Three incidents involving ineffective generic drugs recently occurred in my life.

Incident #1:

After taking Zoloft for years I switched, without problem, to the generic Sertraline carried by my local pharmacy. Then, in an effort to economize, I ordered my prescription through a popular mail-delivery system which sent Sertraline manufactured by yet another company. Within a month my depression returned and I knew the antidepressant wasn’t working. I switched back to the local generic and felt improvements in just over two weeks.

Clearly, even though the active ingredient was guaranteed to be the same, those two generics were not identical.

Incident #2

I recently received an online newsletter from Julie Fast, who blogs at bipolarhappens, in which she shared her recent medication woes.

Open about her life with bipolar disorder, Julie shared details of the past few months, citing changes in energy levels, focus, sociability, and anxiety levels.

In one paragraph, Julie says “…I felt like I was going to jump out of my skin. I was so restless. But I was also super tired! Then the depression started. It was the kind of depression where I not only felt hopeless, I cried a lot and had trouble completing tasks. I have been like this many times in my life, so I kept going, but it was hard.”

All of these changes occurred despite the fact that Julie carefully managed her lifestyle and consistently took her meds. Then it occurred to her– just prior to her deterioration, Julie had switched from Lamictal to the generic Lamotrigine.

Incident #3:

My daughter Chloe suddenly began rapid-cycling, even though she, too, was completely medically compliant, saw her doctors regularly, and managed her lifestyle.

I asked, “Have you switched to any generics in the last few weeks?”

Sure enough, like Julie, Chloe has switched to a generic form of Lamictal just a couple of weeks before her health worsened. And like Julie, when Chloe returned to non-generic, brand-name Lamictal, she stabilized and felt better.

How can this be?

Aren’t generic drugs supposed to be exactly the same?

Well…not exactly…

Even though the active ingredients must be the same as their brand-name counterparts, generics can be manufactured with different fillers and  inactive ingredients. These minor alterations sometimes cause the medication to metabolize and work differently.

Don’t get me wrong…generics are usually just as good as the brand names and they save millions in healthcare costs each year. But in those rare instances when they are not as effective as the original, they should not be used. So try generics, but be aware of how well they’re working. Be your own best advocate.

Nearly half of American young adults experience addiction, substance abuse or mental health issues, but few seek treatment, according to a recent report published in the December 2008 issue of the Archives of General Psychiatry.

U.S. researchers recently analyzed data from more than 5,000 young adults aged 19 to 25, who took part in the National Epidemiologic Survey on Alcohol and Related Conditions.

Researchers found that nearly 48 percent of the study participants met the criteria for at least one psychiatric disorder, but only 25 percent of those identified with disorders sought treatment.

Among those in college, alcohol abuse (20.4 percent) and personality disorders (17.7 percent) were the most common disorders. Young adults not in college were most frequently diagnosed with personality disorders (21.6 percent) and nicotine dependence (20.7 percent).

College students were less likely to use drugs, tobacco, or have bipolar disorder than the non-students; but college students’ potential for alcohol abuse was much greater. Additionally, students were significantly less likely to receive treatment for drug or alcohol abuse or addiction.

“In view of the high prevalence and low rate of treatment of alcohol-use disorders in college students, greater efforts to implement screening and intervention programs on college and university campuses are warranted,” wrote Dr. Carlos Blanco, of the New York State Psychiatric Institute and Columbia University, New York. “The centralized delivery of campus student health services might offer an advantageous structure for carrying out such screening and interventions.”

The researchers also noted that a high overall rate of psychiatric disorders exists among young adults, who are at a vulnerable stage of development. This is not surprising since the average age of onset for many mental illnesses is seventeen.

“The vast majority of disorders in this population can be effectively treated with evidence-based psychosocial and pharmacological approaches,” Blanco wrote. “Early treatment could reduce the persistence of these disorders and their associated functional impairment, loss of productivity and increased health-care costs. As these young people represent our nation’s future, urgent action is needed to increase detection and treatment of psychiatric disorders among college students and their non-college-attending peers.”

Something must change. Facts and information need to find their way to young people, especially those in college. They must learn to recognize the signs and symptoms of mental health disorders and understand their seriousness. Young people must be encouraged to seek treatment, and must have access to cost-effective treatment options.

Consider the numbers—nearly 50% of a generation of Americans is affected. Only a small fraction receives treatment. Their future, our future, is at risk.

Thanks to Violet Crush for the following review of Mommy I’m Still in Here. You can read more interesting comments and reviews at her site.

Here is her review, in it’s entirety:

I am constantly surprised by the knowledge books provide, the way they let you experience and imagine things that could never have been possible otherwise. The way they tell stories that surprise, horrify or humble you. Mommy I’m still in here is one such story. As the tag line says ‘It is the story of a family’s journey with bipolar disease’.

I don’t know about others but I knew nothing about bipolar disorder or manic-depressive illness.

Manic-depression distorts moods and thoughts, incites dreadful behaviors, destroys the basis of rational thought, and too often erodes the desire and will to live. It is an illness that is biological in its origins, yet one that feels psychological in the experience of it; an illness that is unique in conferring advantage and pleasure, yet one that brings in its wake almost unendurable suffering and, not infrequently, suicide.

The author Kate had a perfect family with husband Mark and 3 children Chloe, Michael and Monica, all 3 years apart. Everything is going fine when the eldest daughter Chloe at the age of 17 suddenly experiences severe mood swings and depression. After doctor appointments and observations Chloe is diagnosed with Bipolar disorder. As the depression and mood swings increase, Chloe also starts hallucinating. She sees and hears things that are not there. Her relationship with her mother and siblings becomes strained due to her constant mood swings.

Kate also goes through a series of emotions like confusion, desperation, grief and guilt. Kate blames herself for not recognizing the signs early even though she knew there were a lot of cases of depression and substance abuse in the family.

When after constant monitoring Chloe’s illness becomes somewhat manageable, her son Michael is diagnosed with the same illness. He starts drinking and taking drugs to feel normal.

We can imagine what a mother goes through when one of her child falls sick, this twice is a mother’s nightmare. Kate has made a lot of sacrifices for her children. She explains the difficulties of living and caring for a chronically ill person. This one dialog had chills running down my spine. It’s when Chloe attempted suicide by cutting her nerves and after Kate patched her up.

Through it all, Chloe did not fight me, did not talk, and did not respond. When we were finished, she raised her face to mine and stated matter-of-factly, “Next time I’ll cut the other way, straight down the vein. It’ll be faster and you won’t be able to fix it.”

This is also Kate’s story. She learned not to blame herself when she finally admitted to herself and to others that she is not responsible for what happened or will not be responsible for what happens in the future. Kate says she has come to terms with the fact that eradicating her children’s illness is not the solution.

If we believe that disabilities must be altered or abolished, then we imply that the absence of disability equals a good life. But does it? Because if that’s true, one might deduce that anyone with a disability is inferior. That line of reasoning leads to a horrible, deeply disturbing, and dangerous arena.

Disability does not require solution or abolition, but understanding, and when necessary, temperature to allow the disabled to function more fully.

Bipolar disorder is a chronic mental illness. It does not go away. Chloe and Michael will always have it. It will forever alter their lives, and as a result, will alter ours too. Nevertheless, we embrace the experience and anticipate future legs of the journey because we know that this world, this life, offers everybody opportunities to learn and grow and evolve.

Okay, I’ll stop else I’ll end up quoting the entire book. All I can say is please, please, please read this book. It is sad, horrifying, depressing, uplifting, encouraging, gripping, informative, moving and hopeful. I hope Chloe, Michael and even Monica is doing fine. I hope the entire family is doing fine. I would like to take back my sentence ‘The author Kate had a perfect family…’ and correct it to ‘The author Kate has a perfect family…’. A family that supports one another, that understands each others problems and accepts it without judgment is nothing more than perfect.

Did you know that Napoleon, Mark Twain, Charles Dickens, William Faulkner, Sylvia Plath, John Keats, Virginia Wolf, Vincent Van Gogh were possibly victims of Bipolar disorder?

We’ve made such progress in medicine, learned so much about treatment, especially in the area of mental illness or disorders of the brain. Unfortunately, our actions aren’t keeping up with our knowledge.

Are we caught a medical crisis?

Or a moral one?

Last week, representatives for the Substance Abuse and Mental Health Services Administration, part of the U.S. Department of Health and Human Services, released a report stating that more that 10% of American adults experienced serious psychological distress in the past year. This means that 24.3 million people ages 18 years or older  dealt with serious issues like chronic depression, bipolar disorder, anxiety and schizophrenia. Even more alarming is the fact that fewer than half of those people — our neighbors, friends and relatives — received treatment.

What does it say about our system, our society, when in the year 2008, nearly 13 million of our citizens suffered, untreated, with serious illness? Illnesses that are treatable?

Something must change.

As our country grapples with economic issues, not the least of which is health care, we would be wise to remember that mental illness affects one in five families. That’s a lot of families who experience not only loss of income, but also other expenses related to illnesses that could be managed with proper medical care.  And that proper care, that treatment, is much less costly than expenses which ultimately come out of taxpayers pockets, expenses like emergency care and legal and judicial costs often associated with untreated mental illness.

In a statement released along with last weeks report, Eric Broderick, SAMHSA acting administrator said, “As we focus on advancing and protecting the nation’s health we must ensure mental health services are part of the solution.”

Hear! Hear!

Other facts included in the report indicated that our youth, our future, are particularly vulnerable. Consider the following:

– The serious psychological distress rate was significantly higher among young adults ages 18 to 25 at 17.9 percent than among those ages 26 to 49 years old at 12.2 percent or those ages 50 years and older at 7 percent.

– Young adults aged 18 to 25 experiencing serious psychological distress were far less likely to receive mental health services than their older counterparts.

Also disturbing were the facts related to minorities:

- -Fewer than 30 percent of African-Americans and Hispanics experiencing these disorders received mental health services, compared to 50.9 percent of whites.

We can do better.

We must.

As many of you know, two of my three children have bipolar disorder; and in our extended family a dozen family members have this or a related diagnosis. And we are far from alone.

The fact is, over 100 million people have friends or family members diagnosed with bipolar disorder. Tom and Fran Smith were a part of that group until their daughter Karla ended her own life at age 26, after a seven-year struggle with this serious mental illness.

During those seven years, Tom Smith says “…we received very little guidance…no one attempted to understand or clarify our frustration, concern and fear; we had no manual that suggested ways to cope…”

After grieving the loss of their vibrant young daughter, the Smith’s were compelled to ease the way for other families in similar circumstances. To that end, they founded The Karla Smith Foundation for  parents and loved ones of people with mental illness. Through support groups, peer-to-peer coaching, and educational programs and events, the KSF helps bring balance into lives that are affected by  mental illness or the suicide of a loved one. In addition to that ambitious endeavor, Tom Smith wrote A BALANCED LIFE: 9 Stategies for Coping with the Mental Health Problems of a Loved One (Hazelden, Sept 2008).

Here, in brief, are those strategies Smith believes will make a difference in the lives of others living with a serious mental illness:

1.–Help our loved one find and continue to take the medication needed for a balanced life.

2.–Urge our loved one to maintain a supportive relationship with a therapist, counselor or sponsor.

3.–Learn as much as we can about the mental disorder of our loved one.

4.–Assist our loved one in developing a healthy self-esteem, since it is critical for a balanced emotional live.

5.–Accept mental illness as a fact of life for our loved one, even though mental illness does not encompass all of life.

6.–Take care of ourselves by proper exercise, sleep, diet, relationships, and by monitoring our feelings.

7.–Become a supportive network of family and/or friends who know about the mental illness and who commit to acting in the best interest of our loved one as far as we are able.

8.–Identify the early warning signs that precede a more difficult phase of the mental illness, and help our loved one when these signs emerge.

9.–Acknowledge our dependence on a Higher Power and seek guidance from that Higher Power in whatever way that is comfortable to us.

In A BALANCED LIFE, Smith commits a chapter to each strategy, illuminating his points with real life stories and experiences. In addition, he includes a series of questions that help families or support groups clarify their feelings and understanding of the facts; as well as easy to understand definitions and explanations of  various mental health issues.

If you know or love someone diagnosed with a serious mental illness, or if you belong to a support group related to this topic, this book is a necessity. An excellent resource on so many levels, A BALANCED LIFE helps families achieve just that.

The holidays. I love ‘em, but not everybody does. Sadly, the incidence of suicide peaks at this time of year, especially among the elderly and the nation’s youth.

Here are the facts:

• Suicide ranks as the third leading cause of death for young people (ages 15-19 and 15-24); only accidents and homicides occur more frequently.

• Whereas suicides account for 1.3% of all deaths in the U.S. annually, they comprise 12.3% of all deaths among 15-24 year olds.

• Each year, there are approximately 10 suicides for every 100,000 youth.

• Approximately 11 young people between the ages of 15-24 die every day by suicide.

• Every 2 hours and 15 minutes, a person under the age of 25 completes suicide.

• Suicide rates among 15-24 year olds have more than doubled in the last 50 years. They have declined 25.6% since 1995.

• In the past 60 years, the suicide rate has quadrupled for boys 15 to 24 years old, and doubled for girls of the same age (CDC, 2002).

• Boys between the ages of 20 and 24 were 6.6 times more likely than girlss to complete suicide 2001. Boyss between 15 and 19 were 4.8 times more likely than girlss to complete suicide (2001 data).

• The boy to girl ratio of completed suicides was 5: 1 among 15-19 year olds and 6.9: 1 among 20-24 year olds (2000 data).

• Firearms are the most commonly used suicide method among kids, regardless of race or gender, accounting for almost three of five (57%) completed suicides.

• Access to and availability of firearms is a significant factor in the increase of youth suicide. Guns in the home are deadly to its occupants!

• For every completed suicide by a child, 100 to 200 attempts are made. In grades 9 through 12, 8.8% of students attempted suicide in the previous 12 months (6.2% male and 12.2% female). These numbers decrease from grades 9 (10.7%) to 12 (5.5%). A prior suicide attempt is an important risk factor for an eventual completion.

Source: U Life Line

Suicide.

Hear the word. Hear the comments.

They’re almost automatic.

“Such a selfish thing to do.”…”Don’t they realize what they’re doing to their families?”…”It’s the ultimate sin!”…and on…and on…and on…

As the mother of two young adults who have each attempted suicide in times of severe illness, I understand what compelled them, what prompted their actions. In it’s continuing series on mental illness, Canada’s Globe and Mail published a stark and honest account of one man’s struggle with suicidal thoughts that would not go away. An excerpt of the story written by Erin Anderssen appears below. To read the article in it’s entirety, follow the link.

“It is always there, like a song he can’t stop humming. It plays in the background when he graduates from law school. When he hears “not guilty” in court. When he cheers his son William to victory in the big hockey game or hugs his daughter Sarah for winning the Grade 3 spelling bee. He left Toronto because standing on the subway platform cranked the volume. He tried to shock it out of his brain. For a time, Star Trek episodes muffled it. Drugs, at best, only dull it.

In nearly every moment of his life, Peter O’Neill thinks about killing himself. Sometimes, he makes plans. He buys rope. He sets a date. Mostly though, he is trapped between wanting to die and trying to live, while the same scenes run on a loop in his mind: a noose dangling in shadow, or his body hanging from a rope.

It has slowly drowned out nearly everything else - his marriage, his career, his family.”

Read the rest of Peter’s story at globeandmail.com

Read more on the topic of suicide. The more we understand it, the better equipped we are to prevent it.

One in five families deals with serious mental illness.

Think about it.

If you’re not one of those families, you likely know one…

or two…

or three…

Canada’s Globe and Mail recently began a series on the mental health crisis in their country. It’s a crisis that mirrors a similar situation in the US, where depression, anxiety and bipolar disorder affect 13 to 22 percent of kids under 18.

The series, which I’ll reference and excerpt this week, covers topics like denial, disbelief, fear, rage,  and safety. You’ll learn that seventy percent of adult patients with mental illness can trace symptoms back to childhood; many “vividly recall the first frightening moment of infinite sadness or the anxiety that makes you want to strip off your own skin.”

This article, featuring the Bishop-Quigley family and their ten year-old daughter Erynn, and written by André Picard and Erin Anderssen, graphically illustrates the challenges families face when a child is mentally ill. Read the excerpt below, and thenfollow the link for the entire story, to discover the risks, the cost, the emotional toll and challenges millions of parents face every single day. After you’ve read the story, come back to me and leave your thoughts, ideas, concerns.

“On a Monday morning in September, 2006, during what they call their “darkest of days,” Heather Bishop and Sean Quigley committed their 10-year-old daughter, Erynn, to a psychiatric hospital.

The breaking point came after a Saturday shopping trip to a Sam’s Club in their hometown of London, Ont. When Ms. Bishop casually suggested to Erynn that she put a toy back on the shelf, the girl’s expression clouded, then she erupted into screams. There was no way to bring her back: Soon, she would be throwing punches. They had to get out of the store.

Mr. Quigley slung Erynn over his shoulder and Ms. Bishop abandoned the cart piled high with groceries, just as they had done dozens of time before. This was no simple tantrum. It was everyday life for the couple - trying to protect their daughter and everyone around her while she was consumed by rages she barely remembered afterward.”

For the entire stoey and to learn more about the Quigley family? Click here.

How much is too much?

How much is enough?

When  does support become crippling or enabling?

Does unconditional love mean giving without end?

Too much help…

Can it keep one from self-sufficiency, self reliance?

What if the giver feels used, the gift taken for granted?

Please share your thoughts and experiences.

A Loved One with Mental Illness…

If you have a family member or friend who’s been diagnosed with a mental illness, you’re probably wondering what you can do to help. Although new forms of therapy and medication make it possible for many individuals to lead full, independent lives, the support of family, friends and peers remains an essential element in the recovery process.

What Is a Mental Illness?

(Much of the following has been adapted from material originally published in NAMI publications.) A mental illness is a disease that causes mild to severe disturbances in thought and behavior that results in an inability to cope with life’s ordinary demands and routines. There are more than 200 classified forms of mental illness, all of which can be triggered by a variety of causes: a particular situation or series of events, an illness, genetics, biochemical imbalances, or any combination of those factors. Above all, it’s important to remember that there is help and hope for your loved one.

Encourage a Dialogue for Recovery

A key element in recovery is a productive, two-way communication between patient and doctor. Encouraging your friend or family member to foster this type of relationship with his or her team of healthcare professionals can make a big difference in helping your loved one to recover. There are also many other ways you can help people cope with their disorder, get treatment and work toward recovery. Here are some tips for supporting someone close to you.

Support Strategies

Accept your feelings. You may find yourself denying the warning signs, worrying what other people will think due to stigma, or wondering what caused your loved one to become ill. Accept that these feelings are normal and common among others in your situation.

Educate yourself. Learn about the diagnosis, symptoms and available treatments. Local Mental Health America affiliates, public libraries and the Internet are all good resources.

Be compassionate. Recognize that your family member or friend may feel scared and confused after receiving a diagnosis. Although some people are relieved to get diagnosed and actively seek treatment, it may feel devastating to others.

Motivate. Encourage your loved one to learn about what treatments and services will promote recovery. Recognize that finding the right treatment or services can take time, and can involve a process of trial and error.

Practice “active listening.” Listen to your family member or friend and express your understanding back to them. Acknowledge the feelings he or she is experiencing and don’t discount them, even if you believe them to be symptoms of the illness.

Coping with unusual behavior. Certain behaviors people with mental illnesses may exhibit can be disruptive- especially in public-and difficult to accept. The next time you and your loved one visit his or her mental health professional, discuss these behaviors together and develop a strategy for coping.

Understand the challenges of medication. Although treatments have improved tremendously in the past decade, they can also lead to side effects that can make your family member or friend want to stop taking the medicine. Encourage your loved one to speak immediately to his or her health care provider about any problems related to medications.

Understand that it’s not just about medication. Recovery from mental illness isn’t only a matter of “just staying on your medications.” Self-esteem, social support and a feeling of contributing to society are also essential elements of recovery and should be supported.

Offer practical help. Offer to drive or accompany your family member or friend to medical and other appointments. And, if he or she wants you to, discuss the treatment, side effects or other issues with the doctor and treatment team.

Give respect. Always respect the individual’s need for and right to privacy. People with mental illnesses have the same right to be treated with dignity and respect as anyone else.

Establish a support network. Seek out your own support from family and friends. Self-help and support groups also provide an opportunity to talk with other people who are experiencing the same types of issues you are. They can listen and offer valuable advice.

Take time out. Schedule time for yourself to help you keep things in perspective. Making sure you pursue your own interests will help you have more patience and compassion toward your loved one. You can only help others when you are physically and emotionally healthy yourself. Also, make sure any other family members aren’t feeling ignored, and set aside quality time to spend together.

Maintain hope. There is hope for recovery, and with treatment, many people who have mental illnesses return to productive and fulfilling lives.