- kaleidoscope game
- The Transfer Book. Helpful for college students thinking of transferring.
- Some medical schools have trouble disclosing their disclosure policies! In the case of an NPR show The Infinite Mind, which I liked, the founder, Frederick Goodwin, whom I took seriously, “received over a million [undisclosed] dollars from pharmaceutical companies to give promotional talks.” Details. This is especially horrifying because Goodwin co-authored the “bible” of bipolar disorder research. His influence is great. His co-author was Kay Jamison, who writes a lot about the subject for popular audiences. To me, she’s now tainted by association.
- Robert Woodward, the great chemist. A terrific biographical essay.
Category: mood disorders
Morning Light Self-Experimentation
A 25-year-old Toronto accountant blogs:
A few weeks ago my parents came downtown to take me out for dinner. Apart from leftovers, my dinosaur garbage can and a few pieces of mail, they also brought my Ikea lamp. Now my apartment is very small. It’s a bachelor with about 600 square feet. It faces south and gets a fair amount of light during the day, which is fine during the weekends. But during the week when I’m at home — in the morning and at night — it can get pretty dark.
Now enter my Ikea lamp. The first morning after receiving it I turned it on along with all my other lights, while getting ready for work. I noticed a few things that day. One, I wasn’t angry during my commute via the subway. If you’re not from Toronto you won’t get this. But if you are and you ride the rocket each morning, then you’ll understand the general expression of, “angry defeatism” on most commuters’ faces. My lack of hate was personally noticeable. I also noticed that I didn’t need my usual green tea when I got into work. Even crazier I was alert when I got in, the type of mental alertness that often doesn’t show up until roughly 11 am.
I really thought about this for a while. I couldn’t figure it out until I remembered this post by Seth Roberts. It’s very short. I thought about it for a few days and made a little experiment. I went from turning on all my lights every morning to a few, to none. My “awakeness” varied positively with the quantity and duration of morning light. Along with morning light, I’ve also found that having the TV on and taking Vitamin D amplifies this effect.
It’s not a small impact. It’s had a huge effect on my day-to-day.
I left a comment asking what the Ikea lamp was. One interesting thing about this was the exposure time. Judging from a comment (see below), it was about an hour. That’s the minimum I try to get early every morning (from sitting outside).
After I bought the absolute necessities for my Beijing apartment (bed, water heater, washing machine, etc.), my first optional purchase was a chair for the balcony. So I can sit on the enclosed balcony in the morning.
Even More Room For Improvement at the NY Times
In a widely-emailed article about depression, Judith Warner, a former columnist at the New York Times, writes:
This is the big picture of mental health care in America: not perfectly healthy people popping pills for no reason, but people with real illnesses lacking access to care; facing barriers like ignorance, stigma and high prices; or finding care that is ineffective.
When Atul Gawande fails to mention prevention in a discussion of how to improve American health care . . . well, he’s a surgeon. Of course he has gatekeeper syndrome. What’s Judith Warner’s excuse? Judging from this article, the notion that depression might be prevented has not occurred to her.
Depression and Insomnia Linked at CureTogether
Fourteen years ago I woke up one morning and felt really really good: cheerful, eager, and yet somehow serene. I was stunned: There was no obvious cause. I hadn’t slept particularly well. Nothing wonderful had happened the day before. But there was one thing . . . the previous day I’d watched a tape of Jay Leno right after waking up. I’d thought it might improve my sleep. Now — a day later — my mood was better. Could there be a connection? Two very rare events: A (TV early in the morning) and B (very good mood upon awakening). Did A cause B? Such causality would be far different than anything we’re familiar with. Yet it made some sense: From teaching introductory psychology, I knew that depression and insomnia are related. If you have one you are more likely to have the other. I had done something to improve my sleep; had it improved my mood? The already-known depression-insomnia linkage made the new idea, the cause-effect relation, far more plausible. Subsequent experiments led me to a whole new theory of mood and depression.
CureTogether has found another example of the familiar depression-insomnia correlation. Persons with depression are twice as likely to have insomnia as persons without depression. CureTogether gathered this data much more cheaply than previous studies. Unlike previous researchers, they were under no pressure to publish. (Professional researchers must publish regularly to keep their grants and their job.) Unlike previous researchers, they were under no pressure to follow a party line.
On the face of it depression makes you less active. Yet insomnia is a case of being too active. So the depression-insomnia link is far from obvious. Lots of other facts connect depression and circadian rhythms; they all suggest that the intellectual basis of anti-depressants, all that stuff about serotonin and neuro-transmitters and re-uptake, is wrong. If depression is due to messed-up circadian rhythms, taking a drug at random times of day is unlikely to fix the underlying problem.
More About Faces and Mood
A friend with bipolar disorder writes:
When I wrote in your blog that I use your discovery daily, it means that every day I look in a mirror for an hour, starting at approximately 6:30 a.m. I have the mirror about 20 inches from my face because I have read that a mirror image is half the size of the object reflected. [Life-size faces appear to work best. Using a mirror means the face you see is perfectly life-size, allowing for distance. TV faces can be larger or smaller than life-size.] To keep from being bored while looking at my face in the mirror, I mostly listen to tapes of C-SPAN programs. Sometimes I listen to music. Once or twice a week I may just think, or plan my day. That does get boring after about 30 minutes.
Sorry, I definitely was exaggerating when I wrote “doctors are amazed”. “My doctors” refers only to my psychiatrist and psychotherapist; at best, they seem “impressed” by my condition. My therapist regularly says that I’m doing “great”(variously referring to social relations, self-awareness, and general functioning) — “especially considering my situation“ and my psychiatrist once exclaimed that my bipolar disorder was in “complete remission”, albeit when we were composing an online personal ad. I do think both of them are at least mildly surprised that I seem to be doing alright on half the standard therapeutic dose of Depakote, and a low dose of Prozac.
There was an actual experience that weakly supports my claim about practitioners having no interest in utilizing your idea. I once asked my therapist to suspend his disbelief, and just imagine that your treatment does work as a strong antidepressant. Then would he mention the treatment to his other patients, or give a talk at a conference, or write up a report, or tell his colleagues? In all cases, he said “no”. Although he agreed that ideas for clinical trials have to come from somewhere, evidently that somewhere was not part of his concern.
I stress that my therapist is compassionate and reasonably intelligent, and he has helped me deal with many important practical problems. And of course in your blog even you have admitted that your idea, on the face of it, sounds way too crazy. It’s to my therapist’s credit that he claims to believe your treatment works to some degree — adding positively, “whatever works for you”. Unfortunately, that addition implies that your treatment is somehow working “psychologically” for me (e.g., as a kind of meditation) rather than working “biologically” in a way that, presumably, would work for most people.
If my doctors were following my particular case as closely as they pretend to, then they ought to be amazed. Instead, my sense is that they see me through the lens of their diagnosis. Without actually dismissing the sheer statistical improbability of my having been off of drugs and without a hospitalization for four years, they do seem to forget that fact when we discuss drug therapy. When I mention those four years, they sometimes play the skeptic, offering up alternative possibilities: it was a fluke, or I was in remission anyway, or something else. I don’t try anymore to persuade anyone, not even family, about the treatment — it’s not worth the effort.
I suppose the bigger picture is that there is little credibility to the testimony of a bipolar person who has experienced psychosis. (Perhaps my case is not helped by dramatic pronouncements of mine such as, “History will judge you. People will wonder, “why didn’t they listen to him?”) Too, I’m not paying my doctors enough to get lengthy consultations. If I were paying enough, and if I made the case with details to my psychiatrist, she might be persuaded that there is a big effect. She has a high opinion of you; in fact, she’s the person who told me of the report in The SF Chronicle (5/30/06) about the SLD diet. And, she gives some credence to Dr. Stoll’s results with omega-3 for treating bipolar. Nevertheless, for what it’s worth, I would stand by my original opinion about her not changing her practice.
“Very Happy”
To see faces early in the morning, I have a one-hour Chinese lesson every day at 6 a.m. Today my teacher said, “I feel very happy.”
“Why?” I asked.
“I don’t know,” she said.
“It’s because you see my face every morning,” I said.
“No, it isn’t that,” she said.
Hidden Bonus of the L Prize: Better Sleep, Better Mood
The Department of Energy has a prize, called the L Prize, for a new light bulb that gives off same light as a 60-watt incandescent bulb but uses much less energy. Philips has submitted what it believes will be the winning entry. For the last decade, I’ve tried to avoid fluorescent lights at night. Ordinary fluorescent lamps emit light with far more blue than incandescent lamps and mess up my circadian-timing system. That systems appears insensitive to incandescent light. Squirrels are like me, a study suggests.
Fluorescent lights are close enough to sunlight to affect our circadian system; incandescent lights, being much cooler than the sun, are invisible to it. The timing of exposure matters if it varies from day to day; exposure to fluorescent lights at varying times is like travelling back and forth across time zones. Everybody grasps that travelling across time zones makes it hard to sleep at the right time; what is less understood is that time-zone-crossing travel affects the depth of sleep because it reduces the amplitude of the circadian oscillation. If you are exposed to fluorescent lights at night now and then, you will sleep less deeply. So I try hard to avoid fluorescent lights at night. I avoid supermarkets and subways, for example.
I discovered all this when I discovered the effects of morning faces on my mood. After I travelled back and forth across time zones, the effect took three weeks to fully return. Nothing else had changed. I conclude that it took three weeks in the same place for my circadian oscillator to return to maximum amplitude. And one evening in which I was exposed to an hour of fluorescent light was enough to get rid of the faces effect for a few weeks. The ubiquity of fluorescent lighting has made it hard to study this effect in other people.
Charles Nemeroff Under Scrutiny
For most of its existence, there was no letters section in The New Yorker. A big mistake, which Spy pointed out and made fun of by running Letters to the Editor of The New Yorker. The current version of The New Yorker has letters, of course, but no comments on the web. Another big mistake.
Because those comments can be incredibly good. In its Health Blog, the Wall Street Journal website recently posted news about Charles Nemeroff, the Emory University psychiatry professor who failed to disclose about a million dollars from drug companies. The news itself wasn’t anything special but the comments told me important stuff I hadn’t known:
- What his defenders say. (Not easily summarized.)
- The nature and quality of his research. “Regarding Dr. Nemeroff’s contributions to science, although he has published many papers, a large proportion have dealt with the hypothesis that the adrenal hormone cortisol plays a major role in the etiology of depression. This hypothesis has its proponents, but has not gained widespread support from experimental or clinical data. Drugs designed to inhibit cortisol have been disappointing as treatments for depression. Hence, regardless of any ethical issues surrounding his career, his publications have been numerous, but with low impact on advancing science and on actual clinical outcomes. Actually, it’s a sad commentary on how really difficult it is to understand the biology of mental illness that individuals such as Dr. Nemeroff who conduct rather mediocre scientific work are considered major contributors to the field.” You can read a thousand outraged editorials and blog posts about Nemeroff and not find something this revealing. Without anonymity, it is very hard to say something like this.
- Complete refutation of one of Emory University’s comments. “Emory said its review supports Nemeroff’s contention his lectures weren’t product specific.” WHAT….I worked in pharma sales years ago specifically selling SSRI’s. Nemeroff was WELL known for SPECIFICALLY selling Paxil in his presentations. He was GSK’s Paxil hit man.” So much for Emory’s credibility.
- A surprising suggestion. “Disclosure alone is not going to do that. These are amounts of money that even if Nemeroff had properly disclosed would be unethical -it can’t be right that a Prof is paid 300 K a year for a full time job and get 500 K in addition from drug companies – even IF it was disclosed. Patients will do well in asking their physician to post or tell them about such additional moneys – and should vote with their feet since there are many honest people, though less powerful, in the field as well.”
- A comment on the real cost of people like Nemeroff. “Anon asks, “Who among the bloggers is familiar with his work, conversant with his research, actually read his papers?” I have, and I don’t trust much about what he says in any of his pharma-related articles. Indeed, I have challenged his findings in letters to the editor. The saddest part of this entire scenario (Nemeroff and others) is the wreckage they have strewn throughout our scientific literature in the past 10-15 years.”
Supporting what I said about letters to the editor. The truth about Nemeroff’s research (and by extension a vast swath of psychiatric research) was in the letters to the editor. But a letter to the editor is just one person — and usually these letters can’t be anonymous. This discussion is many people, it’s a discussion, it’s anonymous, and it’s easily available. The emotion expressed — because people can comment quickly and informally — makes the whole thing easy to read.
This is a wonderful age we are living in, that so much nuanced and well-informed comment is available. Never before, not even close. Merry Christmas!
Professor Charles Nemeroff Predicts the Future
The case of Charles “Disgraced” Nemeroff, the Emory University professor of psychiatry, is a touchstone in the sense that it reveals something about the morals (or lack thereof) of those who brush against it. That GlaxoSmithKline (which called Nemeroff “a recognized world leader in the field of psychiatry”) is amoral we already knew — a kind of positive control. The responses of Emory dean Claudia Adkison (“ grateful” that a reporter didn’t know enough to fully expose Nemeroff) and the Emory administration (which called him “a leader in psychiatric research, education, and practice”) are more interesting.
But Nemeroff is also a touchstone in reverse. Not only can we learn about X and Y by seeing how they react to Nemeroff, we can also learn about X and Y by seeing how Nemeroff reacts to them. In a 2006 New Scientist series called Brilliant Minds Forecast the Next 50 Years, Nemeroff wrote this:
In the next 50 years, we can expect several breakthroughs. Identifying gene variants that confer vulnerability [to major psychiatric disorders] will result in the emergence of a new field, preventative psychiatry. Elucidating the causes of mental illness will lead to novel treatments. We will also see breakthroughs in understanding the biology of resilience, now poorly understood. And in contrast with our largely trial-and-error-based system, treatments will be individualised, based on genomics and brain imaging.
That Nemeroff likes these ideas suggests they are wrong. Supporting what I’ve said earlier.
What Does It Say About Psychiatry?
It isn’t just GlaxoSmithKline (who called Emory professor Charles “Disgraced” Nemeroff “a recognized world leader in the field of psychiatry”). It’s also the Emory University administration. According to a presumably well-thought-out statement:
Dr. Nemeroff is recognized internationally as a leader in psychiatric research, education and practice. He has made fundamental contributions to the field over many years.
What this says about the moral compass of the Emory administration is clear — that they are unable to grasp the awfulness of what Nemeroff did. (As Emory dean Claudia Adkinson revealed in spades.) If they did, they wouldn’t spend a millisecond defending him. The harder question is: What does this say about psychiatry?