Updated benzodiazepine boxed warning: What you need to know

“I took the medication only as prescribed,” Bobbi said. After her benzodiazepine was stopped abruptly, she suffered multiple disabling neurological symptoms, including seizures, cognitive and visual impairment, difficulty walking, and hand contractures, leaving her unable to work. Bobbi is one of many patients my advocacy organization helped report their harm to the FDA. Our goal was to raise awareness of the adverse effects of benzodiazepines and advocate for stronger warning labels.

Thus, I was pleasantly surprised last September to see the FDA’s drug safety communication announcing an update to the boxed warning for benzodiazepines “to address the serious risks of abuse, addiction, physical dependence, and withdrawal reactions.” Curious, I filed a FOIA request for the FDA’s 175-page report on benzodiazepines. Many of the document’s conclusions raise the same concerns benzodiazepine safety advocates have had for decades.

updated benzodiazepine boxed warning: What you need to know — https://www.kevinmd.com/blog/2021/03/the-updated-benzodiazepine-boxed-warning-what-you-need-to-know.html

I downloaded the FDA report for future reference.

The report should be fun weekend reading.

Midlife Crisis? Just Another U Shaped Curve

Subsequent research discovered that this age-related U-shape in job satisfaction is part of a much broader phenomenon. A similar midlife nadir is detectable in measures of people’s overall life satisfaction and has been found in more than 50 countries. On average, life satisfaction is high when people are young, then starts to decline in the early 30s, bottoming out between the mid-40s and mid-50s before increasing again to levels as high as during young adulthood. And this U-curve occurs across the entire socio-economic spectrum, hitting senior-level executives as well as blue-collar workers and stay-at-home parents. It affects childless couples as well as single people or parents of four. In short, a mid-career crisis does not discriminate.

Why So Many of Us Experience a Midlife Crisis Harvard Business Review Hannes Schwandt — https://getpocket.com/explore/item/why-so-many-of-us-experience-a-midlife-crisis?utm_source=pocket-newtab

This post originally appeared on Harvard Business Review and was published April 20, 2015. A link popped up on my browser webpage.

U shaped curves are everywhere.

Why PTSD May Plague Many Hospitalized Covid-19 Survivors — Smithsonian Magazine

Scientists warn about the likelihood of post-traumatic stress disorder for patients discharged from the intensive care unit.

Covid-19 isn’t the first epidemic to cause a domino effect of persisting psychiatric health problems across a population. The current pandemic has been compared to the severe adult respiratory syndrome (SARS) outbreak in 2003 and the Middle East respiratory syndrome (MERS) outbreak in 2014 in Saudi Arabia—both diseases caused by coronaviruses. In an analysis of international studies from the SARS and MERS outbreaks, researchers found that among recovered patients, the prevalence of PTSD was 32.2 percent, depression was 14.9 percent and anxiety disorders was 14.8 percent.

Why PTSD May Plague Many Hospitalized Covid-19 Survivors — Science | Smithsonian Magazine

The entire article is worth reading. And from The BMJ probable PTSD in hospital workers too.

Nearly half of intensive care unit (ICU) and anaesthetic staff surveyed for a study reported symptoms consistent with a probable diagnosis of post-traumatic stress disorder (PTSD), severe depression, anxiety, or problem drinking.1

The preprint, produced by researchers at King’s College London, aimed to get a picture of the rates of probable mental health disorders in ICU and anaesthetic staff in six English hospitals during June and July 2020.

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n108 (Published 13 January 2021) BMJ 2021;372:n108

Every Day is an Emergency – Psychiatric Bed Shortages Nationwide

The pandemic and the parallel economic crisis have fueled new concern about access to mental health care. An estimated 40% of American adults are have a condition involving mental illness or substance abuse. In June, federal health officials reported nearly 11% percent of adults surveyed seriously considered suicide during the past 30 days.

‘Every day is an emergency’: The pandemic is worsening psychiatric bed shortages nationwide — https://www.statnews.com/2020/12/23/mental-health-covid19-psychiatric-beds/?utm_campaign=rss

We are just ten months into the Great Pandemic and I fear conditions will get worse before they get better.

Personality Traits Linked to Toilet Paper Stockpiling

The most robust predictor of toilet paper stockpiling was the perceived threat posed by the pandemic; people who felt more threatened tended to stockpile more toilet paper. Around 20 percent of this effect was also based on the personality factor of emotionality — people who generally tend to worry a lot and feel anxious are most likely to feel threatened and stockpile toilet paper. The personality domain of conscientiousness — which includes traits of organization, diligence, perfectionism and prudence — was also a predictor of stockpiling.

Max Planck Institute for Evolutionary Anthropology. “Personality traits linked to toilet paper stockpiling: High levels of emotionality and conscientiousness are indicators for stockpiling behavior.” ScienceDaily. http://www.sciencedaily.com/releases/2020/06/200612172227.htm (accessed November 25, 2020).

In case you haven’t noticed it’s happening again. Where’s the toilet paper?

Diets Don’t Work so Why Are More Teens Dieting?

Well, my first thought was Body Dysmorphic Disorder (BDD) — https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd. But this is merely an educated guess from an insurance guy who has lost 200 pounds and not a trained licensed practicing clinical psychiatrist.

In 2015, 42% of 14-year-old girls and boys said they currently were trying to lose weight, compared to 30% in 2005.

Lead author Dr Francesca Solmi (UCL Psychiatry) said: “Our findings show how the way we talk about weight, health and appearance can have profound impacts on young people’s mental health, and efforts to tackle rising obesity rates may have unintended consequences.

“An increase in dieting among young people is concerning because experimental studies have found that dieting is generally ineffective in the long term at reducing body weight in adolescents, but can instead have greater impacts on mental health. We know, for instance, that dieting is a strong risk factor in the development of eating disorders.”

University College London. “Dieting and weight worries on rise in teens.” ScienceDaily. http://www.sciencedaily.com/releases/2020/11/201116112855.htm (accessed November 21, 2020). — https://www.sciencedaily.com/releases/2020/11/201116112855.htm

And in case you made it this far on this blog post my estimated BMI at age 20 was 53.1. My current BMI is 25.1.

ADHD, financial distress, and suicide in adulthood: A population study

Abstract

Attention-deficit/hyperactivity disorder (ADHD) exerts lifelong impairment, including difficulty sustaining employment, poor credit, and suicide risk. To date, however, studies have assessed selected samples, often via self-report. Using mental health data from the entire Swedish population (N = 11.55 million) and a random sample of credit data (N = 189,267), we provide the first study of objective financial outcomes among adults with ADHD, including associations with suicide. Controlling for psychiatric comorbidities, substance use, education, and income, those with ADHD start adulthood with normal credit demand and default rates. However, in middle age, their default rates grow exponentially, yielding poor credit scores and diminished credit access despite high demand. Sympathomimetic prescriptions are unassociated with improved financial behaviors. Last, financial distress is associated with fourfold higher risk of suicide among those with ADHD. For men but not women with ADHD who suicide, outstanding debt increases in the 3 years prior. No such pattern exists for others who suicide.

Science Advances 
30 Sep 2020:
Vol. 6, no. 40, eaba1551
DOI: 10.1126/sciadv.aba1551 — https://advances.sciencemag.org/content/6/40/eaba1551

Here in the US we’ve seen an steady increase in ADHD diagnoses.

ADHD diagnosis throughout the years: Estimates from published nationally representative survey data — https://www.cdc.gov/ncbddd/adhd/timeline.html

And an alarming increase in suicide.

https://www.nimh.nih.gov/health/statistics/suicide.shtml

Then my mind wanders to drugs (to drugs, not due to drugs).

To summarize, the psychiatric side effects of methylphenidate are quite similar to those of cocaine and amphetamines, giving more support to the idea that almost all CNS stimulants will produce a similar clinical picture. A person using cocaine can experience nervousness,57,58 restlessness,58 agitation,57 suspiciousness,60 paranoia,61–63 hallucinations and delusions,61,63 impaired cognitive functions,64 delirium,65 violence,57,58,62,65,66 suicide,67 and homicide.67–70

Methylphenidate Abuse and Psychiatric Side Effects — http://Prim Care Companion J Clin Psychiatry. 2000 Oct; 2(5): 159–164. doi: 10.4088/pcc.v02n0502

I just hope I’m wrong.

Anti-psychotic Added to Antidepressant Linked to Higher Mortality

The current investigators analyzed national healthcare claims from the US Medicaid program from 2001 to 2010 for 39,582 Medicaid beneficiaries (mean age, 44.5 years; 78.5% women) diagnosed with depression. Patients with alternative indications for anti-psychotic therapy, such as schizophrenia, psychotic depression or bipolar disorder, were excluded.

After a period of at least 3 months of treatment with a single antidepressant, more than half of the patients (56.6%) augmented their treatment with one of these atypical anti-psychotics: quetiapine, risperidone, aripiprazole or olanzapine. The remaining patients (43.4%) added a second antidepressant. The average chlorpromazine-equivalent starting dose for all atypical anti-psychotics was 68 mg/day, which increased to 100 mg/day during follow-up.

A total of 153 patients died during 13,328 person-years of follow-up, including 105 who augmented with an atypical anti-psychotic and 48 who augmented with a second antidepressant.

Compared with those who added a second antidepressant, those who added an anti-psychotic had a 45% increased risk of dying during follow up (adjusted hazard ratio,1.45; 95% CI, 1.02 – 2.06).

Antipsychotic Added to Antidepressant Linked to Higher Mortality – Medscape – Oct 07, 2020. https://www.medscape.com/viewarticle/938707?src=rss#vp_1

‘Staggering’ Increase in COVID-Linked Depression, Anxiety

Since the start of the COVID-19 pandemic, there has been a dramatic increase in depression, anxiety, psychosis, and suicidality, new research shows.

The most profound health problems were found among adults younger than 25 years. Roughly 90% screened positive for moderate to severe depression, and 80% screened positive for moderate to severe anxiety.

One of the most alarming findings was that in June, 25,498 participants who screened positive for depression reported thinking of suicide or self-harm on “more than half of days to nearly every day.” A total of 14,607 participants said they had these thoughts every day.

‘Staggering’ Increase in COVID-Linked Depression, Anxiety

Sadly, not surprising.