty low (while the incidence of some cancers may not be). The objection to PPD screening seems to be, if we find more postpartum depression, we’ll have to treat more of it. And some people may choose an antidepressant, rather than psychotherapy.
But isn’t that a treatment choice between a person and their physician? Who is anyone else to say what treatment someone with PPD should or shouldn’t have available to them (assuming the research makes no clear differentiation)?
Mental health professionals have never been able to figure out what happens in the brain physically that causes depression. And they’ll even admit they don’t know what causes depression in drug detailing literature. So they foolishly study the chemistry of brain and try to control brain function through inhibition of certain chemicals in the brain. Certainly the brain is a delicate organ in which many things can go wrong when it is assaulted for years by chemistry altering drugs. The drugs worsen the situation a person’s body is trying to handle. Of course that viewpoint won’t sell these drugs so that viewpoint is going to be attacked or ignored. And hundreds of thousands of women will be hooked on these drugs that only make them worse. In that way, science preys on those it is supposed to help. Also, I don’t know one person in my life who didn’t die after getting chemo and radiation for cancer and I am 58 years old so I think the number of survivors is much less than medical authorities want to admit.
Thank you for your wonderful post. After the birth of my second child, I struggled with depression as well as PSTD that my birth experience triggered. I had no idea what was happening to me mentally and was certainly not going to mention anything to my doctor or anyone else for that matter. Had I been screened in such a manner as suggested in this act, I would have certainly recovered much quicker and enjoyed those first months much more.
I truly don’t see this as forced treatment in any way. I underwent other screenings including AIDS, diabetes, Group B strep during pregnancy. It seems to make sense that PPD be included after.
“And some people may choose an antidepressant, rather than psychotherapy.”
Come on, Dr Grohol, do you practice any clinical care in the past 5 years? Do you think OBs, pediatricians, family practice MDs are going to review the various interventions with a patient after allegedly determining this woman has PPD? And with the quick fix mentality at hand, is a patient going to make an effort to schedule and follow up with a therapist, or, accept the ready made prescription prepared for her in the office?
This is why the issue is so heatedly debated, because there are the extremists supporting this legislation based on unique exceptions of severe negative outcomes that gather media exposure, and on the other side the antipsychiatry crowd who demand no interventions because anything psychiatric is evil. And then there is us, the middle moderates who see the issue and would like legitimate people with true PPD be diagnosed and treated by responsible and credible providers.
Not with this legislation though. Black and white definitions to gray problems. I just hope the readers who know moderation can see the extremes at hand in this blog debate.
In response to the above comments by Catherine Davis, I would say that with the screening mentioned for AIDS, diabetes and Group B strep, the patient would be able to request documentation to prove that the disease existed before heading to the pharmacy to buy drugs.
The patient would also be able to verify that the drugs were working with those diseases.
In the Mothers Act disease mongering campaign we now have social workers, running treatment centers with websites, diagnosing mental disorders, with 2 and 3 question screening tools, and advising women on which drugs they recommend.
These women have no way to prove, or disprove, whether a disease exists.
It’s hard enough to accept that the nation’s mental health is gauged on disorders defined by a single 38,000 member psychiatric professional group, delegating the treatment of mental illness to social workers, with a doctor signing off on the diagnosis for billing purposes, is not acceptable.
Evelyn Pringle
I’ve been trying to think of a compromise. Knowing what I know now about psychiatry, I would not have gotten involved with it, and as a matter of fact, it remains the only decision I made while “manic” that I deeply regret. The problem is that I don’t see psychiatry/psychology as a very helpful profession for a large number of people and even a psychiatric label alone can exclude one from a number of career paths (med school, law practice). I’m glad to hear that some people feel they’ve been helped by psychiatry. Their experiences should not be denied, but neither should those of us who feel it was detrimental. Until psychiatry ceases to be a one-trick pony operation, and until they post better long term outcomes, I cannot support anything that will result in a major upswing in diagnoses, many of those “affected” being women who are just under a tremendous amount of stress combined with sleep deprivation.
Evelyn Pringle — Mental disorders are not medical diseases, and never have been. But then again, even within medicine, we don’t have diagnostic tests that prove every known disease. What’s the diagnostic blood test for Alzheimer’s? Or any test for that matter… Does that then mean that Alzheimer’s doesn’t exist??
One person’s “disease mongering” is another person’s information campaign. With the history of stigma associated with any type of mental health concern — and trust me, it’s still very much alive in many parts of this country — I think mental health concerns are especially needing of information and education. That’s the reason I started this website in 1995.
14 years and counting and I see we still have a ways to go to combat the continuing discrimination against people who have a mental disorder. Gosh forbid we actually help people learn about them.
I am not the person who keeps bringing up the fact that we screen for other diseases like cancer and AIDs, diabetes, and etc, and comparing it to screening for mental disorders.
I am merely responding to arguments by others that the expense and harms of treating mental illness can be compared to the expense and harm of treating other diseases based on screenings.
Trying to switch the topic to discrimination is really a sorry tactic Grohol.
You have avoided addressing the posts where I show the constant rise in dollar amounts spent on treatment for mental illness in this country and the failure to show any rise in recovery rates, with the great majority of the costs billed to public health care programs.
How much more money do you think tax payers should be willing to fork over to the psycho-pharmaceutical complex if the Mothers Act is passed?
Evelyn Pringle
Again, the blog post was about the research data about risk factors for postpartum depression. Why do you keep bringing the argument back to treatment, an individual’s treatment choices (which some commenters seem to want to restrict) and associated treatment costs? Are you honestly suggesting that a person’s mental health is somehow worth less money and value than their physical health??
If you can’t elaborate a coherent argument as to why mental disorders deserve a different set of standards than medical conditions, I’m not sure we’ll ever find common ground. And I noticed you didn’t answer the question about Alzheimer’s disease.
To save time, I am going to post excerpts from an article I wrote a short time back, which clearly makes my point and backs up my argument, with an example of what is happening with children.
The Cincinnati Children’s Hospital Medical Center website explains childhood bipolar disorder and reports in part:
“Symptoms may be present since infancy or early childhood, or may suddenly emerge in adolescence or adulthood. Until recently, a diagnosis of the disorder was rarely made in childhood. Child psychiatrists can now recognize and treat bipolar disorder in very young children.”
“It is thought that a significant number of children diagnosed in the United States with attention-deficit disorder with hyperactivity (ADHD) have early-onset bipolar disorder instead of, or along with, ADHD
“According to the American Academy of Child and Adolescent Psychiatry, up to one-third of the 3.4 million children and adolescents with depression in the United States may actually be experiencing the early onset of bipolar disorder.”
The child psychiatrists at the top of this center are Robert Kowatch and Melissa DelBello, the gal who landed on Senator Grassley’s list in the spring of 2008 for not disclosing her payments from the makers of psychiatric drugs. Their website also reports that:
“Many times, it necessary to use 3-4 medications to effectively treat a child or adolescent with a bipolar disorder. Typically, there is a partial response to one medication and another psychotropic agent is added in the hopes of achieving a full response. It is not unusual for pediatric patients with a bipolar disorder to be treated with 1 or 2 mood stabilizers, an atypical antipsychotic agent, a stimulant for ADHD, and clonidine or gabapentin for sleep.”
The website bases these recommendations on the “Treatment of Guidelines for Children and Adolescents with Bipolar Disorder,” in the March 2005 Journal of the Academy of Child & Adolescent Psychiatry. The authors of the guidelines are Robert Kowatch, Mary Fristad, Boris Birmaher, Karen Wagner, Robert Finding, and Martha Hellander.
The list for the Working Group Members and Contributors to the guideline project includes, among others, Joseph Biederman and Melissa DelBello.
The project was sponsored by the Child and Adolescent Bipolar Foundation and supported by grants from Abbott Labs, AstraZeneca, Eli Lilly, Forest Pharmaceuticals, Janssen Pharmaceutical, Novartis, and Pfizer.
Keeping in mind that: “It is not unusual for pediatric patients with bipolar disorder to be treated with 1 or 2 mood stabilizers, an atypical antipsychotic agent, a stimulant for ADHD, and clonidine or gabapentin for sleep,” the prices for the anticonvulsants listed above on DrugStore.com at a middle dose, in December 2008, were: Depakene 180 capsules $434, Lamictal 180 tablets $929, Tegretol 180 tablets $152, Topamax 180 tablets $1170, and Trileptal 180 tablets $496. Gabitril was listed at $458 for ninety tablets in April 2009.
The atypical prices, at a middle dose, in April 2009 were:Â Abilify 90 tablets $1230, Geodon 100 capsules $787, Invega 100 tablets $1168, Risperdal 90 tablets $716, Seroquel 100 tablets $839, and Zyprexa 90 tablets $1195.
Some of the December 2008 ADHD drug prices, at a middle dose, were: Adderall 90 capsules $278, Concerta 90 tablets $412, Daytrana thirty 9-hour patches 3 boxes $437, Desoxyn 90 tablets $366, Strattera 90 capsules $464, and Vyvanse 90 capsules $385.
The price for Catapres (clonidine) was $183 for one hundred 2mg tablets and 270 capsules of Gabapentin sold for $209 at 400mg.
For the guidelines in the Journal, the “panel recommended that medication tapering or discontinuation be considered if the patient has achieved remission for a minimum of 12 to 24 consecutive months.”
“It was acknowledged that for many patients, long-term or even lifelong pharmacotherapy might be indicated,” the authors noted.
If a child ends up on the two mood stablizers, Limictal and Topamax, the yearly cost for these two drugs alone will be roughly $25,188. Add Abilify to the mix, at a cost of $14,760, and the annual treatment rises to $39,948.
Then throw in the ADHD drug, Concerta, at a yearly cost of $4,944, and Condine for sleep, at $2,196, and the total yearly price tag comes to $47,088.
In no other field of medicine could parents be suckered into paying fifty grand a year for drugs to treat a disease that could not even be substantiated.
Evelyn Pringle
Sorry, but bad example. Pediatric bipolar disorder is not in the DSM-IV and I’ve written previously on this very blog about my concerns/doubts about the disorder.
I’m not certain how this answers the question about Alzheimer’s disease, though, since you’re the one who claimed PDD is a problem because “women have no way to prove, or disprove, whether a disease exists.” Scientific, psychological measures indeed have existed now for nearly 3 decades that “prove” such conditions. You can choose to ignore all of that research if you’d like, but it doesn’t make the research go away.
Bringing up colorectal screening is a bad choice, read here
http://blog.lib.umn.edu/schwitz/healthnews/
as for breast cancer screening here is my last post on the topic
http://www.beforeyoutakethatpill.com/index.php/2009/02/09/this-just-in-breast-cancer-screening-essentially-useless/
and here is prostate cancer screening
http://www.beforeyoutakethatpill.com/index.php/2009/03/19/prostate-cancer-screening-found-to-be-useless/
the point is that the burden of proof is on the person advocating screening for ANY condition. I would add the same for lung cancer although I have not researched it.
John wants to keep bringing it back to risk factors for PPD but his arguments are lame because he strung together a string of factors that are highly colinear, meaning that they are so intertangled that it is difficult to determine what is specifically related to one of them. The one article I looked at and posted on my website didn’t substantiate his claims. As for the accusation of cherry picking an article, well, next time make sure your arguments are rock solid.
Dr. Grohol,
When I was diagnosed, no one gave me a blood test, looked at an MRI, PET scan, or fMRI. No one biopsied brain tissue. No one mapped my genome and located defective alleles. No one tested chemical levels. What scientific measures are you speaking of? If they exist, I’d like to have them done.
If I go to a cardiologist and complain of chest pain, I don’t get diagnosed with heart disease and prescribed immediate medication for it.
I do think mental illness is real, but the fact is that there are NOT any scientific diagnostic tests to confirm it. And anyone who has been in the psychiatric system for long enough can tell you just how flimsy these psychological methods are. A friend of mine was diagnosed with Schizophrenia in the late 60s. In the 90s, she was “Depressed”. Now, she’s “bipolar”. Um, can you imagine a doctor saying, “Oops! My bad, you don’t have heart disease, you have diabetes” ?
Like I said, I do believe that mental illness is real (inasmuch as any condition that interferes with your functionality in life can be considered an illness) and perhaps one day we will find a scientific, objective test to confirm diagnoses. But as it stands today, mental health treatment is a LONG way from being comparable to physical health treatment. I have AMPLE experience in both areas and I can tell you, it’s not just apples and oranges, it’s apples and frigging cordon bleu steak.
This post is for the benefit of anyone who reads the blog all the way through and wants more information. I have taken my responses to the arguing going on here on over to Dr. Bremner’s blog and will continue to do so.
http://www.naturalnews.com/026634_drugs_suicide_adhd.html
The Mothers Act Disease Mongering Campaign – Part I
You can read Evelyn Pringle’s article on Natural News or my blog uniteforlife.wordpress.com
I do not intend to reply to Dr. Grohol on his blog. If he wants to speak to me he may come to my blog or Dr. Bremner’s to respond. I am tired of the insulting tone here.
Evelyn, you state “In the Mothers Act disease mongering campaign we now have social workers, running treatment centers with websites, diagnosing mental disorders, with 2 and 3 question screening tools, and advising women on which drugs they recommend.”
Please cite your reference for such claims since we all know that political opinion is not a reputable source.
Doug Bremner – Did I miss where the Cochrane Review changed their recommendations?
Sadly, the one article you responded to with the data clearly shows you didn’t represent the findings accurately. If you want to rewrite someone else’s study and findings, I guess you’re welcomed to do so. But what you claim and what the researchers actually found are two very different things (as people can see for themselves).
kimbriel – “…but the fact is that there are NOT any scientific diagnostic tests to confirm it.” Depends on your definition of “scientific.” The Beck Depression Inventory, for instance, is a scientific instrument that’s been around for three decades. It’s been used in thousands of research studies. Is that of no value?
Amy Philo – Sorry to see you go, but it’s not surprising given that your agenda doesn’t really seem to fit into a balanced discussion about risk factors for PPD. I think your tone speaks volumes, too.
Doug Bremner wrote in his own comments section:
I think this, too, speaks volumes about Bremner’s attitude (and tone!) toward non-physicians, and I thought it important to note.
“skills – I’m open to data that shows some of yours and other opponents arguments have merit. Surely the federal government has funded (or tried to fund) prior education and screening measures for other health and mental health concerns, no? Yet I scratch my head to find any data that shows such prior efforts have resulted in *more* misery or some sort of mandate to screen (or else!). Show me the data, and I’ll be happy to reconsider my position.”
-Dr. Grohol- I agree with you for the most part: we should screen. I also believe that the FIRST line of treatment should be talk therapy, not pills. At my blog, noted, I blogged on this on “blog for ppd day.”
I do see a very valid reason for begin suspicious of government-mandated mental health screening programs. The “Texas Medication Algorithm Program” circa 2004 is a strong example of this potential government-promoted nightmare. The problem is that such projects, including TMAP, attract “support” from pharmaceutical companies who smell a steady stream of cash. As in other psych areas, their influence is strong. The algorithms end up being psych-med prescription-based. At the same time, there is great evidence you may be familiar with that talk therapy, not pills, should be the preferred treatment for kids with depression. TMPA was promoted by Gov Bush in Texas. Bush senior was on the board of directors of Eli Lilly. He may still be for all I know. Many of the “clinical resaerchers” involved with TMAP, including at UT Southwestern in Dallas, were, and still are, strongly funded by Pharma.
So, I believe that Bremner has a justified fear of govt-promoted mental health schemes, including systematic screening of anyone. I am generally FOR M B-S because it calls for 1. more research into ppd- there is a great set of issues to study; and 2. it does not involve a treatment algorithm.
Obstetrics has already addressed PPD. Their professional organizations expect CME and vigilence. I am not familiar with the way that pediatrics has addressed PPD, but I see this as the next frontier for addressing PPD: it is the pediatricians who see the moms for the first year post-birth.
Holding Obstetricians and pediatricians responsible as first-line MH providers is a problem: their toolbag is very limited, and is mainly filled with pharma-sponsored CME.