Chantix Early Warning on Suicide Ideation
Chantix (varenicline, manufactured by Pfizer) is a prescription drug to help adults stop smoking. You may have also seen ads during prime time TV. I’ve seen them as sponsors to ABC’s web episodes, which requires you to watch a Chantix ad before you could watch the episode.
According to the FDA website, “An Early Communication reflects FDA’s current analysis of available data concerning these drugs and does not mean that FDA has concluded that there is a causal relationship between the drug and the emerging safety issue.”
Based on FDA’s request for information from the manufacturer, Pfizer, Inc., the company recently submitted reports to the agency describing suicidal ideation (thoughts). In the wake of a case report citing erratic behavior in an individual who had used Chantix, FDA has also asked the company for any information on additional cases that may be similar in patients who have taken the drug.
FDA’s Center for Drug Evaluation and Research is working to complete an analysis of the available information and data. When this analysis is completed, FDA will communicate the conclusions and recommendations to the public.
In the meantime, FDA recommends that health care providers monitor patients taking Chantix for behavior and mood changes. Patients taking Chantix should contact their doctors if they experience behavior or mood changes.
FDA also advises that, due to reports of drowsiness, patients should use caution when driving or operating machinery until they know how using Chantix may affect them.
Full text of the Early Communication about the Ongoing Safety Review can be found at: http://www.fda.gov/cder/drug/early_comm/varenicline.htm.
In Between Meds, Searching for a Diagnosis, Richard Dadd, and Compassion for Your Self
Welcome to another edition of Jane’s Mental Health Source Page “carnival”, a carnival that reads more like a story (much work but worth your internet reading time) than a list of blog links (easier but so boring). People are finally starting to know that I mean it when I say “top quality posts only, please!” because I’ve received many excellent entries to include in this edition, and only had to exclude about 60% of the posts, as opposed to about 80%-90% of all entries in the past.
Jeannette wrote about a precarious period when you wean yourself off one medication and start a new medication for depression, but this post covered more ground than that. Jeannette knew herself well, and during that “in between time”, she did what she could to get through (remaining alert to her own warning signals, trying acupuncture) although it was tough - it always is. She also knew when it was time to call the psychiatrist’s office and was told she had to wait 2 weeks before she could be seen. I don’t understand why the clinic didn’t immediately give her 3-5 referrals; it’s hard enough to call for mental health help without getting into an appointment bottleneck, but that’s the sad “norm” for our medical clinics today. Thankfully, Jeannette’s new med kicked in the next day. She also likes her psychiatrist once the appointment date came around. “Sure the stress of life gets me down a bit, but being up more than down is so much different than what I have ever experienced. I have hope.” Hang tough, Jeannette!
In contrast to Jeannette’s experience with her psychiatrist, Suni’s psychiatrist either hasn’t learned how to listen or can’t listen because it conflicts with his perception of his job (I’m guessing “diagnose and prescribe” rather than “sitting down with patient and have a detailed discussion and Q&A to establish rapport”). Suni is questioning her original diagnosis of bipolar disorder, and her psychiatrist appears convinced that bipolar disorder was the correct diagnosis. To be fair, that could be a possibility, but if it was, the psychiatrist did a lousy job of explaining the basis and rationale for his continued belief that she has a form of bipolar disorder.
Readers must understand that the medical community truly isn’t well trained to deal with patients who request “non-medical alternatives”, at least not yet, and the psychiatrist indeed had a point in his argument about “alternative” therapies not being FDA approved. Yes, FDA-regulated drugs can have dangerous side effects as well, but at least what is known is required by law to be spelled out in detail in the package insert (”PI”), while on the other hand, we hear about the (sometimes fatal) side effects that some supplements or alternative approaches have only after the media reports them. Thus, the doctor can only give you lots of pamphlets on things he can talk intelligently with you about, and have scientific data to look into if you ask questions. Still, this doctor could, at minimum, listen to his patient. I wish Suni well on her quest for a better relationship with a healthcare professional, because that makes a huge difference in mental health help.
Therapydoc shared her post about borderline personality disorder, as if in response to Suni’s search for answers regarding her belief that she suffers from BPD rather than from bipolar disorder of any spectrum. Her post includes the current Diagnostic criteria for 301.83 Borderline Personality Disorder, which illustrates why psychiatric diagnoses are so tough. One who suffers from bipolar disorder or depression or another anxiety disorder may identify with many of the symptoms listed in BPD. I can take cold comfort in the reality that our current medication technology for mental illness act like blunt instruments that cover a gamut of mental health symptoms, and medication used for one condition may often be approved for treating another condition. Still, that doesn’t get doctors off the hook for talking with (caring about) a patient who desires clearer answers.
I was struck when reading Isabella’s 8 points of “emergency preparedness for winter depression” by how big a part “human-to-human interaction” plays in staving off depression. Having some form of daily interaction with another human being makes a big difference in depression no matter what season, at least that’s what I’ve personally found. And no - instant messaging doesn’t count… Skype may be OK, because you get to verbally interact with someone, but nothing beats a real life, interpersonal interaction for the richness of stimuli (sound, sight, smell, even touch) your neurons gain. In fact, human interactions by way of social connectedness has been observed to play an important part in your immune system, as I’ve written about in another weblog.
According to Dr. Vitelli’s blog bio, he’s “still trying to decide what I want to be when I grow up.” You and me both, Dr. Vitelli, and for now, I’m happy with exploring and blogging along the way (I’m beginning to think that I may never get to the point of having “grown up” but that I’m meant to continue “growing and exploring”). Dr. Vitelli shares a short history of Richard Dadd, a painter who suffered from mental illness but didn’t gain the level of notoriety as, for example, Van Gogh. Still, I was amazed at the level of detail of Dadd’s magnum opus, The Fairy Feller’s Master Stroke. I was fixated on how the ground in this painting appeared to have a physical dimension.
Urban Monk aka Albert writes comprehensive articles on aspects of mental and spiritual perception, and his article, Psychology’s unique contribution to your Compassion and Self-Esteem, may be an eye-opening read for those of you who want to better understand your relationship with yourself - specifically, your perception of who you are. This is a very long read, but worth the investment. Interestingly, I recently just purchased a book by The 14th Dalai Lama called, “How to see yourself as you really are”‘ it’s one of those moments when things happen in my field of consciousness that tells me to pay attention, because “this is important”. When we consider that depression has often been referred to “turning anger inward”, our perception and relationship with ourselves may literally be a defining factor of our management of a depressive condition.
Finally, Suni also submitted a second entry that I will write about in a separate, non-carnival related post, because I received a similar topical question from Quint, and the subject warrants an individual article, which I’ve written here (link is activated 11/22/2007).
Announcement re: carnival editions for December 2007 and January 2008 Thank you all for the many positive and encouraging comments relating to my mental health carnival. I love the fact that you recognize my effort in making these carnivals “different” from the many carnivals you find out there, and that you enjoy my personal commentaries and occasional stories that weave these entries together into a coherent post.
I will be taking a vacation from publishing carnivals and resume carnival editions in February 2008 because I’ll be giving birth to our first child. My husband and I will be learning to be parents and function on very little sleep. I’ll post new articles when I can string thoughts coherently together, but I want to take advantage of this time to do something I’ve wanted to do for a while: republish my favorite posts from the archives and share with you many of my personal writings that’s become buried amongst hundreds of articles on this website.
Until next time 
Jane
Moving Beyond Blue
Therese Borchard at Beliefnet’s Beyond Blue interviewed me in October 2007. She asked many insightful questions including, “how do you think you know when or if you can go off your meds?” and “What did you do when you relapsed?”
I had no idea that my answers were interpreted as controversial based on the comments that flooded the interview!
For the most part, people understood (correctly) that my answer to the first question had to do with my early perception of what I was going through, when I knew just enough to admit that I had a condition that required medical intervention, and when I was still naive to know that depression can return like a vengeance, as I had personally experienced when my depression relapsed in 2001. Did I genuinely believe I could “fix myself” with one year of vigilant medication therapy and psychotherapy back in 1998? Yes, that was my naive personal belief at the time, based on my rudimentary understanding of my own depression, mixed in with a lot of denial that I would be managing the risks for this condition on a life-long basis. Am I saying that this is what people should aim for? NO!
There were some who interpreted my personal experiences and choices with medication as “anti-medication” and therefore expressed concern that I was advocating against medication. This was, of course, neither my intention nor my personal practice or belief. It would be strange for me to be antagonistic in biochemical intervention when I had earned a doctorate in biochemistry and specifically trained in looking at the biochemical basis of living systems. Those who are regular visitors to this website will find that I talk about medications and medication therapy as often as I talk about other complementary therapies (for example: exercise). I have a lot of respect for drugs because I have worked with many of them both in research and in clinical trials during the course of my health care career. I’ve always emphasized (here and on my other sites) that drugs are powerful agents with risks and benefits, and should always be administered judiciously, based on a partnership between doctors and patients.
During my relapse, I immediately went for both routes - the chemical route (antidepressants) and the psychotherapy route - as I had done when I was first seeking help for depression. Unfortunately for me, I tried 3 or 4 antidepressants and the side effects were intolerable. I remember taking two antidepressants made by a drug company that I used to work for; one made me extremely drowsy, the other made me so dizzy and nauseous that I was unable to stand up and walk a straight line.
I was forced to resort to psychotherapy as my main line of treatment, and just to be on the safe side, actually enlisted both a psychologist and a psychiatrist for double dose of psychotherapy weekly. The psychiatrist and I tried to find a drug that would work, but after almost 3 months, ultimately decided that given the suboptimal dose of a SSRI that I could tolerate, I wasn’t getting the therapeutic effects anyway, and we would stop trying to find the med that would work given that I was doing well on psychotherapy. If I wasn’t improving on psychotherapy alone, would I continue trying different medication therapies? You bet. My goal was to get better.
My approach to health - including mental health - is quite simple: I have personal responsibility for my own wellness.
This means I am accountable as a partner with my doctor(s) for my health, and given that I know I have risk factors (depression is one), I have a responsibility to monitor my own mental health so that I can recognize early warning signs before something more serious emerges.
This means I need to educate others around me, especially people close to me, so that they can help me detect abnormalities if I miss the signals.
My goal is to be well and stay well. When warranted, I make sure that the treatment decisions I make with my doctor is based on sound scientific evidence, and I make sure that I do my part in whatever non-medical (i.e. lifestyle) changes I need to make to get better.