30 March 2015

mental health mondays :: the plane truth

here we go again. it's sad enough to hear that nearly a hundred and fifty people died at the hands of an individual unwisely entrusted with a a potential missile, but now we get to observe the media circling and waiting for confirmation that the man who may have murdered them had a mental illness. and what a grotesque spectacle it is, because it basically consists of nothing but ominous insinuations that this co-pilot was depressed and so he flew a plane into a mountain, without trying to provide any larger context about the disorder or the millions of people who suffer from it.

to be clear, i don't have a problem with his apparent record of depression being brought up as a possible explanation for what happened. it's possible that there is a link. but smashing a plane full of innocent people into a mountain is not the act of someone who is merely depressed. there is a whole other level of illness going on there and, with the information we have thus far, it seems disturbingly like multiple doctors over a period of years may have missed this. that is the real story about mental disorders here.

most of what we've heard about the co-pilot of the germanwings flight is circumstantial evidence. we know that he sought psychiatric help during the time that he was training to become a pilot. the media have reported that he was treated because of suicidal tendencies [e.g.], however what's actually been said is that there was a note about suicidal tendencies in his file. that might seem like the same thing, but it isn't. asking depressed patients if they ever think about suicide or self-harm is a standard part of  a psychiatric exam; a note on his file could mean that he was actively contemplating or had attempted suicide, or it could mean that he simply answered a standard question "yes, i've thought about it". there's a broad range there.

the media also jumped on reports that he hid an illness from his employers, immediately hinting that it might have been depression. more recently, however, it's emerged that he may have had a detached retina, a serious threat to his vision and, hence, his career. i'm certain that there are people who feel compelled to hide mental illness from their employers, and many who simply don't mention it, but it seems to me that concealing an illness is something that one does because one feels their livelihood could be threatened. [as an aside, you might notice in the linked article a line that says it's unknown whether his vision problems were due to physiological or psychological reasons. i need clarification on how exactly a psychological illness can cause retinal detachment. i did find reports of two patients who suffered retinal detachment after taking topiramate- used to treat both epilepsy and bipolar disorder- but that's hardly conclusive and furthermore, a drug reaction does not constitute a "psychological cause". and fyi, there are lots of drugs that are known to cause vision problems including retinal detachment, including drugs for prostate and bladder problems, male pattern baldness, and antibiotics.]

last night, i saw that journalist/ media personality piers morgan got in a twitter-scrap with a number of people for stating that depressed people shouldn't be flying airplanes. [is it starting to look like i'm obsessed with piers morgan? because i'm not. no, really. not at all. stop thinking those things at me.] i reflexively disagreed with him, although i feel a little hypocritical doing so, because i do believe that there should be restrictions placed on people diagnosed with some mental illnesses owning guns [more to protect them from themselves]. but i think that it opens a dangerous door when you start barring certain avenues of employment to people with mental disorders. if we start limiting career choices based on the [false] premise that anyone with a mental disorder can be dangerous to others, what's to stop insurance companies from increasing rates for any company that employs someone who has had a mental disorder? and if you're a company, why would you even hire someone with a mental disorder, if you believe that they could represent a danger to your business and your employees? and what's the time frame for diagnosis? mental illnesses are often temporary and sometimes they come and go. so how far into your past is an employer allowed to peer before being reassured that you aren't going to become depressed again? [for those who would field an argument like "we don't let blind people drive taxicabs", recognise that the situations are totally different. blindness is a condition that renders a person physically incapable of executing a taxi driver's duties. a closer analogy- although still flawed- would be whether a construction company could refuse to hire a left-handed person because they're more prone to accidents using standard tools.]

one much-reported tidbit is that one of the co-pilot's ex-girlfriends [and for the record, if i'm ever subject to media scrutiny, i would like for my exes not to be a major source of information] has said that he told her that he would one day do something big, something for which he would be remembered. while the media has held this up as indicative of a long-standing mental illness, they've completely missed one crucial fact: these sorts of statements are not typical of depressed people. such a statement seems to indicate that he suffered from delusions of grandeur and possibly, if we choose to believe that there was a sinister meaning behind his words and we assume that he wasn't just planning to build a clean-energy motor or be the first man to pilot planes on the moon, sociopathy. by linking this woman's recollection with his depression, the media has lost an opportunity to talk about the complexities of mental illness, something that would be both timely and useful.

i would like to know more about this man's mental state. i'd like to know if any of the therapists he was seeing believed that there was something wrong with him that wasn't explained by depression. i'd like to know if the rumours of his vision problems were true and, if so, if that made him angry and if he blamed others for his problems. i'd like to know what his work environment was like- whether he was getting adequate time between flights, if he had had confrontations with coworkers or management and, if so, how those affected his mental state. i'd like to know what sorts of services are offered publicly or by employers for people who have high-stress jobs. if it's determined that he was depressed, i'd like an investigation into why he did something so atypical of depressed people. but i don't think that any of that is going to happen.

the media will likely continue to talk about him as "depressed" and nothing else until a more interesting story or angle distracts them, at which point they'll stop talking about him at all. average people will subconsciously internalize the belief that while not all depressed people are dangerous, any of them can be dangerous [and when it comes to policy-making, there's no meaningful difference between "all" and "any"]. saddest of all, the families of the co-pilot's victims will be denied a proper accounting of what caused the deaths of their loved ones. instead, they'll be left with a facade of specious reasoning and the dissatisfying assurance that there is nothing that can be done to stop a "lone nut".

source for the photo above.

28 March 2015

making faces :: dior's baumeshell

b is for balm
i'm happy not to have to go into an office that relies on central air anymore, since having to do so meant that i spent great portions of the year almost unable to talk or smile because my lips were so dry. that said, the cold outside and the heat inside have still had enough of an effect that i've been on the lookout for some products that will wrap me in their tender embrace, promise never to hurt me and give me all the comfort i so desperately need. [because we all need products to do that, don't we?]

because i can't get anything right, a lot of lip formulas that are touted as "moisturising" have exactly the opposite effect on me. chanel's rouge coco shine formula is hit or miss with me. yves st. laurent's rouge volupté is harsher on my lips than sandpaper and salt [i suspect that's at least partly an allergic reaction to something]. so when i heard that dior had come out with a new range of tinted balms- or "baumes" since everything sounds fancier in french- i went through the full gamut of emotions: i could really use something soothing; it would be nice if the colour on these amounted to something for the price; it's a new lip product, which means i must have it; i hope my lips don't fall off.

i'm sure that everyone goes through this.

as usual, i made myself choose one colour to try out. at first, i was drawn to the berry-toned nuit rose and fleur bleue, but since i always start there, i decided to take a chance on "coquette", a brightened reddish pink that makes a good everyday shade for a girl who can carry pretty saturated colours. i was pleasantly surprised to find that the dior baumes have a considerable amount of pigment that lasts very well. they're not as opaque as the armani rouge ecstasy formula [one which i find works extremely well to condition and soothe my lips], but they're more pigmented than dior's own "addict" lipsticks. the pigmentation is similar to the "superpowered" chanel rouge coco shines, where they upped the colour saturation. there's still a little translucency, which means that your lip colour will have an effect, but it won't look like a sheer wash.

coquette

in the case of coquette, i realised that the colour is closer than i thought to armani's rouge ecstasy in "dolci" [this has happened before]. the two look different on the lips because "dolci is a bit more muted, a touch deeper and more matte. 

l to r :: coquette, armani dolci
i've worn "coquette" a lot recently [i've had it for longer than i care to admit and just kept forgetting to review it] and have been mightily impressed. on almost every occasion, my lips felt better as the day wore on. the difference wasn't huge, but i could sense it. nicer still, the pigmentation lasts really well, owing to the fact [i think] that the consistency is more like a balm and less like a gloss; it's not excessively slippery. that also means that it's very easy to get even coverage, which is important if you don't want to look like you were made up by a drunk. i didn't experience any feathering, even when my lips were in rough shape. the one time i wore this with very chapped lips, i felt like it didn't do me any good, but didn't do any harm either. it felt a lot better than any other formula except rouge ecstasy and while it faded much faster, it didn't bleed or emphasize lines.

i'm definitely planning to pick up more of these little marvels, especially since bright, not-quite-opaque colours always seem suited to summer weather for me. in typical dior fashion, there are a lot of pinks and nudes to choose from, with a few bursts of red and fuchsia. the brights do indeed seem quite bright, so don't choose them thinking that you'll get a watered-down version of the shade. i'd recommend swatching these in person if you possibly can since, as i said, your own colouring will affect the final result and i find that some of the online preview images are misleading. [i should say: more misleading than usual, since the swatches shown on retailer websites are not known for their fidelity.]

here's a look at my little coquette in action...





products used

the base ::
nars luminous weightless foundation "mont blanc"
nars radiant creamy concealer "vanilla"
mac paint pot "painterly"

the eyes ::
marc jacobs e/s palette "the glam" [warm cream, shimmery copper, shimmery warm brown]
mac e/s "creamy bisque" [soft neutral highlight]*
stila stay all day e/l "lionfish" [warm shimmery brown]
dior new look mascara

the cheeks ::
mac powder blush "devil" [intense deep orange]
hourglass ambient lighting powder "diffused light" [barely yellowed white]

the lips ::
dior rouge baume "coquette" [reddened rose pink]

*suggested alternate :: creamy bisque = mac dazzlelight [lighter, more shimmery]

the rouge baume formula is permanent [although colours that appear with particular collections will be limited] and is available at dior counters everywhere, as well as at sephora and [if you're canadian] shoppers drug mart.

26 March 2015

world wide wednesdays meets throw-back thursday :: you again?

i was more than a little surprised this week to hear news of brewing troubles in the falkland islands. it seems that tensions are once again surfacing on the tiny archipelago in the south atlantic, with a new player in the mix. i say "again", because the only time i [and probably a lot of others] remembering being alerted to the existence of the falkland islands was over thirty years ago when argentina and great britain very briefly went to war over the them, until bill o'reilly descended from the sky and brought everlasting peace. or something. [ok, o'reilly never claimed to have brought peace to anything, but he did claim that he was a correspondent during the two month conflict, which let him see war up close, something that, on closer inspection, turns out to have been utter bunk. more recently, o'reilly has claimed that he never said he was in the falkland islands, a claim which right-leaning fact-checkers politifact rate as "half-true", since he referred to being in the falklands "war zone", which could be interpreted as meaning a broader area than the islands themselves.]

the current dispute is basically the long-postponed sequel to the original, which saw argentina surrender after just a couple of months, but things are different because this time, argentina has some bigger guns [literally and figuratively] backing them up: russia has publicly questioned britain's claim to the islands and may have started arming argentina in anticipation of a second conflict over ownership of the islands. it also allows russia to thumb their nose at great britain for implying that russia had no claim to the crimea [we talked about this], while continuing to "occupy" the falklands thousands of miles away. it does seem kind of weird that the british would get so wrapped up in a conflict over a tiny community made up chiefly of penguins and sheep, but as we'll see, the falkland islands are kind of a weird place to begin with.

for starters, the islands are the rarest of the rare: a new world location that europeans actually did discover. while it's possible that south american tribes visited the islands, there is no evidence of any permanent inhabitants before european explorers arrived in the seventeenth century. and that would be the french, who could probably assert a claim to the territory themselves if they really wanted to. the french called the islands "les malouînes" after the town of st. malo in brittany [a territory we discussed here]. explorer louis antoine de bougainville [who gave his name to the largest island off the mainland in papua new guinea] established a colony there in 1764, while the british established a colony of their own two years later. before the french and english arrived, there was no one living on the islands and the two settlements were so isolated that it seems they may not have even been aware of each others' existence.

that changed when france ceded the territory to spain, who attacked a british settlement and brought the two countries to the brink of a war in the late eighteenth century. but eventually, the two made up and decided to just live like ebony and ivory, side by side in perfect harmony. that colonialist ambivalence towards asserting a claim to all of the islands is an indicator of how little either cared about the archipelago. they fought to the death over territories around the world, but happily shared the cramped space available on the falklands. [side note :: the spanish and, later the argentinians know these islands as the islas malvinas, which is just the spanish version of the original french name. today, they're known as the falkland islands to everyone in the non-spanish speaking world, but officially, if you're speaking spanish, it's proper to call them the malvinas. because everything is less complicated when you give a country two completely different names.]

after a few years, the british got bored and decided that there wasn't really any point to having this strange little crop of rocks so far from home with very limited exploitable resources. they left a plaque behind to indicate that george iii still claimed the lands, but it hardly mattered, since, in the 1770s, george had rather more pressing colonial concerns. the spanish were so excited about having the islands all to themselves that they didn't even bother to take over the former british space. it just sat there and the spanish used their section of the islands as a penal colony until the first decade of the nineteenth century, the spanish decided they had way better things to do than babysit penguins. they closed their garrison on the islands in 1811 and for years the islands returned to their uninhabited state.

in 1816, the united provinces of the rìo de la plata [more or less equivalent to modern-day argentina] staked a claim to all of the former spanish territories in the south atlantic, which is significant not because others cared very much about the falklands, but because it is the genesis of the argentinian argument that the islands should belong to them. when current argentinian cristina fernandez de kirchner attempts to stoke nationalist sentiment by claiming that the falklands have always been part of argentina, she's being disingenuous. the argentinian case is one of geography, not history. that's fine, because national borders are generally based on geography, but de kirchner hurts her own cause by appearing to make claims that are easily debunked.

argentina's only period of sovereignty over the islands came in the wake of the spanish departure, before argentina existed. the government in buenos aires allowed a german immigrant to set up shop on the empty islands and to try to control some of the mercantile activities around them. this worked reasonably well for a few years, until he came up on the wrong side of a dispute with the americans, which is just never a good idea for a small country. the americans were adamant that they didn't want the united provinces governing the islands and so the british returned, mostly just to get rid of the argentinian nationals who had moved in. their argument at that point was that they'd never said definitively that they didn't want the falklands and after all, they'd left a damned plaque. nonetheless, once they had vanquished the argentinian foe, the british didn't seem thrilled that they had their precious south atlantic rock collection back and it wasn't until the middle of the century that there was a move to really, seriously colonise the place. at that point, a number of scots- people the crown were trying to drive out of the country anyway- were wooed to the land with promises of year-round damp weather and plentiful sheep. [side note :: argentina makes the case that the british did absolutely renounce their claim to the islands in the nootka sound convention of 1790 and that they agreed that spain could have them, a claim which argentina contends devolved to them after the spanish left. for their part, the british said that they never relinquished their claim to the falklands, because plaque and that the agreement at nootka only referred to who could start new settlements, not existing ones. furthermore, the british point out that argentina's own national maps, printed twenty years after the arrival of permanent british settlers, didn't include the falkland islands, which indicates that the country wasn't attempting to claim them until much later than they now say.] 

the current population of the falkland islands is almost entirely descended from scottish and welsh settlers who arrived in that wave of immigration and as far as anyone can tell, these people are the only long-term residents of the islands in history. in 2013, the islanders held a referendum on the question of whether or not they wanted to stay part of the british crown and the result was a nearly unanimous "yes". president kirchner dismissed the result as squatters voting to continue occupying a building, but it does raise some interesting questions: is the british claim to the islands wholly colonial? there's no doubt that they first came to the islands as part of colonial expansion, but for once they didn't displace anyone or come into conflict with existing claims, except for those of other colonial governments. since the islands weren't inhabited, are the argentinians any less colonial simply because of their geographical proximity? how long does one have to live in an empty space before one can be considered a "legitimate" occupant?

the problem is, of course, that the heated rhetoric around the falklands has very little to do with the plight of  her three thousand citizens. the falklands have given britain a seat at the table in discussions surrounding antarctica, which could never have been justified otherwise. there has also been a disproportionately vocal lobby on behalf of the falkland islanders in the british parliament, which has perhaps resulted in britain holding onto the dependency a little tighter and a lot longer than they might have wanted to. the presence of a british military outpost so close to the argentinian mainland clearly has the potential to inflame nationalist outrage and both in the early eighties and presently, the argentinian government may have been guilty of using the issue to distract from the country's economic problems. most recently, there is the very tantalizing possibility that there is oil to be extracted from the ocean floor near the falklands, which means that things are likely to get worse before they get better.

the falklands occupy a peculiar spot in geography and history: a territory that is simultaneously wanted and not wanted and one that could be claimed by any number of countries based on history. parts of bolivia, uruguay and brazil were included in the united provinces that originally claimed the falklands when the europeans had left, so in theory, any of those countries has a reasonable argument that the islands belong to them. fortunately, none of them have yet waded into the discussions. spain could argue that they never ceded the islands to anyone, despite having left and since the british case hinges on their claim that leaving a plaque behind in their absence was sufficient to guarantee their continued ownership of at least part of the islands and since the argentinian case hinges on spain never having relinquished control, but simply allowed their claim to fall to their former colony, spain as a plausible argument that the islands have never belonged to anyone but them. ultimately, though, it comes down to a question of people versus placement: do the british win because the people who live on the falklands are overwhelmingly of british decent and continue to identify with great britain? or do the argentinians triumph because the islands sit on their back porch?

if you want to talk about who has the most legitimate claim, of course, it's not the humans you should be asking...

i don't know if we'll get any answers, but i do sense that the questions are going to be asked louder and louder in the coming months.

25 March 2015

almost here...

we're only one week away from the launch of tricky + conversion, my new book featuring a novella and a screenplay in one convenient volume. the book will be available starting wednesday, april 1st from the more like space bookstore. i thought i'd continue the countdown with a little excerpt from tricky to pique your interest [i hope]:

*

Against all the warnings of his body, he struggled into a sitting position and smiled at her. One of those sheepish smiles where you know you’ve done something wrong, but you want that person to like you in spite of it. He covered part of his face with his hand, trying to limit his exposure to the sun, which made her smile again.

“What kind of drugs were you on?”

“I’m not on drugs. I was just drunk.”

“Alcohol is a drug.”

She had him there. For her, there was little distinction between being drunk and being flipped out on PCP and, truth be told, he couldn’t be entirely sure that alcohol was the only thing he had consumed, just that it was the only thing he remembered consuming. He pulled a little closer to her, hauling himself along the grass like a clumsy snake. She didn’t make an attempt to move away, but just watched him struggle with movement, observing his eyes resting on her, the only part of him that was completely still. 

“I lost my friends. We were out together and somehow I got separated.”

She looked at him not exactly with sympathy, but with curiosity. She told him later that he had been the only person she had ever met from whom she had no idea what to expect. And perhaps that is what had made him attractive. Her whole life, she had been sheltered and guided and sure of what to do. She was aware that there were people who did drugs and ignored the word of God and who didn’t care about their fellow man and who lived with people they never married, but she had never wondered about what those people were really like. Until that moment. 

Jared felt something. He knew she didn’t exactly trust him, but he could tell that she didn’t hate him and that she wanted him to keep talking. So he kept talking, because that much he was pretty good at, even while poisonously hung over. He started telling her about how he had ended up on the lawn, but realised he couldn’t remember that much of it. She found that fascinating, the idea that he couldn’t remember what had happened to him the night before, that a period of time could simply be snatched away from you like that. He tried to explain to her what a hangover felt like, but, since he thought that he might actually like to see what she was like when drunk, he played its horrors down to a minimum. It wasn’t so bad. You just woke up confused some times.

*

of course, that's just a small part of what happens, but if you think you'd like to know more, you'll be able to in just a week's time.

p.s. :: will there ever be a wednesday? yes, yes. i said that world wide wednesdays would return this week and they will. but a little late, which isn't that unusual. i'm having a bit of a time keeping up with everything lately. i'm thankful i can remember my name although, truth be told, there are certain times of day when i might have to think about it. 

23 March 2015

mental health mondays :: off the beaten path

i've mentioned before that i get migraines. they invariably sneak up on me in the middle of the night, which is a pain not just because it sucks to start the day with a migraine, but because the only medication my doctors have been able to give me is something that must be taken as soon as you feel the very first symptoms of a migraine coming on. i'm not one of the "lucky" thirty percent of sufferers who get an aura 24-48 hours before a migraine sets in, which means that by the time i'm aware of one, it's already in full force and the medication i have is useless. i gave what i had to dom, who generally gets more advance notice and i've never bothered to get a new prescription.


something that i have done, however, is raid my stash of meds for some form of benzodiazepine. if you have issues with anxiety and panic attacks, doctors will generally give you a prescription for one of these to keep on hand "just in case". personally, they don't do much for me on that front, but i continue to fill the prescriptions for one reason: they're the only thing that offers a little relief when i have a migraine. i can't explain the chemistry behind it; certainly one of the effects of a benzo is that it relaxes you, so it's possible that this in itself does some good. another theory is that, if migraines are a very mild form of epilepsy, benzos might help because they are a mild form of anti-convulsant. either way, they take the edge off.

what i've just confessed to is in a legal grey area. it's my prescription, after all, and i am supposed to be taking it on an as-needed basis, which is what i'm doing. it's just that what the drug is supposed to be needed for and what i need it for are two different things, which is a bit sneaky. that would seem like a bit of a slippery slope to some, but it's actually pretty common, with things like cardiac and asthma medications being used for ulterior purposes. it's most common, however, with psychiatric meds. there are good things and bad things about this, but what's truly disturbing is that it's become so normalized that no one is talking about it.

clear sailing?
in order to be approved to treat anything, drug companies must show that they have conducted various sorts of testing and shown a clear and consistent result that backs the claims they are making. the language of the claims is often very restricted [although companies are not restricted to using only those claims when advertising or promoting a drug]. claims don't just deal with what a drug says it can do, either. testing submitted must also indicate the safest maximum dosage, the length of time a drug can safely be taken and the ages for which it is appropriate. [getting drugs approved for the very old or the very young is a whole separate set of hurdles.] off-label prescribing involves going outside the boundaries of any of these variables.

one study found that 96% of off-label psychiatric prescriptions have no scientific data to back them up, which is troubling to say the least. the most common off-label uses are exceeding the maximum recommended daily dose and keeping a patient on a drug longer than recommended. the logic behind doing this is that the patient hasn't responded well or has responded well: if a patient's symptoms show improvement, but not enough improvement, within the parameters of the recommended dosage, a doctor might decide that the risk isn't sufficiently high and recommend taking more of the drug each day; on the other hand, if a patient has responded well to a drug that has only been proven safe to take for a year, a doctor might want to avoid the disruption and frustration of having to discontinue one set of meds and find another. there isn't data to back these uses up, because once the "safe zone" is established, there's no incentive for pharmaceutical companies to test outside it. there are specific thresholds that must be met when it comes to dosage and duration and once a company has established what those are, they don't test any further. so the doctor is extrapolating the likelihood of something bad happening and weighing the risks and benefits. but that doctor doesn't have any real evidence to back up those extrapolations.

probably the most controversial use of medications is outside the age range for which they are approved. older patients who may be experiencing signs of senility [on top of a mental disorder] or children who are starting to exhibit worrying signs often fall outside the testing parameters used to get a drug approved. brains in "transitional" phases can react quite differently to drugs than those that are, relatively speaking, stable and for that reason, most pharmaceutical companies don't start off applying for a claim that their product can be used for children or the elderly. so a doctor, looking for a solution, may work from the assumption that the drug should do more or less the same thing as it would to a regular adult. [50-75% of psychiatric drugs given to children are prescribed off-label.]

feeling armpathy?
that sounds a bit horrible, but consider the position of the doctor: 80% of conditions described in the diagnostic and statistical manual have no medications that are recommended to treat them. the only "cure" is therapy. that's all well and good, but therapy can take months or years to be effective and most doctors don't want to leave a patient suffering for that length of time, especially since mental disorders have a tendency to disrupt a person's ability to work, sleep, relax or interact with other people. furthermore, there are very few options that are even available for patients in certain groups [children, the elderly, people with certain health conditions], so if those don't work, then the doctor is faced with the choice to abandon drug therapy entirely or try something experimental. makes a good "what would you do?" question, i think.

things get even more complicated when you have a doctor who uses the "logical extension" argument to prescribe a drug off-label. [this is actually what i'm doing with my benzodiazepines.] in this case, the doctor is assuming that if a drug does "x", then it stands to reason that it should be able to do "x + 1". don't worry, that's all the algebra for today. that can mean that s/he uses a drug for a completely different purpose, based on its mechanism of action, or in combination with another drug, understanding that the combination should achieve an end to which either on its own would be insufficient. we all like to think that such logic puzzles are common sense, but consider that even experts don't know the exact way in which a lot of psychiatric meds work and you start to see where things could go awry. [it's not just psychiatric drugs, either. technically, biochemists haven't even figured out the exact mechanism of action of aspirin.]

off-label prescriptions can help provide valuable information on a drug's potential for other applications. [and if you're nervous about the idea of being used as a human guinea pig, ask yourself this: how do you think they get the drug approved in the first place?] it can also offer a fast solution or stop-gap measure while waiting for other methods to work. but it's a risk and all risks are susceptible to failure. furthermore, if a drug is used repeatedly off-label for a specific condition, it dissuades pharmaceutical companies from conducting the testing necessary to prove that it is effective and safe. and this happens with alarming frequency. anti-psychotics are increasingly prescribed to help with insomnia, which is like seeing a big spider and getting rid of it by running it over with your car. sure, it'll help you sleep, but it's likely to do a great deal more that might not be to your liking.

what's the worst that could happen?
one of the most surprising examples i came across of this sort of prescribing is lamictal [lamotrigine]. it is currently one of the most, if not the most commonly prescribed drugs for bipolar disorder, particularly type 2. because it has a much lower side effect profile and is generally much better tolerated than the "heavy-duty" drugs like lithium and valproate [which are now reserved more for patients who have experienced full-on psychosis as a result of their manias]. used alone or in concert with other drugs, lamictal is a  mood stabilizer that is particularly effective against bipolar depressions and helps to steady the boat. so it might surprise you to know that it's not actually approved for use in the treatment of bipolar disorder type 2 in either the u.s. or canada. its first application was as an anti-convulsant and it was used to treat epilepsy. when it was discovered that it actually functioned as a mood stabilizer [one of the only true mood stabilizers available], approval was gained to have it prescribed for bipolar disorder type 1. and that's all it's approved for.

ironically, lamictal doesn't seem to be as effective against bipolar type 1, especially not alone, because it's not as effective at controlling acute manic episodes. so doctors prefer to prescribe it for forms of bipolar disorder where the patient is in less acute need of calming. this has been done for so long that a lot of doctors might be surprised to know that it isn't an officially sanctioned bipolar 2 medication. but because it's now so commonly used as such, there's no incentive whatsoever for its manufacturer to actually conduct testing to prove that it's effective for that particular form of bipolar. it's not like official approval is going to increase the number of cases of bipolar disorder.

as i said near the beginning of my post, there are arguments for and against off-label prescribing. what can't be argued is that, with mental health becoming a greater and greater concern and in-patient resources becoming more and more taxed, it is well past the time when these things need to be discussed publicly. because educated guesses are only going to get us so far and we shouldn't be happy with medical treatment based largely on guesswork anyway.

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