Remembering Frieda

Frieda, a dear friend and one of my earliest blog followers, died on Monday. She was a great, great lady in my book. Old enough to be my mother, she and her sister, Tresa, were role models in many ways but particularly when it came to sisterhood. Now those ladies knew what it meant to be sisters. They were practically joined at the hip. You hardly ever ran into one without the other.

Watching the two of them together has given me hope about sistership with Jerri. Tresa once confided they hadn’t been that close when they were growing up. Neither were Jerri and me. I was the favored child and anyone who’s ever had to live in the shadow of “the favored one” knows what that’s like. She hated me. We bickered incessantly, told on each other, read each other’s diaries, vied for each other’s boyfriends, used each other’s stuff without asking. And then we were estranged for almost 25 years.

I suspect that Frieda and Tresa’s paths may have parted for a time as well. I’ll have to remember to ask Tresa about that. You would never have known it though by watching them. They were genuinely fond of each other, always laughing and teasing. Oh I saw them disagree a time or two but never heatedly. And I never heard either of them ever say an unkind word about the other. Now that is truly something.

When I first moved Jerri to Durham and had just started to realize I’d bitten off more than I could chew, I sent out an urgent email to a number of women I knew would rally around me in prayer. Frieda and Tresa were both in that list along with several of you who follow this blog. I can’t tell you what your support has meant.

20120428-234634.jpgThe last time I saw Frieda was a few months ago at the Eno River Eatery. On Sunday’s, Stan likes to grab a waffle there and it also seems to be a regular haunt for “The Ladies” as we often run into them. The Ladies, in addition to Tresa and Frieda, include their two friends, Joyce and Martha. They’ve been a foursome for almost as long as I’ve known them. On that particular Sunday, my sister, Jerri, was with Stan and me. Frieda knew all about Jerri’s illness, of course, from the blog.

One of the really sad things about mental illness is the loss of dignity. People treat you like you aren’t human, like you have no feelings, like you don’t matter. People don’t touch you, they look away and try to avoid interaction. That morning at Eno River, The Ladies came over to our table and Frieda plopped down right next to Jerri. She talked and teased and treated Jerri like she was one of the girls.

I called Jerri this week and told her one of The Ladies from Eno River had died. “It was Frieda,” I said. “Do you know which one she was?” Jerri said, “Yes, the one who sat next to me.” And I could tell by the way she said it, she’d been deeply touched simply by being treated like a human being. That was Frieda.

After the funeral on Friday, I took my place in the motorcade to the cemetery. We had quite a procession. Several policemen escorted us on motorcycles, lights flashing, racing to the intersections to hold the traffic. Not a single driver seemed put out. They all moved docilely off the shoulder and waited solemnly for us to pass. We wound through the Trinity section of old Durham, past stately homes with gardens in full flower. At one house, a man who’d been on his knees in his garden, stood up, took off his cap and held it against his chest as we passed. I had the oddest sensation I was somehow a part of something way bigger than me and that we were celebrating a far greater person than even I knew. I could almost hear Frieda saying, “All these people. All this is for me?”

Tonight I believe she’s hanging out with Wade in a place more beautiful than I can imagine. It’s been about 9 years since she’s seen him. The thought of it makes me smile.

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Desperately Seeking Perspective

Tuesday morning, my iPhone woke me at 5 am. Not the alarm clock app, but an actual caller, Catherina, Jerri’s case worker. She was calling from North Carolina and didn’t realize, of course, that I was in San Francisco on business. “I’m about to go into a meeting with Housing for New Hope,” she said. “Looks like they want to evict Jerri.”

“Based on what, Catherina?”

“Well, I won’t have all the details until after the meeting but she’s leaving the external door to the building propped open with the mat, not cleaning her apartment, and apparently Brian found her sleeping on the floor of her apartment one day, practically unconscious, and he had a terrible time getting her up and into bed.”

I’ve already had a conversation with Brian about the door mat and he knows all the residents are doing it. And since when can you get evicted from sleeping on your apartment floor? And if Jerri was sleeping so soundly that Brian couldn’t get her up, how did he get in the apartment? Master key? It’s like one big perpetual game of Bullshit.

Here’s what no one is saying. Housing for New Hope suspects recreational drugs. That’s against their covenants and reason for eviction. The mat in the door is to allow a dealer to enter. The unkempt apartment and heavy sleeping is because she’s wasted.

And they could be right. It’s true Jerri looks terrible and continues to lose weight. When using, addicts often don’t eat or take care of themselves. But the same can be said for people experiencing a psychotic break or even a debilitating illness like cancer. And that’s Jerri’s claim. Something is terribly wrong with her and she feels really sick all the time.

At 11 am, same day, Jerri called fuming mad as if I was in on some conspiracy. Why would I possibly want her to be homeless? What could possibly be in that for me? You know, some days I don’t need anyone to drive me crazy because, thank you very much, I can walk there from here.

Jerri says she can’t keep her apartment clean because she feels bad. She doesn’t know what’s wrong but thinks its probably her liver. But she won’t go to the hospital because she has a doctor’s appointment next week. Catherina thinks she won’t go to the hospital because they’ll find drugs in her system. Honestly, I don’t know what to think. I spent two hours on the phone trying to get Jerri to see other people’s perspective and how based on appearances, it’s easy to jump to the “drug use” conclusion. If she’s really that sick (and she’s been saying this for about a month now), why not try to move the doctor’s appointment up? Or go to the ER? Jerri refuses to do either.

Today, Jerri called around 3 pm. She’d just gotten up and has no food in the house. We’d planned to do a grocery run but she just didn’t feel like it. Could I drive over a chicken sandwich and a large Sprite? She didn’t feel like walking to the shelter to eat. I didn’t particularly want to get out either. I’ve still got jet lag and the weather is nasty. And this is the third time this month, she’s asked me to deliver food. (Once I said yes and the other time, no, for those of you keeping score.)

Stan asked why I was even considering it. That’s the crux of the matter. Why am I? Trophy daughters are known enablers; I don’t want to be one. I want Jerri to make better choices like always having some food in the house and I realize when she doesn’t experience consequences of bad choices, she has no incentive to make better ones. But then I think about my close friends. If one of them called with the same request I’d do it in a heartbeat. Why? Because I love them. Because they wouldn’t ask unless they really needed help. Maybe I should just have “sucker” tattooed on my forehead. All I know is, if I was really, really sick, I’d want someone to bring me a meal. Curse you, Empathy!

So I’d like some external perspective here. In a situation like this, how do you decide when to give and when to set boundaries?

As a sidebar, I saw the movie Blue Like Jazz this week and at one point the main character, Don, says (and I paraphrase), “In the past, I’d always used the what-would-Jesus-do method to figure things out. Just what would Jesus do if his mother had an affair with his Youth Pastor? I couldn’t even imagine . . .” If you happen to know WWJD in my situation, I’m all ears. Because frankly, I can’t even imagine.


Great Post on Dual Diagnosis and Self Medication

This is the first time I’ve re-posted another author’s work and I’m not sure of proper etiquette. The original post can be found here. I thought about summarizing but the post is so informative, I didn’t want to leave anything out. Of particular interest to me is the part on which came first, the addiction or the mental illness. As I’ve shared before, my mom strongly believes Jerri’s mental illness was triggered by her drug use in her teens. When I look back at our childhood, however, there were a number of signs that indicated something wasn’t quite right long before Jerri hit puberty. I’d heard of the Self Medication Hypothesis, which posits that the addict’s drug of choice is actually selected because of the drug’s effect on the “primary feeling states” of the user. In other words, the user understands, perhaps subconsciously, that something is off and upon trying various drugs, becomes addicted to the one that makes her feel less “off”. Interestingly enough, mood disorders including bipolar and ADHD are more common in cocaine abusers (Jerri’s drug of choice) than opiate abusers (20% vs 1%).

I did not include all the links in the original article so worth visiting it if you find this as fascinating as I do. Hope you find informative and please share your thoughts!

Addiction Causes: Understanding Self Medication And How I Lost My Sister To Substance Abuse

(by Victoria Costello, Posted: 02/25/2012 11:33 am, Huffington Post)

In light of the continuing controversy surrounding Whitney Houston’s death, including questions of blame and responsibility for what the coroner may determine was an overdose involving drugs and alcohol, here is a look at the science behind the central and often misunderstood concept of self-medication in mental illness, addiction and recovery. My interest in this is both professional and personal. My sister Rita died of a multiple drug cocktail at age 38 — after a downward slide that began over 20 years earlier and finally caught up with her. She was, like Whitney Houston, a victim of her own demons and a culture that favors self-medication over getting mental health treatment. As both of their premature deaths demonstrate, self-medication and aging don’t mix well.

Mystery of the Missing Spoons

When spoons began to disappear from my mother’s silverware drawer in the late 1960s, neither my mother nor I suspected my younger sister Rita’s dope use. It didn’t dawn on us that heroin had be mixed with water and cooked over a flame before it was injected. At that time, my friends and I smoked pot regularly, and we had also tried psychedelics, mushrooms and acid — tried being the operative word. Rita went further and did it much faster and more overtly. She flew through pot and discovered barbiturates, speed and cocaine.

Heroin was too pricey without help from an older dealer-boyfriend. Nonetheless, by the time she was 16, Rita had made it her drug of choice. Between boyfriends, she stole to finance her new habit. Mom’s wedding band was one of the first casualties. Soon, cash could no longer be left in a drawer or purse. This was before drug rehab as a concept had entered the American cultural lexicon, certainly that of the suburban northeast, leaving my mother baffled and ashamed at the behavior of the prettier and once the easier of her two daughters. My mother was an unknowing soldier in what had become all-out guerrilla combat.

What Remains

When President Richard Nixon declared his war on drugs in 1971 — hopelessly lost in the
four decades since — it did one constructive thing by creating a new and favorable climate for
research into the causes of addiction. This research gave birth to the field of drug rehabilitation, and out of this wave of new treatments came the theory of self-medication — the idea that addiction comes about because people are attempting to alleviate the distress of preexisting mental disorders. The concept had come originally from Freud, in 1884, after he noted the antidepressant properties of cocaine.

By the 1970s, the theory of self-medication formally arrived, and immediately caused a storm
of controversy because it challenged views then held by the medical community and law
enforcement that attributed drug abuse to peer pressures, family breakdown, affluence, escapism and lax policing. For the first time, the nation’s newly minted white, middle-class drug addicts (typified by my sister) were joining their less affluent urban counterparts, who were already populating U.S. jails and hospitals. Junkies — hippies, rich and poor, black and white, addicts and alcoholics — constituted an equal-opportunity mental health crisis for public health doctors on the front lines of treatment in big-city hospital emergency rooms.

The father of the self-medication hypothesis is Edward J. Khantzian, a founding member of the Psychiatry Department at Harvard’s Cambridge Hospital. Writing in 1985, Khantzian stated his belief that addicts weren’t victims of random selection. Instead, he explained, they had a drug of choice: a specific drug affinity dictated by “psychopharmacologic action of the drug and the dominant painful feelings with which they struggle.” Like Freud, he pointed to the
energizing effect of cocaine and other stimulants in response to the depletion and fatigue of
addicts dealing with preexisting depression. In his patients who abused opiates, including heroin, Khantzian noted their calming effect on the addicts’ typically problematic impulsivity. This point particularly hit home for me as I recalled my sister Rita’s tendency to get into fist fights with her arresting officers, crash her car and land in the E.R. after passing out in public places.

The idea that human psychological vulnerabilities had anything to do with addiction was a
new piece of the puzzle, and it reflected Khantzian’s psychoanalytic background as much as
his clinical work at the Cambridge Clinic. Decades later, self-medication is accepted medicine
within the mental health field. However, broader cultural understanding of its implications
for individuals with undiagnosed mental disorders who may be self-medicating has lagged far
behind; not unlike continuing popular resistance to addiction as a disease over which the addict has little or no control, and widespread refusal to accept the robustly established precept that treatment for addiction is effective.

One of the major stumbling blocks to greater understanding of the principle of self-medication appears to be the culture’s continuing confusion about which comes first: the mental illness or the addiction.

One sign of this missing understanding has to be the recent vitriolic “debate” over New Jersey’s decision to fly its flag at half-staff in honor of Whitney Houston, one of the century’s greatest musical artists; a celebrity whose cause of death will no doubt reflect her two-decade struggle with the disease of addiction but is not likely to include any recognition of an underlying mental disorder.

Chicken or Egg?

The fundamental question of which comes first when someone has what is now called a “dual
diagnosis” remained unanswered up until the 1990s. In 1992, with a first-of-its-kind national
survey of the state of the nation’s mental health called the National Comorbidity Survey (NCS),
scientific understanding of comorbid addiction and mental illness went mainstream. The NCS
evaluated 8,098 average Americans, ages 15 to 54, interviewed in face-to-face home settings by trained laypersons — making them far less able to lessen or deny symptoms and patterns.

Among the striking results of the NCS survey: 45 percent of those people with an alcohol-use
disorder and 72 percent with a drug-use disorder also had at least one other mental disorder.
Perhaps more important at a time when the self-medication theory was still under attack, the
NCS survey provided a concrete and comprehensive answer to the chicken-and-egg question
about addiction and mental illness.

So Which Is It?

The NCS showed that when an alcohol disorder accompanied another mental disorder, the alcohol abuse began after the individual was suffering from symptoms of the other mental disorder, usually a year or more after. Not including other forms of substance abuse, the most common preexisting mental disorders reported among those interviewed were anxiety, depression, and, for men, conduct disorders.

When an updated NCS survey was done with a new group of ten thousand people in 2002
(called the NCS-R, for “replicated”), its findings were strikingly similar to the first. Faring
worst by age group in the 2002 numbers were 36- to 44-year-olds, among whom 37 percent
had anxiety disorders and 24 percent had mood disorders in addition to their alcohol abuse
issues. Depressed women in their 30s and 40s have a 2.6 greater risk for heavy drinking,
compared to those without major depression. It occurred to me as I read these numbers that
age 30 to 44, when comorbid disorders are highest, are also women’s prime childbearing years.

A 2012 report by SAMHSA (U.S. Substance Abuse and Mental Health Services Administration) offers an eerie corollary in its finding that 10 percent of American kids today live with an alcoholic parent — certainly a conservative estimate.

Too Late For So Many

My sister Rita died at 38; a year after an overdose of barbiturates and alcohol put her into a
three-week coma and, upon waking, left her unable to walk or talk. It was the end of a torturous 25 years for her and for those of us forced to helplessly stand by and watch. While packing for a move not long ago, I found a letter I’d received from Rita, written during her first stint in Rockland County Jail for robbery a decade earlier, dated March 1982:

I should have known I was heading for trouble again. I was having black outs from small amounts of liquor (small amounts for me). But I went on another drinking binge and now I’m back here again. I guess I’ve hit the pits this time. I just finished speaking to a woman from the jail ministry. She’s quite sure that God brought me back here to save my life or try again. She may be right. I just feel really bad now that I won’t be home for Easter when you come. So much for all that. Meanwhile pray for me, forgive me for letting you all down, try to talk to Mom for me and take care of my beautiful nephew. Love, Rita.

I didn’t have any inkling of the unequal effect of alcohol and drugs on different people back in
the 60s when my friends and I started experimenting with whatever we could get our hands on. Back then, I suppose I went no farther than thinking that Rita and others like her were weaker than I was in some fundamental way. Science now illuminates the finer points of the unequal inheritance of predispositions to addiction even in the same family, as well as the debilitating effects on those who carry the heaviest genetic load, especially when they grow up as my sister and I did in a family and culture where, due to the continuing widespread stigma towards those with a mental disorder, self-medication is the preferred option to seeking mental health treatment.

In this broader and hopefully more enlightened context, simplifications like personal weakness
simply don’t cut it anymore. It’s time for the culture to catch up with the science and practice of treatment and recovery.

Victoria Costello is an Emmy Award winning science writer with articles in Scientific American MIND and Brain World. In addition to HuffPost, she blogs for PsychCentral.com and her own MentalHealthMomBlog. As an advocate for a prevention approach to mental health, she serves on the board of the Mental Health Association of San Francisco and leads workshops for parents and providers around the U.S. Her latest book, A Lethal Inheritance, A Mother Uncovers the Science Behind Three Generations of Mental Illness is available from Prometheus Books.


BringChange2Mind

Over the weekend, I saw the BringChange2Mind public service announcement for the first time. In it, crowds of people are walking through Grand Central Station. One man walks toward the camera which zooms in on his white tee-shirt. It says “Schizophrenia.” The camera steps back and a woman is standing beside him in an identical tee–only hers says “Mom.” Another couple walks down the steps. His tee says “Post-traumatic Stress Syndrome”; hers says “Battle Buddy.” The camera follows a third couple. On the back of his shirt, it says “Bipolar”. On the back of hers, it says “Better Half.” When Glenn Close and her sister, Jessy walk up, Jessy’s tee says “Bipolar” and Glenn’s says “Sister.” This, naturally, moved me to tears.

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The message of the ad is “Change a mind about mental illness and you can change a life.” The campaign tagline is “Working together to erase the stigma and discrimination of mental illness.” For me, there couldn’t be a more timely message.

I am a witness to stigma against mental illness every time Jerri and I are out together. I hear stories of her experiences when she goes out alone. I observe how she wrestles with her own feelings toward others with brain disorders and yes, how I also struggle. This overt discrimination has to STOP. That’s what Glenn and Jessy are trying to achieve.

I’m particularly appalled about discrimination within the healthcare system. On Wednesday, I saw my internist about a minor health issue. He is also Jerri’s doctor and given my rant last week about the-medication-of-which-we-do-not-speak, I thought it a good opportunity to re-iterate my concerns. “I read the PI for Adderall last week, Dr. F, and it’s contraindicated for people who have glaucoma. Did you know Jerri has glaucoma?”

He said he did not, however, he should because I’ve told him before. On multiple occasions.

“Is she still taking classes?” Dr. F. asks this question because Jerri tells him she can’t focus without the Adderall and she needs it for school. He is willing to prescribe the drug if she is in school despite her history of addiction.

“No. Her financial aid was suspended because she needed to complete two-thirds of her coursework with a passing grade. She dropped one of her courses and failed another, so she lost financial aid.”

Dr. F. gives me that look. You know the one. The one that says, “Jerri going to school is a joke. Of course she messed up. She is c-r-a-z-y.” Finger-twirl to right of ear.

I keep talking. I don’t know why. Maybe from guilt. Maybe I too have sent him signals indicating its okay to disrespect her. “She can get it back if she completes two-thirds next semester but she has to pay for the semester on her own and she can’t afford that.” This is more information then Dr. F. needs to know but I seem unable to shut-up.

“Her case worker offered to go with Jerri to the financial aid office, explain Jerri’s situation, and see if they could work out a way for her to continue, but Jerri feels so bad right now, she’s not interested in pursuing it.” Geez, you’d think I WANTED her on this med.

Dr. F’s body language indicates he’s heard enough. He is ready for me to wrap things up.

“She really does seem to feel bad. I know people with depression can experience physical pain and Jerri is very depressed right now. I’m concerned that she’s not eating. You know the time she was hospitalized with that infection, she didn’t even know she was that sick. She almost died. I’m concerned that this could be a repeat.”

Dr. F smiles condescendingly. He doesn’t believe she’s really sick. “Oh, there’s something wrong with her alright. And it’s more than bipolar. She’s bipolar alright but there is something else too. I’m not sure what but it’s more than bipolar.”

He’s not saying he’s concerned about her physical status–he’s saying she’s nutty as a fruit cake. That she’s making it up. His tone is exasperated not concerned. I recognize it because, sadly, he sounds so much like me.

You see, its okay to treat people with mental illness with no respect even if you are in the medical profession. Its okay to roll your eyes, give them lip service, ignore what they tell you, and hurry them through the visit just to get them out of your office. When Jerri sees him in two weeks, that’s exactly how Dr. F. will behave–unless I go with her. Having a relative present somehow makes you more deserving of dignity.

Here’s what Deb, one consumer of mental health services, had to say about the stigma:

“I have endured every medication as well as ECT. I have endured family, “friends”, even health care providers discriminating, belittling, and abandoning me. I am young-ish – the joys and possibilities of life have been robbed by my illness and those “superior” and unempathetic souls who judge against it. I haven’t given up yet; but it’s hard – especially when you feel alone. Life is hard enough for us already – help us to not live in fear of something we didn’t cause or ask for.”

Jerri is sick. She has a brain disorder. We treat other sick people with preference and concern. I can’t imagine Dr. F. rolling his eyes and shooing a cancer patient out of his office. So why is it okay with bipolar? The answer is it’s not. It’s not okay. And it will take every single one of us taking a stand to change it. Mental illness should not be a “safe harbor” for discrimination.

That’s what BringChange2Mind is all about. I encourage you to check it out and take the pledge:

I pledge to follow the Bring Change 2 Mind principles:

For people living with mental illness:

  • I am living with a mental illness that is treatable and manageable.
  • I am a valuable and valued person and I deserve to be treated with respect.
  • I am responsible for the decisions and choices I make in my life.
  • Educating myself about the symptoms of my illness, and any side effects I may have from
    treatment, will help me find and use the resources I need to work toward stability.
  • Communicating about my experiences with others will help them support me in difficult times and keep me “on track.”
  • If I am feeling suicidal, it is critical that I reach out for help, for in the face of real pain and suffering, it is others who can help me with a commitment to live.
  • I can reduce stigma in myself and in others by being open about living with mental illness, naming it out loud, and raising people’s awareness.
  • For everyone:

  • It is likely that someone I know is living with a mental illness and that fear of stigma may be preventing them from accepting their illness and seeking help.
  • I can make a difference by learning about mental health issues and the devastating effects of stigma.
  • If someone I know exhibits sudden changes in behavior, I will pay attention and reach out to them.
  • If someone I know is experiencing suicidal thoughts, I will take it seriously and make every effort to ensure they get help.
  • I will not perpetuate or tolerate stigma of any kind and will commit myself to changing the way society views people living with mental illness.

  • The Medication of Which We Do Not Speak

    I’ve just come off a week of mandatory training on epilepsy and anti-epileptic drugs, many of which are also used to treat mental illnesses. Some time around the end of training day 3, as I was slogging through prescribing information (PI) for 4 different products, it occurred to me that we take pharmaceuticals far too lightly here in the US.

    I’m speaking as a consumer and sister of someone who takes some serious psych meds and not as an employee of a pharmaceutical manufacturer. This is strictly my own opinion and does not necessarily reflect the perspective of my employer.

    There is an odd cultural phenomenon in our country that, based on my international travels, appears peculiar to the US. We expect and, to a great extent, trust the government and big business to keep us safe. If they fail to do so, we file a lawsuit. And we often win with outrageous settlements giving the government and big business further incentive to continue trying to protect us from our own stupid decisions. Our confidence in prescription medicine goes hand-in-hand. We tend to believe a product is “safe” if the FDA (Food and Drug Administration) approved it. Am I right? While it is true that the FDA requires two randomized clinical trials demonstrating safety and efficacy for a medication to be approved, that does NOT mean, by any stretch of the imagination, that the medication is without risk. FDA approval basically means the benefits of the product outweigh the risks for the population in which the medication was tested and for whom it is indicated. In pharmaceutical math, that doesn’t necessarily equal “safe”.

    If you read the PI for any given medication, you’ll find a contraindication section which specifically lists conditions in which the use of the medication is decidedly not “safe”. There is also a “Warnings and Precautions” section that outlines specific usages, with concomitant medications or in patients with specific illnesses or conditions, in which healthcare providers should exercise extreme caution when prescribing.

    If you aren’t familiar with PIs, I’m not surprised. All medications in the US have one; the FDA requires it. It’s that multipage document in teeniny print to which origami is applied to reduce it to the smallest folded size possible. You are supposed to receive a copy of the PI with every medication you fill, but some pharmacies may or may not provide it based on your medication’s packaging. For example, if your medication comes in the standard orange vial with white screw-top, you likely won’t get a copy of the full PI but you may get some excerpts stapled to the bag.

    You can find a copy of the full PI online for many medications. If the medication is relatively new (< 10 years) and is currently being promoted (via commercials, media ads, sales representatives), there is likely a manufacturer website named http://www.[insert drugname].com where you can usually locate a PDF of the PI (sometimes as a link at the very bottom of the homepage in small print or sometimes under a tab for professionals). If there is no brand website, DailyMeds, an NIH (National Institutes on Health) site, has PIs online for over 35,000 drugs.

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    If you have a family member taking psych meds, I highly recommend you read the PIs for all their medications. It’s written for healthcare professionals and can be daunting to understand–do it anyway. In recent years, the medication guide (often found at the end of the PI) is an attempt to translate the information in the PI for the average consumer.

    Here’s why you need to read it. In addition to the peculiar faith we Americans place in The Establishment, we place a similar faith in the medical profession. We tend to believe all health care professionals are intimately familiar with every medication. Ridiculous, if you think about the sheer number of drugs actually on the market. But also scary. Particularly when dealing with medications that target the brain.Your family member with mental illness could be taking a drug that should never have been prescribed for them given other co-existing medical conditions or other medications they are taking.

    Take, for example, the medication-of-which-we-do-not-speak. If you’ve read my older posts, you know I’m referring to ADHD medications, specifically Adderall at the moment, a widely-abused amphetamine. While this medicine may be arguably safe and effective for children with ADHD, no one with Jerri’s history should be prescribed Adderall. Here’s what the PI says:

  • Adderall is contraindicated in patients with glaucoma and a history of drug abuse. (Jerri has both.)
  • Sudden deaths, stroke, and myocardial infarction have been reported in adults taking stimulant drugs at usual doses for ADHD.
  • Both hepatic (liver) and renal (kidney) dysfunction have the potential to inhibit the elimination of amphetamine and result in prolonged exposures. (Jerri has hepatitis C which impacts liver function.)
  • Particular care should be taken in using stimulants to treat ADHD patients with comorbid bipolar disorder because of concern for possible induction of mixed/manic episode in such patients. (In other words, Adderall can cause manic episodes in people like Jerri with bipolar disorder.)
  • There is some clinical evidence that stimulants may lower the convulsive threshold in patients with prior history of seizures, in patients with prior EEG abnormalities in the absence of seizures, and very rarely, in patients without a history of seizures and no prior EEG evidence of seizures. (Interpretation: Adderall can increase the likelihood of seizures particularly in people with a past history. Jerri has a prior history of seizures.)
  • Adderall is a schedule II controlled substance. Amphetamines have been extensively abused. Tolerance, extreme psychological dependence, and severe social disability have occurred. There are reports of patients who have increased the dosage to levels many times higher than recommended. Abrupt cessation following prolonged high dosage administration results in extreme fatigue and mental depression; changes are also noted on the sleep EEG. Manifestations of chronic intoxication with amphetamines may include severe dermatoses, marked insomnia, irritability, hyperactivity, and personality changes. The most severe manifestation of chronic intoxication is psychosis, often clinically indistinguishable from schizophrenia. (Need I say more?)
  • So you can see why I’m so against Jerri taking the drug. For her, the benefits do not outweigh the risks. For her, it is not safe. Her prescribing physician (who is not her psychiatrist) should know better as I’ve made sure he is aware of Jerri’s medical and psychological history. I’ve repeatedly expressed my concerns but he continues to prescribe it. Perhaps he thinks it will do no harm. Ha! He needs to read the PI. It should not come as a surprise to any of us if that medication eventually kills her.

    Jerri is just as adamant about taking Adderall as I am opposed to it. Can you say “psychological dependence”? So it has become the-medication-of-which-we-do-not-speak. It’s very difficult knowing my sister is basically playing Russian Roulette and I’m unable to get her to put down the gun. I feel for those of you in similar circumstances.

    The moral of this story is know your meds. If you have a family member with mental illness, know their meds. Don’t take their medications lightly. Read the PI or medication guide. Talk to a pharmacist if there is any information you don’t understand. Speak up if you have concerns. You have a voice–use it. You may not be able to change either the prescribing behavior of the doctor or the drug-seeking behavior of your loved one but at least you’ll be better informed should a drug-related crisis occur.