Should Every Primary Care Patient Be Screened for Depression?

Depression affects about one person in five across their lifetimes. It is a significant source of disability, loss of productivity, and impaired relationships, and a major risk factor for suicide. A study from the 1990s revealed that, in the absence of routine screening, primary care providers at an HMO in Washington state missed the diagnosis in approximately 35% of patients who had depression.  

It seems common sense, doesn't it, that routine screening for depression would improve care by better diagnosis and follow-up treatment?

Actually, no. Despite more widespread practice of routine screening in primary care settings in the US in recent years, and despite subsequent increase in the use of antidepressants, the benefits have yet to show up.

Real Suicide Prevention or Self-Satisfied Nonsense?

It's Suicide Prevention Month/Week/Whatever again. Those of us who are or have been suicidal know suicide prevention as a year-round, full time job. Those of us who are or have been suicidal have a whole lot of experience at preventing suicide. Is anyone interested to hear from us? Some of the following came from an earlier post. It bears repeating, 'cuz evidently even some bright people have some strange ideas. Like:

Suicide is not a choice

The way people talk, you'd think we sit down and make a list, pros and cons of suicide. Then based on our calculations, we make some kind of decision. She chose to end her life. Or, How could he have been so selfish.

This is called the volitional theory of suicide, suicide as an act of will. The suicide prevention approach that addresses it is to weigh in on that list of pros and cons, like Jennifer Michael Hecht's book, Stay.

You know -- Suicide is a permanent solution to a temporary problem. Or, Think of what you'll miss out on. Or, whatever. In other words, how dumb or short-sighted or irresponsible or selfish you must be to decide to kill yourself.

Resisting COVID Depression, One Song at a Time

Who knew COVID would last this long? Did you, like me, feel a bit of hope last spring? We had the tools; we got the jab; the numbers started falling.

But . . . not everybody got the jab.

Then . . .

Now? Children are thrown into a virus laden cauldron while state legislatures pass laws prohibiting measures that would reduce the spread of a pandemic. Nurses are dropping like flies. A guy died in an emergency waiting room this week because there was no room for him in ICU.

And people with a high school diploma and an internet connection know better than the medical community. Instead of heeding the pleas of their doctors, they are taking horse-deworming medicine. Our local feed store has run out of it.

I guess next up--the horses start dying.

So, it looks like this thing is going to be with us for a while.

Prejudice, Not Stigma: How People with Mental Illness Get Crap Health Care

Eight years ago I published an article titled Doctors' Prejudice Against Mental Illness. It lays out the reasons why it is so damn hard for doctors to learn. Here is a paragraph from that original rant:

Similarly, people with other mental illnesses as well often do not receive routine standard of care for a whole host of conditions, including screens for infections, dental care, metabolic syndrome, even blood pressure checks, even while receiving medications that put them at risk for all of these health complications. As a consequence, the death rate gap between people with mental illness and the rest of the population is growing.

The link in the second paragraph is to a World Psychology article, a review of the literature documenting the crap health care that people with serious mental illness receive, with the consequence that we die an average of ten years sooner than people without mental illness.

The difference in lifespan is only slightly due to suicide. For the most part we die of the same things everybody else dies of, heart disease, cancer, that sort of thing. We just die sooner because our heart disease and cancers are not detected as early, nor treated as aggressively, as everybody else's.

Surviving Heat Waves with Bipolar Disorder

Did you know that more people are murdered at 92 degrees Fahrenheit than any other temperature? I read an article once. Lower temperatures, people are easy-going, over 92 and it's too hot to move, but just 92, people get irritable.

That's what the sheriff said in an opening scene of It Came from Outer Space. Set in Arizona -- even in black and white, you could feel the heat rolling off the sand. And throughout the movie, they attributed people's reports of strange sightings to heat-induced lunacy.

As I read that quote from 1953, I think -- 92, if only!

Everybody is irritable right now in -- how shall we put this? -- the coolest summer we will experience for the rest of our lives. Everybody is exhausted. But some of us more than others.

via GIPHY

One Exciting Thing and One Ironic Thing About Prozac Monologues and Psychology Today

Last week Psychology Today posted Bipolar Disorder: How to Get Correctly Diagnosed, my interview with Monica Starkman, M.D. about Prozac Monologues: A Voice from the Edge. Its tag says, The average of seven years to receive accurate diagnosis is unacceptably high.

Damn straight it is! The article is about how to improve that rate, or at least to improve the odds for the people who follow its suggestions.

This popular journal chose to place the article in its Essential Reads section on its bipolar resource page. The article's key points include:

• Bipolar disorder, particularly Type II, is often misdiagnosed.
• People tend to spend much more time in a depressive state and often do not recognize mild or hypomanic symptoms.
• The chance of getting properly diagnosed is increased by using online screening tools and bringing family/friends to doctor visits.

I spent a mere (!) five years misdiagnosed with major depression, two of them taking the antidepressants that threw me into mixed episodes and made me suicidal. A random conversation on an airplane led me to the Mood Disorder Questionnaire referenced in the Psychology Today article. Taking the MDQ was the first step to discovering my bipolar and, more importantly, getting on the road to recovery.

So the exciting thing is that this information will be accessible to a larger audience than those of us who go poking around medical journals. That is my mission. Contact me on my website if I can speak to your book club, church group, or fraternal organization about mental illness and recovery.

The ironic thing? -- The photo the magazine chose to accompany the article.

On the Road Again for NAMI: No Cougars Encountered

NAMI and I go way back. I don't even know when or how I heard of this organization, the nation's largest grass roots organization dedicated to building better lives for the millions of Americans affected by mental illness. But it has walked beside me for thirteen years now, as I have tried to build my own better life.

NAMI began in 1979, when some Wisconsin parents of people with schizophrenia pushed back against the prevailing theory of the day, that they had caused this terrible disease in their children. They aligned their new organization with the view that schizophrenia is an illness of the brain, and a commitment to support research into medical approaches to alleviate this and other mental illnesses.

NAMI provides advocacy, education, support and public awareness. My own life has been touched by NAMI through their Peer to Peer classes and support groups. My wife attended Family to Family classes. In the last ten years, these core programs have expanded to address other needs.

So most years, I have participated in their annual fund raiser, the NAMIWalk. For the first few years, I walked with NAMI Johnson County in Iowa City, with Team Prozac Monologues. It was a party affair, kicked off with balloons and Middle Eastern dancers and roller derby demonstrations. And t-shirts, always t-shirts.

This year we did it DIY. COVID cancelled the big events. We all walked our own routes.