Question: What are the best medications for ADHD?

Answer: Surgeons are practical. “A difference that makes no difference is no difference”. Recognizing ADHD and finding the right treatment makes a dramatic difference in someone’s life.  ADHD is relatively easy to diagnose. There are more studies showing the effectiveness and safety of medication in treated ADHD than in any other mental health disorder and most general medical disorders.

Stimulants are almost twice as effective as other types of medication (like Strattera, Provigil, and Wellbutrin XL, Tenex). Long acting stimulants are usually safer (especially less rebound) and more effective. Sometimes short acting medications can be used to supplement the long acting stimulants. Some people do better on amphetamines and some do better on methylphenidate type of stimulants. Some do okay on either.

More people do better on amphetamines according to one study.  In another study amphetamines were more likely than methylphenidate to allow ADHD patients to function at the highest level.

In general, amphetamines are more effective for the majority of ADHD patients because they have a broader spectrum of action relative to both subtypes of ADHD symptoms.  Because amphetamines have been shown to be very effective for a higher percentage of patients than methylphenidate, I start most patients on Adderall. Because long acting medications are safer and generally more effective I start with the XR form. It generally has at least an 8 hour duration of good effect. Some people take it twice a day to get 16 hours of calm focus.

I use the new Daytrana patch if Adderall does not work well, or when the advantage of the patch lasting up to 15 hours is the most important clinical consideration.

Some patients prefer Adderall because of the help with weight control – not usually decreased appetite but they stop eating out of boredom or stress. They also are more physically active and more likely to be able to motivate themselves to exercise. In fact, stimulants in general enable an ADHD person to choose what they want to do or focus on instead of being at the mercy of only doing things they have a high interest in.

To me, the ultimate test of medication is how it does in the long term.  I tell patients I’m not interested in them coming back and saying, “I think it’s helping a little bit doctor”.  I’m looking for, “This medication is great. It has helped me change my life and I don’t have any significant side effects”, and they are still saying it 1 year, 5 years, etc. We have almost 70 years of research showing the effectiveness and safety of amphetamines and 55 years with methylphenidate. I have patients who have done well on stimulants for over 30 years. I don’t see any long term problems. I can’t say that for any other type of medication that I prescribe.

I frequently add Tenex (Guanfacine) to stimulants to enhance efficacy and to further minimize side-effects.

Click link below for new ADHD med info:

www.askdrjones.com/2007/07/16/vyvanse-new-treatment-for-adhd/

That’s what I wish I would have said.  So I’m feeling guilty for just sitting there.  "I’m coming out!" I heard in a deep, but anxious voice.  I turned to see a large man built like a linebacker pushing his way against the flow of people walking down the aisle of a 747 American Airlines flight heading to DFW from the New Jersey airport.  Then I heard the flight attendant say, "where are you going?"  He replied, "I’m not going, I’m scared."  My first impulse was to jump up and go after him – I knew I could help.  I didn’t.  But I should have at least given him my card and said, "call me, I can help you."  Maybe he would have said no thanks but that’s no excuse.  I should have offered.  Why?

I feel obligated to offer help when I see someone in distress and I have the knowledge and  ability to help.  For 30 years I have had a special interest in panic disorder and associated phobias.  Fear of flying associated with panic disorder is easy to treat of course.  I don’t know for sure that he had panic disorder.  He might have had an irrational fear that the plane might crash.  Patients with panic disorder are afraid they are going to have a panic attack which can be a form of claustrophobia.  Fear of panic attacks frequently causes panic because the individual gets so tense that they can’t breathe properly and the combination of increased muscle activity (metabolism) and shallow breathing cause CO2 levels in the blood (hence the brain) to go up and patients with panic disorder have a lower threshold of CO2 tolerance.  Everybody at some CO2 level will panic because the brain is hard wired to let us know if we are in a poorly ventililated place – basically the lower brain centers send the message – "get out of here or you’re going to die!"  This can be life saving under some circumstances – but panic attacks are a "false alarm". 

What the man leaving the plane needed was first to understand the physiology and cause of his symptoms.  Second, he needed to be offered Niravam (fast acting alprazolam that dissolves on the tongue), or sublingual Klonopin that would quickly calm him down, raise his stress tolerance level, and help him maintain control.  He might also have needed psychological support – at least for the first few minutes.

I can try to rationalize "it was none of my business" (cop out).  I could remind myself  "no good deed goes unpunished" (frequently true but cop-out) or I could think well at least he didn’t get gunned down – remember the poor guy in Florida?  (See previous blog).  Maybe he’ll go on line and end up on the Anxiety Disorders Association of America website, http://www.adaa.org/., where I’m listed as a resource.

If you or anyone you know suffers from fear of flying make sure to get the treatment needed.  There’s a lot of things we can’t do anything about, this isn’t one of them.   http://www.anxieties.com/home.htm

Question:  I have ADHD, and it is ruining my life.  I can’t function like everyone else.  I keep making appointments to see a therapist, but I never go.  I don’t want to do this anymore.  I want to go to college, but everyone I know says it’s not a good idea for ME.  Can ADHD people succeed in college?

- Stacy

Question:  Why are you so down on Luvox?  It has worked well for me in the past.  Also, I use 1200 of Lithium and my creatinine is 1.2.  I have used it 10 years.  At what creatinine level should Lithium be stopped?  I would try Abilify but am diabetic. - John

Prolonged use of Lithium can lead to some type of kidney impairment, probably inflammatory.  It’s more likely if serum levels are higher (1.0 and above) and may be more likely in individuals that have frequent urination and thirst.  It usually develops after years of use, and so far in my experience, it has not progressed to be a severe problem. But usually the Lithium itself was stopped.

I don’t routinely monitor creatinine levels.  They only start going up if kidney function is reduced by 75% or more.  If that occurs, the serum Lithium will go up without a change in dose or decrease in sodium intake or excess sodium loss (e.g. taking diuretics, vomiting, or diarrhea).

As with all meds, the decision comes down to benefit vs. risks, and in your case, Abilify might be a good option.

Question: I recently saw a special on deep tissue stimulation for OCD. It worked in this patient. How does deep tissue stimulation work? – Lea

Answer: I have not seen anything about that.  However, I recommend the Brain Lock technique to all my OCD patients – preferably to listen to the audio tape version of the book.
In the book Dr. Schwartz describes a cognitive behavioral technique used in a successful study done at UCLA.  The most important step in the technique is to shift your focus to something else.  At any given moment your focus is in your mind, in the environment, or in your body.  When stuck in obsessive thoughts or compulsive rituals, you need to shift focus.

• In your mind: thinking about something else or visualizing.
• To the environment: listening to music, watching a movie, playing a video game
• Into your body: exercising, yoga, etc. 

Deep tissue stimulation at the least would help shift focus to the body.  If combined with breathing or other relaxation techniques, it could also facilitate a shift into a more relaxed state of brain activity (alpha rhythm – slower and bigger waves than the usual beta activity of the awake state).  In the alpha state, the mind is more creative and not distressed which facilitates more positive thinking and imaging.  The same state can be achieved through long aerobic activity like running or meditation.

So, I can see where deep tissue stimulation could be useful for anyone with stress overload symptoms.  The problem that I would expect to see is that it works that day and the benefit lasts for awhile, but next week or next month, significant symptoms may return and deep tissue stimulation may not be available or feasible.

Brain Lock

I generally love to fly – it’s great for reading or doing the crossword puzzle with my wife. Thursday morning (08-10-2006) the news was dominated by the early morning arrest in London of over twenty Islamic terrorists who were in the final stages of plans to blow up ten jumbo jets enroute to the U.S. Although they were citizens of England, they had ties to training camps in Pakistan, most likely al Qaeda.

British security had managed to prevent a disaster with a loss of life equal to 9-11. The bombs were going to be assembled on the plane using innocuous looking liquids that could be easily gotten through security. I wondered if American security agencies are doing as well in monitoring extremist activity here.

Earlier in the week I watched news stories predicting a major escalation in terrorist activity of possibly cataclysmic proportions. Your life and mine and all our loved ones are intimately tied to an Islamic faction that sees us as evil. Our destruction is their way of glorifying God. How much do you know about Islamic history?

Unfortunately I had to fly to Tucson, Arizona Thursday afternoon to do a presentation and then fly back Friday morning. Fortunately I didn’t have to check a bag – and I knew there were new restrictions on what could be carried on – no liquids, gels, not even toothpaste. Getting through security and boarding was fairly routine except that every couple of minutes there would be an announcement "no drinks or liquids of any kind can be taken on the plane." So I was surprised that the woman boarding in front of me was carrying a "Big Gulp" soft drink. Surprisingly no one said anything to her as she walked past 3-4 agents and flight attendants and took her seat. I thought, "did I miss something?". So I asked a flight attendant in the back if they reversed the rule already. She said absolutely not and she went down and confiscated the lady’s drink. I felt like a snitch but I also wondered how close are they paying attention – not real reassuring.

I’ve got to admit I don’t have a lot of faith in the security rules. Remember when you had bottled water or coke and you had to take a sip of it? I asked one time why we had to drink the cola but not the shampoo or conditioner. I was told, "I don’t make the rules, Mack." Another time they had me break the mini file off my fingernail clippers; then two agents debated as to whether the 1/8" stub was safe. I said "if you’re thinking that might be a weapon, my ballpoint pen would be better." I asked another time if anyone had ever answered yes to "are you carrying a bag that some stranger asked you to carry for them?" Why not be more direct and ask, "are you stupid?" My wife once remembered that she had a pocket knife in her purse after she got on the plane – it was missed when they searched her purse item by item. As we deplaned, I asked the pilot what is involved in reporting a security violation. I wasn’t interested in a lot of red tape and paper work. He said "don’t worry about it, they’re doing the best they can. But what I worry about is that they took my finger nail clippers, but they want me to carry a gun". I should mention that I always prefaced my comments/questions with "I’m not wanting to cause trouble." Do you get the feeling we don’t have our sharpest minds developing our security rules and then we don’t have the most attentive people enforcing them? It makes me nervous.

Since I wasn’t checking a bag I was able to get on an earlier flight coming back, 5:15 am. But then I started to worry. I have to admit I’m a little superstitious – I like to knock on wood when I comment about good luck. Because of this mild superstition disorder – when you are a psychiatrist you think of all your disorders as mild – I was a little concerned about changing planes. I thought what if I’m changing from a safe flight to one that gets "dry gulched?" I hated to call and wake my wife up so early but I didn’t want her to end up freaking out if on the news they reported a "problem" with my planned flight. I also considered the alternative – her feeling relieved if the news reported that the flight from Tucson that I had changed to was sabotaged. What a mess. Fortunately when I wrote this on the plane I wasn’t feeling anxious – it was more of a theoretical concern – thank God for medication that helps control focus because I have at least one of the worry genes.

An editorial in Saturday’s Dallas Morning News by Leonard Pitts of the Miami Herald identified a major problem in America. We don’t like to be inconvenienced. And the powers that be don’t want to offend us (since we vote and all). Security in England is supposedly tighter and the Israeli El Al airline is so unimpressed with the TSA screening in the U.S. that they screen passengers again before they allow them to board. How inconvenient would it be to be blown out of the sky?

I’m an optimist. Deep down I feel blessed and protected. I believe God will probably wait as long as possible to bring me home. I can be a real pain in the butt.

When my wife and I flew to Puerto Rico three days after 9-11-01 the plane was mostly empty. It felt a little spooky. The hotel where I was teaching a seminar on, ironically, stress and insomnia, was virtually deserted. It was mostly us and all the service people. But times have changed. My flights to and from Tucson were full. In this instance a terrorist disaster was averted so people weren’t in a panic.

I have quickly become addicted to the Glenn Beck show on CNN Headline News at 9:00 pm eastern time. I love this guy! He’s definately one of us. I believe God put ADD people on this earth to stir things up and challenge the system. Earlier this week he had some expert on his show that said there are 1.1 billion Muslims in the world, most of whom are "normal" people. But 100 million of them hate our guts and want to destroy us (non Muslim infidels), especially Americans, and they are willing to die in the process. I feel sorry for the Muslims, especially in America who don’t have this radical mindset. It’s a lot like being Japanese post December 1941. But I also feel that as a group the Muslims have been way too passive in confronting their extremist factions. Case in point is the Lebanese citizens who embrace Hezbollah even though they celebrate the murder of Israeli women and children.

One of the things I like about Glenn Beck is that he says a lot of the things that I feel – sometimes exaggerated to make a point. The other night he started with "I hate politics. No, I hate politicians". My response was, amen! He also talks about how useless the UN is, amen! He refers to the extremist Muslims as "nut jobs". I wish they were crazy – insanity can be treated. Theirs is a fundamental ideology more powerful than ours. Our soldiers risk their lives in defense of democracy. The extremist Muslims are willing, even excited about blowing themselves up in defense of their beliefs. How scary is that? Beck has said repeatedly that we are already in WWIII and the Iranians (and their partners, especially Syrians) are even worse than the Nazis – because among other things they don’t care about their own survival. In fact the most extreme group believes that the return of their Messiah will be preceded by a time of great chaos and destruction. I believe in the power of self-fulfilling prophecy, so that makes me nervous.

But are the radical Muslim terrorists and suicide bombers, etc. really crazy? Unfortunately, mostly no. How can we understand their mind set? How can we be empathic – i.e., able to see things from their point of view? We are admittedly only beginning to understand the science of mind. Notice I didn’t say the mind because it’s not one thing – it is the most complex entity that we have yet found in the universe. If you’re not caught up in the outdated pseudo dichotomy of, science or religion you know that living things have been adapting, evolving for millions of years. Most people accept that there is competition in nature, especially when resources are scarce – the survival of the fittest and all that. But there is an equally powerful adaptive force in nature, cooperation.

Years ago a psychology teacher wanted to demonstrate how prejudice develops. He divided his class into two groups and they were to role play either being a prisoner or a guard over the next few days. He had to stop the experiment early because of the cruelty shown by the guards and mental distress that was rapidly developing in the prisoners. It turns out that part of our genetic hard wiring is the capacity, force that pressures us to identify with our peer group. It’s easy to say "but I would never do that" – be like a Nazi soldier or a Ku Klux Klan member or suicide bomber. But the forces of nature are powerful. I feel confident that I wouldn’t – but I’m also one of the ADD people put in this world to challenge the system.

For years I’ve been telling my patients "we weren’t made for this world." We were made for a world where we were outside all day, physically active. Life was hard but simple. Hundreds of years ago they thought the world was flat. Now according to one of my favorite writers and political analysts, Thomas Friedman, the world is flat again. We are all intimately connected. My security while flying from Tucson to Dallas was tied to the faith and feeling of well being of Muslim terrorists all over the world. I, we are hated and our destruction is their loftiest aspiration and connected to their "nirvana". It’s scary.

But I don’t think the world will end yet. If God is ADD and we’re all entertainment (a theory I’ve had for years that’s never been effectively challenged) then why would everything stop now? It’s just getting interesting. Besides there’s no way the world can end before the Cubs win a world series, and there’s no chance this year. God has to be a Cub’s fan.

You may notice I’m talking a lot about God. When we feel in danger and especially when we feel helpless that’s the time more than any other that our faith can get us through. Unfortunately our enemies feel righteously the same way.

Let me know how you feel.

What do we know about the cause of postpartum psychosis?

Hormones, especially estrogen, have a significant effect on mood. Estrogen raises serotonin. When estrogen drops precipitously, as it does premenstrually, postpartum, and at the onset of menopause – the brain serotonin levels drop. In women who are sensitive to low serotonin (because of genetics or previous episodes of significant depression) dropping the level will bring on symptoms of depression.

This principle can be demonstrated experimentally. By giving someone a drink of amino acid (from which tryptophan has been removed) the level of brain serotonin will temporarily go down. This is because tryptophan is the amino acid the brain uses to make serotonin. Only people with a vulnerability to becoming clinically depressed will show a depressive response to the serotonin level drop. This phenomenon contributes to premenstrual depression and menopausal (especially perimenopausal) depression.

Think about how dramatically hormone levels drop after child birth. This is why postpartum blues (brief symptoms of mild depression) is extremely common. The postpartum period is the highest risk period for full blown clinical depression.

Post partum psychosis is an extreme form of mood disorder in which underlying genetic vulnerability causes not only depression but a psychotic state. This fortunately only occurs in 1 out of 1000 births.

Psychosis is often confused with delirium. Delirium is a state of severe confusion and disorientation that can be brought on by toxins, severe infections, and many other causes. Every area of functioning is impaired. Psychosis means there is a distortion between conscious reality and external reality.

The most common symptoms of psychosis are hallucinations (seeing things or hearing things that aren’t there) or delusions (beliefs that aren’t true). A person can have one serious delusion that can affect their behavior but can be totally normal in other areas of functioning.

A woman who has had one postpartum psychosis is at a very high risk in any future pregnancies. It was for this reason that Andrea Yates was advised not to have any more children. So why did she and her husband ignore this? I don’t presume to know all the factors that they took into account. But I know she was never diagnosed as bipolar.  And they were never adequately educated about the physiology and medical science that we do have about what causes postpartum depression and psychosis.

Another factor in the Yate’s decision to continue to have children was their faith. They relied more on spiritual experience and counseling with their minister than medical advice. Unfortunately they had come under the influence of an extremist minister, and their medical advice was inadequate and not convincing.

Can they be faulted for not realizing all of this?  I think not. It is not unusual for a person of strong faith to at times feel caught between science on the one side and their faith on the other.

Many centuries ago St. Augustine showed more wisdom in this matter than many of our current experts. He said in effect science and religion aren’t in opposition. They are both ways of looking at and understanding one truth. When science and religion don’t agree we need to discourse and study so that the disagreement can be resolved – without feeling like you have to choose one or the other. Of course not all supposed science is valid and not all ministerial counsel can be trusted. Extremism of any type is dangerous.

“They found Andrea Yates not guilty,” my receptionist said to me Wednesday afternoon. I was delighted and surprised. I felt proud to be a Texan. Twelve jurors were able to do the right thing in spite of an almost impossible legal standard complicated by obstacles and hurdles imposed by a system that has the intellectual sophistication of the dark ages. The political powers changed the rules after Hinckley was found not guilty by reason of insanity for shooting President Reagan. Politicians and ultimately judicial officials pander to the vote – that’s the system.

Wednesday night the backlash began. I like Nancy Grace – the popular CNN Headline News Channel’s attorney/program hostess. She is tough but I usually agree with her. She is willing to take on any issue or individual and challenge the system in desperate need of repair. But on her Wednesday night show she was in la la land. She acted like a trial lawyer with their client (in this case the five murdered children) but dehumanized the opposing side, in this case Andrea Yates. Her position was that Andrea Yates was stressed out by taking care of five small kids and being trapped at home all day so she murdered them to make her life easier. Give me a break. Yates immediately called the police, told them what she did, she knew she was going to prison; she probably even thought she would be put to death – this is making your life easier?

On Thursday night I was speaking to a group of physicians and pharmaceutical reps in Lubbock, Texas. I asked, “How many of you are happy with the Andrea Yates verdict?” Only one doctor raised his hand. The overwhelming majority thought she is guilty and should spend the rest of her life in prison.

Then, on Prime Time Thursday night on ABC, they showed one of the prosecution’s “expert witness” psychiatrists interviewing (badgering) Yates on video tape having her retell detail by detail the horrible scenes that will forever torture her mind. He was splitting hairs in an apparent attempt to trap her into telling what he thought was the truth – that she planned and carried out a cold blooded murder of her children because she was tired of the strain of motherhood. What an idiot. He impressed me not as an insightful, empathic physician but as a member of the oldest profession.

On the brighter side, The Dallas Morning News editorial on Thursday morning supported the verdict and noted that they were reversing their position from their earlier support of the guilty verdict. Friday morning the USA Today editorial headline read, “Yates verdict reflects a healthy evolution.” They applaud the new verdict and conclude that “society has come a long way since the acquittal of Hinckley…” They also added that the law needs to come a bit further. I’m afraid it’s going to take more than a bit.

Why is there so much confusion? How can intelligent caring people be so polarized?

I am totally convinced that nothing is going to change until the majority of voting citizens clearly understand the issues and support a separate handling of individuals like Andrea Yates who is in almost every way the opposite of a criminal.

Only when public opinion changes will politicians change the rules. Is it possible to change people’s minds? Yes, most people want to do the right thing.

We need to start with the word guilt. When most of us ask ourselves “is she guilty?”, we mean “did she do it and did she do it on purpose?” Included in that is “did she know what she was doing?” The law defines guilt more strictly in terms of “being responsible for her act.” This use to mean knowing it is wrong and being in control of your behavior – but post Hinckley it was changed to just knowing it was wrong.

Some states have already changed the language to the more appropriate option of “guilty and insane.” We need to have a national standard that reflects this more accurate and comprehensible description of severe mental illness and legal accountability. A verdict of guilty and insane should not be “you’re free to go, have a nice life.” It should mean you go to a locked psychiatric treatment facility where you are treated as long as necessary, perhaps for life. It should mean that if you are released it is under the close monitoring of the judicial system for as long as necessary, commensurate with the crime. Whatever enforcement monitoring is necessary to assure protection for all concerned is feasible and should be a mandatory component.

Another problem that unnecessarily made the Yates jury’s decision more difficult is that they were not allowed to know what would happen to her if they found her not guilty. For all they knew she could have walked out the front door. This is ostensibly so that they make their decision based strictly on the law (with all its nebulous and abstract concepts). They should not be deciding based on the practical element of “what difference does it make what we decide?” Why not? Because despite the iconic balanced scales, the law is not about logic or fairness, it’s about “what are the facts and what is the law?”

In fairness, Andrea Yates did not meet the Texas law’s standard for criminal insanity. She knew what she was doing was against the law, and she knew she would be punished. She also knew it was against God’s law and the commandments. She believed that by killing her children she was sacrificing her life and her soul to save theirs. She felt responsible for them being bad kids (misbehaved) on the wrong path. In fact, Pastor Michael Woroniecki often quoted from the gospel of Mark, “whoever causes one of these little ones to stumble, it would be better for him if, with a heavy millstone hung around his neck, he had been cast into the sea.” She had attempted suicide twice because in her mind that would be protecting her children from her bad mothering. How ironic that it was the ultimate sacrifice of a mother for her beloved children.

Basically the jury decided – we don’t care what the law says, this woman was (and still is) crazy, psychotic. She is not a criminal – what she needs is help not punishment.

It’s hard to put yourself in someone else’s shoes. One of the best definitions of empathy that I’ve heard is: can you tell the other person’s story from their point of view? (which does not mean you agree with their thinking or that you approve of their behavior.) How can you imagine being insane? The closest I think you can get is to think about how your mind works when you are dreaming – random, weird, sometimes scary. That’s how a psychotic person’s mind works when they are awake. They cannot control their mind – it controls them.

What kind of a person is Andrea Yates? She is the opposite of a criminal. She was an R.N. She has been described by people who know her well as one of the most selfless and giving people they know. When her father was sick and dying, she’s the one who was taking care of him in addition to taking care of her own five kids. When someone in the neighborhood was sick, she’s the one that prepared meals for them. Her ex-husband, who also lost his five kids, has never wavered in his support for her. He knows that she killed the children out of love and psychosis. What possible criminal motive could she have had? She didn’t try to get away with anything – she immediately called the police.

To really understand the ordeal that she and her whole family went through you should read the excellent book, Are You There Alone?: The Unspeakable Crime of Andrea Yates, by Suzanne O’Malley. They went through years of suffering and medical mismanagement. It has been known for at least 10 years that postpartum psychosis is a rare complication of childbirth and that it is almost always a form of bipolar disorder (the old term is manic depressive).

For centuries throughout the world, new mothers in a state of insanity have murdered their babies. The U.S., to my knowledge, may be the only industrialized advanced country that considers it murder.

We have known for years that patients with bipolar disorder are made worse by antidepressants – unless they are on adequate doses of mood stabilizers or at least on an antipsychotic. Yates had been on Haldol (an older harsher antipsychotic – but more acceptable to insurance companies because it’s in generic), but even that had been stopped. When she killed her children she was on just antidepressants. Whose fault is that?

Yates had been hospitalized on several occasions, but kicked out early due to insurance company pressure. The hospital unit she was last treated on was for drug addicts, where she was forced to go to group therapy and lectures about addiction. How useful was that? Whose fault was that?

Ironically again, she was a devout Christian who was unduly influenced by a lunatic minister who repeatedly burdened her with guilt and impossible standards by which she was to judge the mental/spiritual health of her children. The thread of extreme fundamentalism seems to appear too often in cases where mothers kill their babies.

Could the influence of extreme “spirituality” on someone with the genetics of bipolar disorder contribute to the loss of control by the rational part of the mind?

There is no question that five children tragically lost their lives, but who/what is really to blame? Is it the system, the minister, the insurance companies, the hospitals, the doctors? Some people blame the ex-husband. When I review all the facts I see him as one of the victims. Maybe he relied too much on faith. Maybe he didn’t scream loud enough when her treatment wasn’t working. But I believe he did everything he knew to do.

If all the discussion and TV specials (that attract a lot of viewers and make the networks a lot of money) ultimately lead to greater understanding, then a change in public attitudes and a change in laws might happen. Then the death of five children will not have been in vain. The best outcome would be for a greater awareness to lead to early diagnosis and effective treatment for postpartum psychosis so that future babies aren’t the victims of Dark Age mentality in the 21st century.

Guilt is feeling bad because you hurt someone else. Shame is feeling bad because you don’t live up to your own standards and values. Shame is what the system should feel for not protecting the five children of Andrea Yates. Shame is what the system should feel for letting her sink deeper and deeper into the depths and torture of psychotic hell. Shame is what the system should feel for rubbing her nose in it over and over and parading her around like a freak show exhibit.

Shame on everyone who contributed to the problem or exploited it for personal or financial gain.

Andrea Yates, her ex-husband Rusty, and all their family and friends will suffer the rest of their lives because babies of mothers with postpartum psychosis don’t have a lobby group and can’t vote. Let’s change the system!

Let me know what you think by adding your comments.

Question:

Answer:

Strictly speaking, there is no standard treatment for Fibromyalgia. I’m not aware of any treatment having formal FDA approval. Cymbalta does have some positive controlled studies and Eli Lilly may be applying for approval.

Low thyroid is a common problem associated with fibromyalgia (see Thyroid Facts and Myths).

Stimulants are frequently used for chronic fatigue although they are not FDA approved for this. You are on a good combination of meds. If you are taking Cymbalta early in the day, switching to bedtime might help.

There are multiple options that could help motivation and energy levels:

• Increasing Concerta
• Increasing Cymbalta
• Adding Wellbutrin XL

Of course, you would need to discuss options with your doctor. It’s usually best to make only one change at a time.

Good luck!

Dr. Jones

The Supreme Court this week turned their back on patients with severe psychiatric illness – as in “we ain’t lettin’ no crazy people off the hook.” They also turned back toward the dark ages where psychosis was thought of as totally mysterious, or demonic possession.

After reviewing a case where a 17 year old paranoid schizophrenic boy fatally shot a police officer in Flagstaff, Arizona, the Supreme Court let stand the guilty verdict of the Arizona court. In 1993, Arizona passed a new insanity defense law that made it virtually impossible to qualify as insane. The judge in Arizona refused to allow testimony from psychiatric experts about the characteristics of mental illness.

The Supreme Court by a 6-3 vote ruled that Arizona has the right to restrict the insanity defense as long as they don’t deny him or her due process – say what? They also defended the courts right to not allow psychiatric testimony because “there is considerable disagreement within the profession, and experts often disagree in court testimony.” Excuse me, but if court testimony is not allowed when there is disagreement in the area and experts disagree, we should just board up all the court houses.

The most disappointing thing to me is that the highest legal authorities in the land had an opportunity to move us in the direction of being not only more scientific but more humane, and they just didn’t get it.

Many of the more advanced countries in the world have gradually changed their laws to incorporate the advances in the understanding of the “broken brain.” The U.S. on the other hand, changed the laws to severely restrict the insanity defense. This was another example of a knee-jerk response to an event – in this case, John Hinckley being found not guilty for reason of insanity after he shot President Reagan. Rather than educate the public about mental illness we change the laws so that they will keep the congressmen in office.

A new jury is currently being subjected to the horrifying details of Andrea Yates’ murder of her five children. They will have a difficult decision because although her motivation was totally insane, she knew it was against the law. In Texas, as in many other states since the Hinckley ordeal, this makes her guilty of capital murder – only an overzealous prosecution expert witness kept her from the death penalty.

More on Andrea Yates next week…….