Omega-3 Fatty Acids and Mood Disorders

By Sari Harrar from  Today’s Dietitian Vol. 14 No. 1 P. 22
Research suggests omega-3s can help mild to major depression and even schizophrenia.
Long recognized for their heart-health benefits, omega-3 fatty acids are emerging as an effective therapy for mood disorders ranging from major depression and postpartum depression to bipolar disorder and schizophrenia.

“Research suggests depression rates have risen as our intake of omega-3s has fallen over the past 50 to 100 years,” says omega-3 expert Gretchen Vannice, MS, RD, an independent nutrition research consultant based in Portland, Ore., and the author of The Omega-3 Handbook. “Studies show they help many mood disorders. So could getting enough of certain omega-3 fatty acids help reduce depression rates? Many experts think that among people who don’t have a genetic predisposition for mood disorders, they might.”
Yet giving your clients the green light to consume omega-3s for mental health benefits isn’t as simple as saying “swallow three fish oil capsules and call me in the morning.” It takes the right combination of fats, in addition to other therapies a client may be using, to get results, research shows. And many people with mood disorders should speak with their doctors first to avoid making mistakes like stopping other depression treatments.

But it’s a conversation worth having. According to the Centers for Disease Control and Prevention, nearly 10% of Americans are battling some type of depression. Forty percent of those have major depression.1 Another 2.6% of Americans are living with bipolar disorder, and 1.1% have schizophrenia. Meanwhile, about 10% to 15% of women experience depression during pregnancy, and up to one in five new mothers lives with postpartum depression.2 These disorders make daily living a struggle—and can be life-threatening. Ninety percent of suicides, for example, occur in people with treatable psychiatric illnesses, according to the American Foundation for Suicide Prevention.

Fats on the Brain
Enter the good fats. The human body uses omega-3s in many ways. They seem to be especially important for a well-functioning central nervous system, for the transmission of signals from the eyes to the brain, for heart health (some omega-3s protect against abnormal heart rhythms, reduce triglycerides, lower the risk of blood clots, and discourage the growth of plaque in artery walls), and they even promote healthy brain development in babies during pregnancy and breast-feeding.3

While your body can synthesize other types of fat from dietary components such as carbohydrates and proteins, it can’t make its own omega-3s. We have to get them from food or fish oil supplements. Omega-3s come in three varieties:

• Docosahexaenoic acid (DHA): Found in fatty cold-water fish such as salmon, mackerel, halibut, sardines, tuna, and herring, DHA concentrates in the brain’s gray matter and the retinas in the eyes.
“DHA molecules are long-chain fatty acids. They’re fluid and flexible,” Vannice explains. “They become part of the membrane of brain cells and work at synapses, where chemical signals jump from cell to cell.”

• Eicosapentaenoic acid (EPA): Also found in cold-water fish, EPA seems to have a unique role in maintaining a healthy mood.

“EPA doesn’t become part of a brain cell’s structure the way DHA does. It seems to help by reducing inflammatory processes in the brain and by balancing out metabolic pathways,” Vannice says. “Many studies show that DHA alone doesn’t work for depression. You need a little more EPA than DHA to get results. We’re still trying to understand exactly why, but we know it matters.”

In addition, some EPA is converted to DHA in the body.
• Alpha-linolenic acid (ALA): Found in flaxseed, canola oil, pumpkin seeds, purslane, and walnuts, and in small amounts in Brussels sprouts, kale, spinach, and salad greens, ALA doesn’t directly influence mood management although it may help with heart health. The human body converts a small percentage into EPA and DHA.4

While most Americans get plenty of ALA, we’re woefully low in the consumption of DHA and EPA. The American Heart Association recommends people eat fish twice a week, which, on average, would give you the recommended dose of 500 mg of DHA and EPA daily. But most adults and kids get closer to 100 mg or less, Vannice says. As a result, blood levels of these fats are low—and even lower in people with depression.

Do Good Fats = Better Moods?
Research from laboratory and population studies and clinical trials that tested omega-3 supplements in people with various types of depression suggests that raising EPA and DHA levels can make a difference. Omega-3 researcher David Mischoulon, MD, PhD, director of research in the Depression Clinical and Research Program at Boston’s Massachusetts General Hospital and an associate professor of psychiatry at Harvard Medical School, says EPA and DHA “are thought to be active as antidepressants” in the brain. From their catbird seat in cell walls, omega-3s help with what brain researchers call “second messenger systems” that carry messages from outside into cells.

Mischoulon and others who study the effects of omega-3s on depression have found the following:
• EPA plus DHA can improve primary depression. When M. Elizabeth Sublette, MD, PhD, of the New York State Psychiatric Institute and her team of researchers reviewed 15 trials involving 916 participants, they concluded that supplements with at least 60% EPA improved depression symptoms. Their meta-analysis was published online in the September 2011 issue of the Journal of Clinical Psychiatry. A Canadian study published in the August 2011 issue of the same journal found that a similar 60/40 ratio of EPA/DHA eased depression somewhat in people with depression who didn’t have anxiety disorders.
“The human brain likely benefits from a combination of EPA and DHA since they occur together in nature and both have apparent benefits for depression and suicide,” Mischoulon notes.

• Omega-3s help some aspects of bipolar disorder. In an analysis led by researchers from Australia’s University of Melbourne, Mischoulon and colleagues concluded that omega-3s could have a significant effect on bipolar depression but not on bipolar mania.5

• Low omega-3 levels are associated with suicide and self-harm. In response to increasing rates of suicide in the military, researchers from the National Institutes of Health (NIH) recently found that low blood levels of omega-3s were widespread and raised suicide risk by as much as 62%. The study was published online in the August 2011 issue of the Journal of Clinical Psychiatry.

“A previous placebo-controlled trial demonstrated that 2 g of omega-3 fatty acids per day reduced suicidal thinking by 45% as well as depression and anxiety scores among individuals with recurrent self-harm,” says researcher Capt Joseph R. Hibbeln, MD, acting chief of the Section of Nutritional Neurosciences at the National Institute on Alcohol Abuse and Alcoholism’s Laboratory of Membrane Biochemistry and Biophysics in a press release from the NIH. He and other study authors concluded that “ensuring adequate omega-3 nutritional status is likely to benefit, and unlikely to harm, people at risk for suicide.”

• Omega-3s help menopausal depression. When 20 menopausal women with major depression took 2 g of EPA plus DHA daily for eight weeks, 70% found their mood improved, and 45% found their depression went into remission. Mean scores on the Montgomery-Asberg Depression Rating Scale fell from 24.2 to 10.7. And the study participants enjoyed a bonus—fewer hot flashes—according to researchers from Massachusetts General Hospital in the March 2011 issue of Menopause.

• Omega-3s improve depression during and after pregnancy. Low-dose DHA/EPA supplements lifted major depression for 15 pregnant women in a 2006 study published in Acta Neuropsychiatrica. Other research has found that women with higher intakes of omega-3s after pregnancy are at lower risk of postpartum depression.6

In a small 2006 study published in the January issue of Acta Psychiatrica Scandinavica, 16 new mothers with postpartum depression took 0.5 to 2.8 g of EPA/DHA daily for eight weeks. Depression scores dropped about 50% in all groups. The researchers say that lifting postpartum depression is good for mothers and their babies: “Children of affected mothers may experience impaired attachment, and [postpartum depression] may adversely affect behavioral and cognitive development. Some women refuse medications during pregnancy and/or breast-feeding because long-term effects of antidepressants on the infant are unknown. Omega-3 fatty acid supplementation is associated with health benefits and is an attractive potential treatment.”

• Omega-3s may protect against schizophrenia. In a 2010 study published in the February issue of Archives of General Psychiatry, 81 people at extremely high risk of schizophrenia took 1.2 g of omega-3s or a placebo daily for 12 weeks. At the end of the study, 28% in the placebo group had developed the disorder compared with 5% in the omega-3s group.

“Intervention in at-risk individuals holds the promise of even better outcomes, with the potential to prevent full-blown psychotic disorders,” the study authors wrote.

Using Omega-3s Safely and Wisely
While low-dose omega-3s are a safe choice for most people, experts say people with depression and other mood disorders shouldn’t try to use this fat as a home remedy for depression. “I prefer that they at least talk to a physician first,” Mischoulon says. “Depression is a potentially dangerous illness because of the risk of disability and suicide, so a doctor’s input is important.”  

Here are some guidelines you can use while counseling patients who suffer from depression:
• Safest dose: For general good health, adults and kids should get omega-3s by eating two or more servings of fatty cold-water fish per week. That’s the recommendation of the American Heart Association and the Omega-3 Fatty Acids Subcommittee organized in 2006 by the American Psychiatric Association.7 “That works out to about 500 mg per day, which you also can get from fish oil capsules or other products [see sidebar],” Vannice says. People with mood disorders may benefit from 1,000 mg of EPA plus DHA daily from fish oil supplements, according to the subcommittee, but they should consult a doctor first.

• Don’t stop taking antidepressants, lithium, or any other medications or treatments. “They shouldn’t necessarily be viewed as a replacement for standard antidepressants or for psychotherapy, if these are being used,” Mischoulon says.

Suggest clients get their doctor’s approval before starting any dose of omega-3s if they’re pregnant, nursing, taking blood thinners, or have a bleeding disorder. Omega-3s can reduce blood clotting; if clients are already taking a blood thinner for this purpose, the combination could be dangerous.

— Sari Harrar is an award-winning freelance writer specializing in health, medicine, and science. Her articles have appeared in national magazines, including O, The Oprah Magazine; Reader’s Digest; Good Housekeeping; Better Homes and Gardens; and Organic Gardening.

Alternatives for Fishy Burps
It’s an unpleasant turn-off—and a big reason clients stop taking fish oil supplements. “People feel embarrassed about fishy burps and may not tell their dietitian, so this is a good area for an RD to become familiar with,” says Gretchen Vannice, MS, RD. She recommends these strategies for minimizing unpleasant “repeats”:

Take fish oil capsules with food. Suggest clients pair them with the largest meal of the day.
Try a higher-quality supplement. “Spending a few more dollars could alleviate the problem.” Look for enteric-coated capsules, too.

Switch to a spoonable fish oil. Recommend clients try Coromega (http://www.coromega.com/), an orange-flavored gel that delivers 350 mg of EPA and 230 mg of DHA. Or have them try Barlean’s Omega Swirl (www.barleans.com/omega_swirl.asp), which has a fruit smoothie taste and consistency and provides 350 mg of EPA and 350 mg of DHA in 2 tsp. Barlean’s is also good for kids who can’t or won’t swallow fish oil capsules.
— SH

References
1. Centers for Disease Control and Prevention. Current depression among adults—United States, 2006 and 2008. MMWR Morb Mortal Wkly Rep. 2010;59(38):1229-1235.
2. Centers for Disease Control and Prevention. Prevalence of self-reported postpartum depressive symptoms—17 states, 2004-2005. MMWR Morb Mortal Wkly Rep. 2008;57(14):361-366.
3. Linus Pauling Institute. Micronutrient information center: essential fatty acids. http://lpi.oregonstate.edu/infocenter/othernuts/omega3fa. December 2005. Updated April 2009.
4. Harvard School of Public Health. The Nutrition Source. Ask the expert: omega-3 fatty acids. http://www.hsph.harvard.edu/nutritionsource/questions/omega-3/index.html.
5. Sarris J, Mischoulon D, Schweitzer I. Omega-3 for bipolar disorder: meta-analyses of use in mania and bipolar depression. J Clin Psychiatry. 2011;Epub ahead of print.
6. Hibbeln JR. Seafood consumption, the DHA content of mothers’ milk and prevalence rates of postpartum depression: a cross-national, ecological analysis. J Affect Disord. 2002;69(1-3):15-29.
7. Freeman MP, Hibbeln JR, Wisner KL, et al. Omega-3 fatty acids: evidence basis for treatment and future research in psychiatry. J Clin Psychiatry. 2006;67(12):1954-1967.

Posted at http://www.darkestclost.blogspot.com/

"Off-label" Use of Antipsychotic Drugs for Some Conditions Not Supported by Evidence

Madness in the NFL - The Greg Montgomery Story

“Madness in the NFL - The Greg Montgomery Story” documentary takes us on Greg's journey from All-Pro NFL punter to his diagnosis with bipolar disorder in 1997 while playing with the Baltimore Ravens. Ultimately, his journey towards recovery from bipolar disorder has been a positive and successful one. Now almost 14 years after his diagnosis of bipolar disorder, Greg is a powerful advocate in the field of mental health. He recognizes that help is desperately needed for the millions living with mental illness and is making a difference by speaking out.

Greg is also an avid writer and blogger. Through his blog, Zen In The Art of Living Bipolar, Greg openly shares his experiences of anxiety, depression and bipolar disorder with educational, honest, and engaging content. You can also follow Greg on Twitter @ZenPunter.

We commend Greg for his advocacy efforts and for working with numerous mental health organizations on raising awareness and fighting the stigma that surrounds mental illness. DBSA looks forward to partnering with him on these upcoming DBSA initiatives:

• The October eUpdate will feature an empowering article written by Greg.
• In November, DBSA will host a live Telechat with Greg. Stay tuned for more information and how you can submit your questions in advance.

http://www.dbsalliance.org/site/PageServer?pagename=eupdate0911#1
Reposted at darkestcloset.blogspot.com

Book Review: "A First-Rate Madness: Uncovering the Links Between Leadership and Mental Illness" by Nassir Ghaemi, M.D.

The Penguin Press (2011), $27.95 (hardcover)

By Bob Carolla, NAMI Director of Media Relations

One of the best books to document and discuss in detail the link between mental illness—specifically depression—and great leadership is Lincoln's Melancholy by Joshua Wolf Shenk. Dr. Ghaemi, the director of the Mood Disorders Program at Tufts University, now takes the discussion of mental illness and leaders further by including bipolar disorder and expanding the scope to several other historical and contemporary leaders, including Civil War general William Sherman, Winston Churchill and Ted Turner. Also included are Mahatma Gandhi and Martin Luther King, whose names are new to "famous people" lists that provide inspiration to many people who live with mental illness.

The book makes the case that four elements are essential to leadership in times of crisis: realism, empathy, creativity and resilience. Living with depression can enhance the first two traits and mania can enrich the third. Both can help instill resiliency. At the same time, some conditions such as psychosis can prove disastrous.

Leadership can be exercised for good or evil— independent from mental illness. In other words, free will and moral values remain part of the equation. The book includes a chilling discussion of Adolf Hitler, who presided as the leader of Germany during World War II and the Holocaust; Ghaemi makes a case that Hitler lived with untreated bipolar disorder which gave him charisma, resilience and political creativity in his rise to power. On the other hand, by the time the war began, he was being treated with barbiturates and amphetamines (including meth) for insomnia and fatigue, a combination that only worsened his mental illness. Essentially, his mind spun out of control—possibly into some form of psychosis. In that respect, impairment of his leadership abilities because of heavy drug use was a stroke of good fortune for civilization. “In his final two years, Hitler probably never experienced a day of normal mood,” Ghaemi writes. “His world was collapsing; his mind already had.”

The book also includes discussion of other leaders such as John F. Kennedy, Richard Nixon and George W. Bush, arguing that “homoclite” leaders who “want to be liked” can be dangerous in times of crisis. “Normal” mental health may actually be a drawback. This section, as well a chapter on stigma and politics, are not the books strongest but they raise issues that are worth thinking about carefully. Would our country ever elect a president who acknowledges living with bipolar disorder—and perhaps even campaigns on it as a qualification suited for the times? In some cases, personal experience with mental illness may be a strength, providing vision and a foundation for brilliant leadership, but the stigma surrounding mental illness still prevents a completely open discussion.

Posted at NAMI Advocate. NAMI Bookshelf August 2011. http://www.nami.org/ADVTemplate.cfm?Section=20111&Template=/ContentManagement/ContentDisplay.cfm&ContentID=126353

Reposted at darkestcloset.blogspot.com

I like Bi-Winning.

In a recent article by Amy Yashinsky* of the STOMP Newsletter, by a group of mental health advocates in Michigan, whom I respect, she wrote:

“I want to cringe every time I hear someone speak incorrectly about bipolar disorder (or any mental health challenge, for that matter!), and as such, the last month of Charlie Sheen’arama has been one big cringe-fest!

Whenever someone asks me about him, my reply has been ‘he’s making it difficult for me to do my job! When comics are comparing him to Gadhafi, how am I supposed to teach people that those dealing with a mental health challenge are not dangerous or unstable?!’”

I was with Amy when she spoke about the inappropriateness of armchair analysis, but here I must differ. It is a “cringe-fest,” but I am right there with Charlie when he says “I’m bi-winning!”  He is not making your job harder, mental illness, and hundreds of years of ignorance, discrimination, fear, prejudice and mistreatment make it difficult for people with mental illness to recover and others to understand and welcome into the greater community.

Some people who experience who experience mental illnesses are dangerous, some are unstable, most are not. The same can be said for the general population. Education about discrimination and fear is very difficult. Charlie Sheen’s story provides an opportunity to talk about things which are hard to bring up in day-to-day conversation with the general population. Opportunity is a good thing.

I do not know, nor have I ever met Mr. Sheen, his friends, or family. MY impression has always been that he is an intelligent and funny guy who likes to live his life on his own terms. Am I interested in what the media or parasitic friends and “professionals” have to say about his motivation or behavior? No.

I am more disgusted by the talking heads and mental health experts who have come forward to explain his behavior than I could ever be by something that Mr. Sheen has said in public. It is inappropriate to speculate or worse, “diagnose” someone from a taped interview or public behavior. These mental health experts crawling from the woodwork to pontificate on what Mr. Sheen needs are shameful leeches.

He true friends may express concerns if his behavior becomes dangerous to himself or others. Mr. Sheen determines what is a priority for his own wellness. He has been open for many years about his sexual and social preferences. He is a wealthy may who engages in consensual activities. This is none of my business, or anyone else’s.

There have been some individuals who expressed sincere concerns about whether he is being exploited in a vulnerable period of his life. It is possible to be an ass and still be vulnerable. Writer, actor, comedian, Rickie Gervais has expressed these concerns, in a caring way.

If Mr. Sheen is experiencing a mental health crisis, I hope that he seeks help from someone he can trust. The general public cannot determine if he is, or is not, simple because he acts in an outrageous way. Many performers and no-performers act in outrageous ways for many reasons that have nothing to do with mental illness. He does not have to disclose his illness, if he has one, to the public, regardless of what it may be, ever, for any reason. Being an actor, or an activist, or a famous person does not justify making you a target.

Recovery is a non-linear process. Everyone’s process is different. Respect Mr. Sheen’s right to express himself as he wishes, whether you like what he has to say, or not.

As for me, I like the way “Bi-winning” sounds.

Posted at *http://www.cnsantistigmaprogram.org/stomp_newsletter_2011-04-15/newsletter.html#7 Reposted at http://keystothecloset.blogspot.com/

Charlie Sheen sets up bipolar awareness walk

Actor has only admitted he's 'bi-winning,' but he makes pitch for cause in Toronto

Posted at http://today.msnbc.msn.com/id/42612186/ns/today-entertainment/    Reposted at http://darkestcloset.blogspot.com/

By Lindsay Powers Hollywood Reporter Hollywood updated 4/15/2011 2:54:27 PM ET 2011-04-15T18:54:27 

LOS ANGELES — In a series of new tweets, Charlie Sheen has announced that he is organizing a bipolar awareness walk in Toronto Friday evening.

He has asked fans to meet him at his Ritz Carlton hotel and walk with him 1.2 miles to Toronto's Massey Hall, where he performed to mixed reviews Thursday night and is set to take the stage again tonight.

"Stop the Stigma!! Bipolar Awareness Walk!! Please join me at 6pm at the Ritz tonight! Raise Money! Raise Awareness! #BIPOLAR #BIWINNING," read one message.

Sheen tweeted that he plans to take donations for the Canadian group OBAD, the Organization for Bipolar Affective Disorders, and is "matching all donations $ for $"

A rep for the actor tells THR: "Charlie wants to bring awareness to bipolar and he has lined up with OBAD to do this walk. And it was totally his idea."

A Sheen pal tells THR the walk has nothing to do with actress Catherine Zeta-Jones' announcement this week that she has sought treatment for the disorder.

Sheen has denied having bipolar disorder. When ABC News' Andrea Channing asked him about rumors last month, he said that he is "bi-winning." He admitted that his brain is "maybe not from this particular terrestrial realm."

The Sheen insider tells THR that the actor is just "really passionate" and a "hoot."

Zeta-Jones may help dispel stigma of bipolar disorder

By Rebecca Dube  TODAY TODAY  updated 4/14/2011 Reposted at http://darkestcloset.blogspot.com/

Oscar-winning actress Catherine Zeta-Jones suffers from bipolar disorder, and checked herself into a mental health facility earlier this month, her publicist has confirmed.

The news may be shocking to fans who associate the actress and wife of Michael Douglas with her image of polished glamour. But bipolar disorder – which used to be called manic depression – can take many different forms, psychiatrist Gail Saltz told TODAY.

"It can look like a very high-functioning person who is just super 'up,' " Saltz said.

Zeta-Jones is diagnosed with bipolar II disorder, which is less severe than bipolar I. People with her condition swing between major depression and what’s called hypomania, which can include intense irritability, sleeplessness, relentless optimism or grandiose elation.

Zeta-Jones’s publicist, CeCe Yorke, blamed stress for the actress’s recent hospital stay. In the past year, her husband was diagnosed with advanced throat cancer; he’s also been battling a lawsuit from his ex-wife seeking half of his recent movie earnings. Zeta-Jones and Douglas have two children, ages 7 and 10.

Stress can indeed be a trigger for bipolar episodes, Dr. Nancy Snyderman, NBC’s chief medical editor, told TODAY. And a brief stay in a hospital would not be uncommon, either to bring a manic episode under control, or to tune-up medications for more effective treatment, Snyderman and Saltz noted. Bipolar disorder can usually be controlled with a combination of medication and therapy. Lithium is one of the most common treatments.

Researchers aren’t quite sure what causes bipolar disorder -- a combination of genetic and environmental factors seem to come into play. They do know the disorder is associated with an imbalance in the brain chemicals called neurotransmitters.

Bipolar disorder affects about 2.5 percent of the U.S. population, around 6 million people. Mental-health advocates hope Zeta-Jones’s public struggle will help dispel some of the myths and fears about mental illness.

"There is a ridiculous stigma in this country about this," Snyderman said. "We have to get over it. People get sick, our job as doctors is to get them well."

Saltz applauded Zeta-Jones for announcing that she has bipolar disorder after the National Enquirer reported that she had checked in to a psychiatric hospital.

"I think it’s tremendously brave of her to come forward and I’m delighted that she’s doing that," Saltz said. "There are many people getting a new diagnosis, and we want them to know they have every hope, if they get treatment, of having wonderfully productive lives."

Yorke, Zeta-Jones’s publicist, said the 41-year-old actress is "feeling great and looking forward to starting work this week on her two upcoming films." © 2011 MSNBC Interactive. 

PARENTS OF ADULTS WITH MENTAL ILLNESS FACE THE CHALLENGES OF BEING AN AGING CAREGIVER

Parents face a host of challenges when caring for a child with a serious mental illness (SMI), such as schizophrenia and bipolar disorder. As the parents age and face their own age-related problems, the care burdens can become even greater when the child becomes an adult. A recent AHRQ-funded study looked at the subjective burden and personal gains of older parents who cared for adult children with SMI. It found that various supportive measures in the home can create opportunities for the adult child to help their aging parents, while at the same time helping the parents cope with caregiving challenges. http://r20.rs6.net/tn.jsp?llr=87kw7ieab&et=1104894294000&s=155&e=001knmwUl_ELJTnDiqP4zfkiRlkC2AxWv-lgx-ZQISmI99yEGtLGgHWRU5GteqERqN_c8Z1Dcgrf2zS14faDxODQU2KnvEwoX0IQGO6URsN_fOZOSGJ0sVVZSl5glTTGdg-LLz3bjihQJNl1t_yQdt6lQ==

I Would File this Under Inappropriate Professional Behavior

Dangerous doctors slipping through the cracks

It took the discovery of guns and grenades to suspend the license of a psychiatrist who some say should have come under scrutiny years earlier

By Megan Twohey, Tribune reporter 8:50 p.m. CST, February 24, 2011 posted on http://darkestcloset.blogspot.com/

One night a Crestwood police sergeant doing a routine building check noticed an open door to the office of psychiatrist Joel Carroll. Stepping inside the cluttered office, he discovered roaming cats, a Colt AR-15 assault rifle and other guns, ammunition, military-grade smoke grenades, sex toys, and pornography.

"Well, for the lack of better terminology, we considered it a pigsty," Sgt. Thomas Kaniewski testified about his April 2009 discovery. "It looked in complete disarray. We couldn't believe that someone could actually conduct business in an office like that because of the conditions it was in."

When state regulators determined that Carroll had engaged in sexual misconduct and committed other violations of the state Medical Practice Act, they suspended his license, proclaiming him "a danger to his patients," according to state records.

But the psychiatrist's practice could have been shut down years earlier, after the Illinois Department of Corrections in 2007 found that Carroll — as a state contractor — committed inappropriate conduct with a female inmate and barred him from working in a prison, a Tribune investigation showed.

Critics say the case raises questions about a crucial part of the medical disciplinary system.

State agencies, county prosecutors, insurance companies, and health care employers and associations are mandatory reporters — they're required to report potentially dangerous and unprofessional doctors to medical regulators, who can bar the doctors from practicing and keep patients out of harm's way.

But the mandatory reporters sound few alarms, and when they do, regulators rarely take action, the Tribune found. There were 348 mandatory reports filed with the state in 2009. That's out of nearly 46,000 physicians statewide. In only one case did the Illinois Department of Financial and Professional Regulation respond by suspending the physician's license, records show.

Sue Hofer, a department spokeswoman, said it can take longer than a year to discipline a doctor following a mandatory report. She said regulators frequently learn of a dangerous doctor from members of the public before being told about the doctor from a mandatory reporter. If they are already investigating, she said, the regulators don't make a separate record of the notification.

But in the case of Carroll, the corrections department provided no notification that the psychiatrist had breached security during a visit to the inmate and allegedly made a sexual advance toward her, even though state agencies must report any potential violation of the Medical Practice Act. Carroll's actions might have amounted to "dishonorable, unethical or unprofessional conduct" — a violation under the act that can lead to suspension — but regulators were robbed of the opportunity to seek disciplinary action, said John Goldberg, a former medical prosecutor.

"The Department of Corrections should have reported, but these agencies hardly ever do," Goldberg said. "If they had, the regulators could have opened an investigation that at the very least asked: What's the explanation for your actions against this inmate? What else is this doctor doing?"

Regulators also were not contacted at the time by Wexford Health Sources, the contracting agency that fired him after his administrative lockout from the prison system. Health care employers must report terminating or restricting a doctor's privileges based on actions that may directly threaten patient care. Elaine Gedman, a spokeswoman for the Pittsburgh-based company, said that in 2007 the "Department of Corrections did not necessarily disclose their rationale for revoking an employee's clearance."

"When we look at this, we realize there are places where dangerous doctors get caught, where they're identified, but no one reports it, or the state doesn't take action," said Gary Schoener, a Minneapolis psychologist who has consulted on thousands of medical misconduct cases across the country.

Sharyn Elman, a corrections spokeswoman, said prison officials believe they did not have to report Carroll to regulators because they could confirm only that he breached security during a visit to the female inmate, not that he engaged in sexual misconduct as alleged.

But after police stumbled on the office, regulators received documentation from the Department of Corrections indicating "the doctor had told that inmate that he would take her to Mexico, and hugged her and kissed her," a medical investigator said during a 2009 disciplinary hearing.

Carroll, who could not be reached for comment, said in the hearing that the inmate made a pass at him, not vice versa.

The psychiatrist maintained his practice while he worked in the prison system from September 2006 to February 2007 and during several months in 2009 while he worked at medical centers for veterans in Danville and Marion.

His personal appearance was concerning to patients and other observers, as was his office, according to testimony.

One former patient said the psychiatrist went shoeless with holes in his socks. A pharmacist questioned whether he was really a doctor.

"He looked messy, unkempt," the pharmacist testified in a disciplinary hearing. "I was surprised at his appearance. He did not look, to me, like any physician I had ever met before. … He was wearing a T-shirt. It did not appear to be clean. It was very wrinkled. He was unshaven."

Carroll's former secretary said the presence of pornography and guns in the office was disturbing.

"The point is, putting myself aside, why does a doctor — a psychiatrist — have guns in the office with psychiatric patients?" she said during a hearing. "That's the problem."

When asked about the weapons in his office, Carroll said he collected them for fun and protection. He told authorities he had close to 100 guns stored in the walls of a Skokie home, state records show. Carroll had a firearms license.

The police never arrested Carroll. During the disciplinary hearing, Kaniewski said he did not know whether Carroll's assault rifle was a type that is illegal for him to own, only that he thought it was cause for concern. (Crestwood police Chief Theresa Neubauer did not respond to written questions or calls seeking comment.)

While law enforcement did not pursue charges against Carroll, state regulators determined that having these weapons at his office amounted to dishonorable, unethical or unprofessional conduct.

The former secretary, who first had been a patient of Carroll's, said she was surprised when he visited her behind bars and then offered her a job immediately after she finished serving time for a drug conviction.

Carroll gave her presigned prescriptions to use when he was out of the office, she said. The woman, a recovering drug addict who had no medical training and suffered from bipolar disease, would pen prescriptions for patients — a violation of drug laws, a Drug Enforcement Administration official testified.

"The medications would range from antidepressants all the way up to controlled substances such as Methadone," the woman explained during the hearing.

Carroll took the woman to New Mexico when he attended a conference and they shared a hotel room, according to the secretary's testimony. Carroll denied it, but she testified he walked around in his underwear and made an unwelcome sexual advance toward her.

When the secretary quit after the state launched its investigation, Carroll showed up at her home more than once, prompting her to call Chicago Ridge police, records show.

"Because after the investigation started, he went and he bought more guns and he just … I don't trust him today," she said in a hearing.

Carroll admitted he spent numerous nights at the home of a patient who suffered from anxiety and panic disorder, state records show. Regulators alleged he took nude pictures of her while she was asleep, threatened to have her committed, masturbated in front of her and attempted to climb through her bedroom window while she was in bed with her boyfriend — all of which he denied.

Another former patient who had turned to Carroll for treatment of severe anxiety said she was confused when he showed up unannounced at her family's Crestwood home. He allegedly tried to kiss her as he was leaving, which prompted her to cry to her mother.

The psychiatrist allegedly returned to the house more than 20 times, records show. The woman and her mother testified he would lay his body against the doorbell and throw rocks at her window.

"It upset me. I was crying. … I did call his telephone and asked him to please don't come to my house," the former patient said in a medical disciplinary hearing.

Carroll said he only threw rocks at the woman's window once. He denied he tried to kiss her.

When she realized the Department of Corrections and Wexford Health Services had taken action against Carroll in 2007 but had not informed regulators, she was outraged.

"This guy should have been out years ago," the woman said. "This should never have happened to any of us."

Withdrawal from the drugs wasn't the only hard part, she said. Her anxiety, already debilitating, worsened.

She is afraid to leave her home, she said, for fear that Carroll will be outside.

mtwohey@tribune.com

FDA panel advises more testing of 'shock-therapy' devices

By David Brown Washington Post Staff Writer Friday, January 28, 2011; 10:10 PM

An expert panel advising the Food and Drug Administration decided Friday that electroconvulsive therapy (ECT) machines should undergo the same rigorous testing as new medical devices coming onto the market - a decision that could drastically affect the future of psychiatry's most controversial treatment.

The majority of the 18-member committee said not enough is known about ECT, also known as "electroshock" or simply "shock" therapy, to allow the devices to be used without more research into its usefulness and hazards.

If the agency follows the panel's advice, which it usually does, the two companies whose machines are used in the United States will have to provide evidence of the therapy's safety and effectiveness either from existing research or new studies. If the FDA isn't convinced, the devices could be removed from use.

The panel's opinion is the latest chapter in ECT's seven-decade history, during which the treatment has been lauded as a lifesaver, villified as a form of legally sanctioned torture, and has seen its popularity rise in recent years after a long decline.

ECT machines deliver an electrical current to the brain, inducing a generalized seizure in which the patient briefly loses consciousness. How that may be therapeutic or cause permanent memory loss - the side effect most frequently mentioned by patients - isn't known.

About 100,000 Americans undergo ECT each year, usually getting about a dozen treatments over several weeks. Some then get "maintenance" ECT every few weeks, as the therapeutic effect, when it occurs, often doesn't last. The treatment is most often used for depression and has also been prescribed to patients with schizophrenia, catatonia, and more recently, to some violent children with autism.

"It was the best possible outcome we could have gotten," said John Breeding, 58, a clinical psychologist from Austin who says the procedure should be banned. He testified before the panel at a two-day meeting in Gaithersburg.

For some patients, ECT epitomizes what they view as the coercion and lack of respect for the patient's point of view that is unique to psychiatry. That's also largely how it's been depicted in popular culture, most famously in the book and film "One Flew Over the Cuckoo's Nest," where it was a tool of punishment and social control of mental patients.

"I lost not only my memories of the time I was subjected to this torture but I was robbed of almost all memories from about 2003, two years before treatment, to 2008, three years after treatment stopped," testified Evelyn Scogin, a special-ed teacher who got ECT after a suicide attempt. Her statement was read by a friend because Thursday's snowstorm stranded her in the Charlotte airport.

Other patients described ECT as a lifesaving, if mysterious, treatment worthy of wider use.

Among them was Kitty Dukakis, the 74-year-old wife of 1988 Democratic presidential nominee and former Massachusetts governor Michael Dukakis. She first got ECT at age 63, and continues to get it once a month.

"It is not an exaggeration to say that I don't think I would be alive without ECT. It has been a miracle in my life," she said.

One proponent, a nurse from Baltimore, drove through the snow on her day off to read a grateful Christmas card from a patient, choking up as she did.

"I actually think it's more controversial than abortion," Amy Lutz, a 40-year-old mother of five from Villanova, Pa., said of ECT, which her 12-year-old autistic and manic-depressive son gets regularly.

She brought with her two poster-size photographs of the boy, his face and hands bloodied from self-inflicted blows. She told the committee that ECT, tried after a half-dozen other therapies, stopped the violent behavior and increased her son's achievement in school.

A 1976 law requiring safety and effectiveness of all new medical devices permitted ones in longstanding use, including ECT machines, to stay on the market. Later, however, Congress told the FDA that those grandfathered-in devices either had to undergo rigorous testing or be officially "reclassified" as already-proven to be safe and effective (although, in some cases with special warnings about their use).

In addition to patient testimony, the advisory panel heard FDA staffers describe their analysis of hundreds of ECT studies.

As a group, the studies tended to be poorly designed and with too few patients to allow the drawing of firm conclusions. Many failed to follow patients long enough to discover the duration of ill effects. Ones done decades ago studied techniques and electricity dosages different from current practice.

The FDA staff reported the existing research suggests that for depression, ECT is more effective than placebo or "sham" shocks and after a month more effective than antidepressants.

In terms of hazards, the FDA staff's review found the treatment is associated with "impairment in orientation, memory and global cognitive function immediately after ECT and up to 6 months." Certain aspects of memory may return to baseline after six months. "Autobiographical memory" - recollection of events in one's life - appears to be at greatest risk. High-dose electric current and current applied to both sides of the brain are associated with more thinking and memory problems.

Panel member Christopher A. Ross, a psychiatrist and neuroscientist at Johns Hopkins University, asked if the published studies identified any risk factors that predisposed patients to memory loss and thinking impairment.

"Evidence-based data for that issue just doesn't exist," said Peter G. Como, a neuropsychologist at the FDA.

Panel Chairman Thomas G. Brott, a neurologist at the Mayo Clinic's campus in Jacksonville, Fla., said he was amazed that essentially no research had been done on ECT's effects using functional MRI imaging, repeated brain wave (EEG) studies, or autopsy examinations of patients.

"I tried to look and saw very little. I concluded that the evidence is not there to decide either way," he said.

When Mental Health Meds Are Out Of Reach, Hospitalization More Likely

Too often, mental health patients have problems accessing or paying for their prescription drugs under Medicaid. The results - longer hospital stays and more emergency room visits - are hard on patients and costly for the entire health care system, a new study finds.

Lead author Joyce West, Ph.D., and colleagues analyzed Medicaid data from 10 states and found that psychiatric patients who reported access problems with their medication visited the emergency department 74 percent more often than those who had no such difficulties.

Of the 1,625 patients West and colleagues tracked, almost a third could not access the clinically indicated or preferred medication because Medicaid did not approve it. Patients with medication access issues experienced 72 percent more acute hospital stays compared to patients without access problems.

Access problems included prescribed medication being discontinued, temporarily stopped or not covered. Some patients had problems making the co-payment.

"What's particularly troubling is that it can often take several trials and many months, if not longer, to find an appropriate medication regimen that a patient responds to," said West, policy research director at the American Psychiatric Institute for Research and Education and an assistant professor of mental health at Johns Hopkins University.

The study appears in the November-December issue of the journal General Hospital Psychiatry.

"There are major clinical risks to psychiatric patients when they're stable on their medication and then switch to a different medication," West said. "Policies to facilitate medication continuity are critically important for this highly vulnerable population."

Policymakers can save money in the Medicaid program by clamping down on medication, but other areas including emergency room visits will undeniably increase, said Ken Duckworth, medical director for the National Alliance on Mental Illness and assistant professor at Harvard Medical School.

"It's another piece in a body of evidence that says what you're doing when you're restricting access to psychiatric drugs is squeezing the balloon," Duckworth said. Psychiatric hospitalization costs $800 to $1,000 a day. "So it is quite expensive for the system," Duckworth said.

Duckworth said incarceration it particularly is important for patients with conditions such as schizophrenia, bipolar disorder and borderline personality disorder to take medications consistently. TERMS OF USE: This story is protected by copyright. When reproducing any material, including interview excerpts, attribution to the Health Behavior News Service, part of the Center for Advancing Health, is required.

General Hospital Psychiatry is a peer-reviewed research journal published bimonthly by Elsevier Inc.

West JC, et al. Medicaid medication access problems and increased psychiatric hospital and emergency care. Gen Hosp Psych 32(6), 2010.

Source:
Health Behavior News Service
http://www.medicalnewstoday.com/articles/211062.php