Editor’s Comment
We at Safe Harbor want to thank all those who attended our conference in Los Angeles, June 15-16, 2002, entitled “Non-Pharmaceutical Approaches to Mental Disorders.” Attendees came from across the U.S. and as far away as India. It was a great pleasure to meet many with whom we had corresponded by phone and email.
It was equally satisfying to hear from so many of those in attendance who said they would take the data learned back to their respective corners of the world and make good use of it.
“What a fantastic conference,” one healthcare professional wrote us. “You have no idea how much it energized me to do what I need to do back in New England. I know a lot of people are going to be helped now in my area who have had no hope before.”
Thank YOU. Why do our staff and volunteers work long hours, usually for no pay? It’s so that some day the information in this ezine and on our website will be known and in use in mental health facilities around the world. It’s so that doctors and psychiatrists can some day be a Safe Harbor themselves where patients don’t dread to go for fear of being drugged into oblivion or worse. It’s so that some day the word “recovered” will mean actually getting well and not “getting your meds fine-tuned.”
Thanks for coming and doing your part.
Announcement: Safe Harbor Conference Tapes Available
Safe Harbor is pleased to announce that tapes are now available of our conference held in Los Angeles on June 15 and 16: “Non-Pharmaceutical Approaches to Mental Disorders.” For most of the tapes, lecture notes and copies the accompanying Powerpoint slides are included.
To purchase tapes, go to http://www.alternativementalhealth.com/orderconf.htm
Lecture titles include:
Introduction to Conference by Dan Stradford, President of Safe Harbor
Basic Brain Science and Brain Metabolism by Prof. James Croxton
Mechanisms That Can Lead to Severe Mental Symptoms by Prof. James Croxton
Lab testing for causes of mental symptoms: Addressing the molecular basis of chronic metabolic disorders (Lecture 1) by Jeff Baker, ND, of Great Smokies Labs
Specific Syndromes by Prof. James Croxton
Lab Testing for Causes of Mental Symptoms: Addressing the molecular basis of chronic metabolic disorders (Lecture 2) by Jeff Baker, ND,of Great Smokies Labs
Case histories, Q and A by Prof. James Croxton
Natural Treatments for Addiction by Charles Gant, MD, PhD
Medical Conditions that Present with Psychiatric Symptoms by Stuart Shipko, MD:
(Note: 89% of the audience surveyed gave the content of this lecture the highest rating possible.)
Nutritional and Herbal Treatments for Anxiety and Depression by Hyla Cass, MD
The Role of Hormones in Mood Disturbance by Cynthia Watson, MD
Complementary Medicine Solutions for Children Diagnosed with Attention Deficit Disorder by Charles Gant, MD, PhD
Recovery Panel: Six individuals discuss their recoveries from mental symptoms without drugs
Announcement: Pfeiffer Center to Offer Treatment in Santa Clarita, CA
As part of their national outreach program, THE PFEIFFER TREATMENT CENTER will be providing patient services in Santa Clarita, California, USA, at Residence Inn, 25320 The Old Road, Stevenson Ranch. Dates: August 5, 6, & 7.
PFEIFFER is an outpatient clinic dedicated to assisting children and adults with nutritional treatment of biochemical imbalances. “We offer natural, individualized treatment emphasizing ADD, ADHD, learning disabilities, autism, depression, thought & mood disorders. Our doctors prescribe individualized nutrient therapy for each patient’s unique biochemistry.”
For information or an appointment call 630-505-0300 8:30 A.M. – 5:00 P.M. (CST) Mon.-Fri.
If you know of a family member, friend, or organization that would be interested, please pass along this information. Promotional flyers are available from the Center, or visit their Website at http://www.hriptc.org.
St. John’s Wort Study Misleads Public?
Editor’s note: The following article was written by psychiatrist Hyla Cass, author of many books, including two on St. John’s Wort and the recently published “Natural Highs.” The study discussed by Dr. Cass in this article was mentioned in our last issue and we are presenting Dr. Cass’s article to give a full perspective on that study. More information is available at http://www.cassmd.com.
A recent study on the popular herbal remedy St. John’s wort published in the April 10 edition of the Journal of the American Medical Association (JAMA) concluded that St. John’s wort was ineffective in treating severe forms of depression. So was the widely prescribed antidepressant Zoloft(r) (sertraline)! The emphasis, though, both in the article and even more so, in the media’s response, has been on the failure of St. John’s wort in the treatment of depression, ignoring many published studies that have shown conclusively that St. John’s wort is effective in the treatment of mild to moderate depression.
Why all the fanfare over the fact that St. John’s wort is shown to be ineffective for a condition that it was never purported to treat? The bigger news is that this study showed that a drug with sales of over $2 billion and prescribed to millions of Americans for severe forms of depression may be no more effective than placebo. We are addressing a significant problem here: In the U.S, approximately 10% of people suffer from major depression at any one time, and 20-25% suffer a major depressive episode at some point during their lifetime.
Speaking as a clinician who regularly prescribes St. John’s wort, I have seen repercussions from similarly slanted interpretations of an herbal study. While the placebo effect generally works in our favor, there can be a negative placebo effect, as follows. After hearing this news about St John’s wort, many individuals who have been successful in relieving their depression with the herb may question their positive response, lose confidence in it, discontinue use, and revert to their depressive state. Many others may dismiss the St John’s wort as useless without even giving it a try. Both groups may then turn to prescription medications, with their more severe side effects, such as loss of libido, memory impairment, headaches, nausea, and significant withdrawal problems. St John’s wort’s side effects, in contrast, are generally mild and transitory, with no withdrawal symptoms when it is discontinued.
St John’s wort is known to have interactions with certain drugs, almost all of these for relatively small, specific populations (e.g. HIV patients on protease inhibitors, transplant patients on cyclosporin, those on coumadin, etc). Despite this, the overall risk/benefit ratio is far better than that of the prescription medications, and the drug/herb interactions are easily dealt with as with any active medication – with proper warnings and patient selection. I might add that grapefruit juice has a similar effect on drug potency, blocking liver enzymes that break down the drugs.
Depression can be a debilitating illness, and yet we are in effect “hexing” the use of a perfectly good herbal medicine that has been prescribed successfully in Europe for years as a first line treatment for mild to moderate depression. If it doesn’t work, then the patient can always be given the more powerful, pharmaceutical antidepressants. Does St. John’s wort lose its efficacy when it crosses the Atlantic? The medical profession is bound by the Hippocratic oath to “first do no harm,” and to use the simplest, most natural, least harmful medicines first. Why put so many people as risk?
Perhaps the most interesting finding of this study is the power of the placebo effect, a belief in a substance’s efficacy, reflected in the improvement of the group that received the dummy pills. In this study, the placebo group actually responded better than both of the others (32% for placebo vs 24% for St John’s wort and Zoloft). The human mind is complex, and many factors go into the healing process. Research shows the placebo effect to be a very significant aspect of treatment response for almost all medications. As physicians, we do best when we fully encourage and support it. Of course, there is no way to tell in any one individual how much relief is due to the placebo and how much, to the active medication, be it herb or drug. To JAMA’s credit, an accompanying editorial actually addresses the issue, concluding that “this may be Nature’s way of providing clues to fundamental aspects of the healing process, even as advances in medicine and the discovery of new therapies takes place. It is important to learn from rather than dismiss the variability of the therapeutic response.” This might be the true news of this article.
We can make some generalizations about the media, herbs, and pharmaceuticals to be considered in evaluating this and other news stories:
The researchers’ job is to get their research published.
The journal’s job is to inform, but unfortunately, often with a pro-pharmaceutical bias. The pharmaceutical industry is by far the largest funding source of the journals (and of almost all of the research), as well as being one of the largest lobbying groups in Washington. Even though this study was NIH-funded, there is a complex web of relationships here. Most researchers also conduct other studies that are funded by this industry.
The media’s job is to sell news, and generally, by being as sensational as possible. The public must read between the lines to ferret out the truth, and make up their own minds. We hope that this has been of some help in the process.
Re: Davidson JRT et al. Effect of Hypericum perforatum (St John’s Wort) in major depressive disorder: A randomized controlled trial. JAMA. 2002;287:1807-1814.
Therapy Aims at Improving Stunted Mental Functioning
One of the common phenomena of people diagnosed with schizophrenia is that they often reach a point where mental development seems to cease. Certain thinking processes and problem-solving abilities stagnate. Since most people in this condition are on medication, it can be impossible to sort out whether this stunted mental growth is due to the drugs or is naturally-occurring.
This slowed development can limit the ability of the person to gain employment, find housing, maintain a romantic relationship, and solve a myriad of the large and small problems of living.
The Planned Lifetime Assistance Network (PLAN) of Northeast Ohio, a nonprofit organization, has developed a mental exercise program that improves cognitive functions of such patients diagnosed with schizophrenia.
Cognitive Enhancement Therapy (CET), as it is called, is the reverse of traditional psychotherapy. Instead of giving solutions to the patient, it gives the patient problems to solve. Instead of interpreting the patient’s remarks, it requires that the patient explain himself. Instead of concentrating on the patient’s behavior, the focus is on his development. The accent is on ability.
In group meetings led by a “coach” (not a therapist), the patients are given problems to solve which actually increase their stress in a controlled environment during the session, thus increasing their ability to tolerate stress, rather than teaching them to always avoid stress.
Computerized puzzles are used as well as other problem-solving methods, including improvement of social skills. Although the organization specifically states that CET is not intended to replace medication, PLAN reports increased and improved recovery and increases in mature behavior, the ability to think abstractly, and the ability to get the “gist” of a concept.
For more information, contact PLAN at (216) 321-3611.
Recommendations May Lead to Over-Prescription of Antidepressants
In recent years, the diagnosis of depression has become more and more common.
A 1996 study done by the U.S. Preventive Services Task Force to determine the need for routine screen of depression found “insufficient evidence to recommend for or against the routine use of standardized questionnaires to screen for depression in asymptomatic primary care patients… Clinicians should, however, maintain an especially high index of suspicion for depressive symptoms in adolescents and young adults, persons with a family or personal history of depression, those with chronic illnesses, those who perceive or have experienced a recent loss, and those with sleep disorders, chronic pain, or multiple unexplained somatic complaints.”
However, In a press release of May 20, 2002, The U.S. Preventive Services Task Force announced that the panel has reversed it’s decision, and now recommends that general practitioners screen their patients for depression.
However, instead of screening patients who have “a family or personal history of depression, … chronic illnesses, … recent loss, … sleep disorders, … chronic pain, or multiple unexplained somatic complaints,” Task Force Chairman, Dr. Alfred Berg, Chair of the Department of Family Medicine, University of Washington, Seattle, said that the panel now recommends the use of just two simple questions: “Over the past 2 weeks, have you ever felt down, depressed, or hopeless, and have you felt little interest or pleasure in doing things?” He further states that these two questions “May be as effective as using longer screening instruments.”
If the patient’s answers are in the affirmative, further diagnostic tools may be used. If the problems have lasted throughout the previous two weeks, and have interfered with the patient’s ability to perform day-to-day tasks, doctors may make a diagnosis of depression.
Award-winning investigative reporter Nick Regush, who also served as a consultant to the Center for Bioethics, University of Montreal, commented on the Task Force’s recommendations in a recent Redflags Weekly (http://redflagsweekly.com) article: “The over-prescription of anti-depressants is already epidemic…” this type of screening “will likely lead to mindless drug prescriptions for people who are having some common, momentary difficulties in their lives.”
Mr. Regush goes on to say, “Only a cultural/social idiot, totally oblivious to the themes of our times, not to mention the overhanging, ever-present threat of terrorism and a world going to hell, would ask these types of questions as some sort of a screener for depression.”
Light Therapy Useful for Depression During Pregnancy
Bright-light therapy may be an effective treatment for depression in pregnant women. The availability of an easy-to-use, potentially non-toxic antidepressant — light therapy — in pregnancy is a clinically attractive option.
Researchers conducted a pilot experiment to see whether exposure to bright light, a technique used to treat those suffering from seasonal affective disorder (SAD) or winter depression, might also work on women suffering from depression during pregnancy.
Around 5% of pregnant women meet the criteria for major depression. Doctors are justifiably reluctant to prescribe antidepressant medications to pregnant women for fear of their effect on the fetus.
Previous research has suggested that bright light exposure may help people suffering from major depression or from postpartum depression. The exact mechanism has not been fully isolated. Some data suggest that light therapy advances the timing of the daily biological clock, which may then bring about the antidepressant effect.
Sixteen pregnant women suffering from major depression completed the pilot study. They were instructed to expose themselves to an hour a day of bright ultraviolet light from a light box within 10 minutes of waking up for three to five weeks.
The patients showed a moderate improvement of their levels of depression after just three weeks of light treatment. For the seven women who underwent five weeks of light therapy, their average score on a scale that measures depression improved by 59%. When the light therapy was discontinued, the women showed signs of an increase in their levels of depression.
(American Journal of Psychiatry April 2002;159:666-669)
German Environmental Office Issues Drug Pollution Warning
Earlier this year, we mentioned a UK Sunday-Times article alerting readers that prescription drugs, including antidepressants, were being detected in European lakes and rivers at levels potentially destructive to aquatic life (Alternative Mental Health News #19, “PRESCRIPTION DRUG POLLUTION THREATENS FISH, HUMANS” ).
The German Federal Office for Environmental Protection issued a warning in February that medicine manufacturers must examine environmental risks more strictly in light of findings that even tap water was significantly affected.
After ingestion, hormones and other stable chemical substances, as well as their metabolites, pass into sewage and ultimately into groundwater and even drinking water. Experts estimated that German surface waters contain 2 micrograms per liter of the estrogen 17alpha-Ethinylestradiol from birth control pills, four times the concentration necessary to alter breeding patterns in fish resulting in fewer offspring.
In the year 2000, according to the agency’s statistics, 29,000 tons of medicine were sold for human consumption in Germany including 7,000 tons of synthetic chemicals. An additional 2,320 tons of animal medications were sold in Germany that year.
While the drugs themselves have been tested on their intended users, the effects of drug metabolites – substances produced by the body after ingestion – are largely unknown, the agency warned.
Examining the effect of medicines on the environment is a relatively new function of the German Federal Office for Environmental Protection.
Psychiatrists Voice Concerns Over Drug Marketing Tactics
“Of course, it’s going to bias us — the question is whether the bias is benign,” said David McDowell, a Columbia University psychiatrist who helped monitor industry sponsorships for the recent annual APA meeting in Philadelphia, referring to the aggressive marketing of psychiatric drugs at the convention.
Without industry money at the gigantic Philadelphia Convention Center, added McDowell, “we’d be sitting in the basement of the YMCA.”
“Let’s face it — they make the money back” through greater sales and prescriptions, said Robert Eilers, a psychiatrist in the state Office of Mental Health in New Jersey, in a session where several doctors assailed top APA officials. “It’s totally out of control.”
The quotes appeared in Shankar Vedantam’s recent expose of pharmaceutical marketing practices at the convention. Vedantam is a science reporter on the national desk of The Washington Post.
In the days leading up to the meeting, pharmaceutical companies mailed attendees hundreds of free phone cards, as well as invitations to museums, jazz concerts and fancy dinners.
The 19,000 psychiatrists arriving for the meeting were greeted by a highway billboard advertising AstraZeneca’s anti-psychotic, Seroquel. Outside the giant convention center, curb signs for buses ferrying doctors to their hotels advertised Prozac’s manufacturer, Eli Lilly and Co. Each attendee was handed a gray bag with the insignia of the meeting and the orange logo of GlaxoSmithKline, maker of Paxil.
Boston Globe staff writer Ellen Barry described the contents of one Mexican psychiatrist’s goody bag:
“As a reward for attending the American Psychiatric Association’s annual meeting, she had received a small egg-shaped clock from the makers of the antidepressant Prozac; a sleek thermos from Paxil, also an antidepressant; and an engraved silver business card holder courtesy of Depakote, an anticonvulsant. She got a neat little CD carrying case from Risperdol, an antipsychotic; a passport holder from Celexa, an antipsychotic; a neat green paperweight from Remeron, an antidepressant; and a letter opener, representing what drug she could not remember.
“For the duration of the weekend, though, Velazquez’s loyalty belonged to Pfizer, which had paid her airfare from Mexico City (along with 30 of her colleagues and her 18-year-old nephew) and put them all up in hotels near the APA meeting. That night, also courtesy of Pfizer, she would attend a glittering banquet at the Philadelphia Academy of Fine Arts.”
Concern over psychiatry’s ties with industry was widespread enough to be the focus of several panels at this year’s convention. Some psychiatrists said the association should simply sever all ties with industry. Harvard Medical School psychiatrist David Osser suggested that companies pool symposium money into a common fund, which could then be used to conduct sessions chosen exclusively by mental health professionals. Andrew Ho, a UCLA psychiatrist, said the extent of industry involvement — and the dependence of the association on the money — raised questions about who was controlling the association and the profession.
Levine told APA officials that even patient organizations such the National Alliance for the Mentally Ill had been shunted to the “far, far corner of the auditorium” as funding companies got center stage in the exhibitors’ hall. “It hurts me the APA this year has become part of that effort,” he said.
“There are strings attached,” agreed Stephen Goldfinger, APA’s top monitor of industry sponsorship at the conference, at a session discussing potential conflicts of interest. “When you dance with the devil, you can’t control all the steps.”
The industry-sponsored symposiums at this conference are unusual – most major medical associations do not allow them — said James Thompson, APA’s deputy medical director. If companies want to take advantage of the conferences of those other groups, they have to set up their own, independent “satellite symposiums.”
Part of the APA’s dependence on industry sponsorship is because the association has been ailing financially, and revenue from the annual convention represents about 22 percent of all funding. That money is becoming increasingly important, as revenue from dues has dropped in recent years from $11 million in 1998 to $9.9 million last year, and is expected to drop further in the years ahead. The association has run at a loss for three out of the past four years.
Book Review: Mad in America
Robert Whitaker’s “Mad in America” is a must read for anyone interested in the field of mental health. The former Boston Globe medical journalist takes a painstaking look at the history of the treatment of America’s most debilitated mental patients – those labeled with schizophrenia and how this treatment has evolved over the years.
What he reveals is often disturbing and sometimes shocking. He removes the veneer of the entire mental health establishment, challenging the notion that today’s madman is better off than those of yesteryear or even those in third world countries.
Whitaker takes a thorough look at the actual results of drug therapies and other treatments on modern-day patients and what he reveals may stun you. He also gives a hard scrutiny to the politics behind the psychopharmaeutical industry. This book will remain a landmark publication on mental health for a very long time.
The book is published by Perseus Publishing.
Book Review: Children with Starving Brains: A Medical Treatment Guide for Autism Spectrum Disorder
In 1996, Jaquelyn McCandless, M.D., discovered that her two-year old granddaughter had been diagnosed with autism spectrum disorder. “Her diagnosis and unusually compelling nature,” says McCandless, “inspired a reorientation of my professional life from the practice of psychiatry with a focus on alternative and anti-aging medicine to an immersion into the biomedical aspects of autism.”
Her recently published book, “Children with Starving Brains: A Medical Treatment Guide for Autism Spectrum Disorder”, is the result of that immersion. McCandless takes the reader into the latest scientific research on the many risk factors in autism: toxic reactions, heavy metal contamination, wheat/milk allergies, viral causes, etc.
This is a much-needed, practical hands-on book for physicians and lay people alike that gives them real tools in bringing about improvements and sometimes complete recoveries for those children unfortunate enough to fall prey to the autism epidemic that has swept the world in recent decades.
The publisher is Bramble Books.