We had the biggest turnout for any program we've held at the Giant Supermarket, as you can see by the above photo.
Before Dr. Shlewiet got there, I addressed the audience and asked how they heard of the event.
As usual, NAMI groups brought most of the folks, but a new resource - the Midweek Wire - brought several people there.
Only a handful of people were from New Directions.
I also told the group that after the talk, we always meet downstairs in the Coffee Shop to schmooze.
We also discussed mental hospitals. Most people had excellent experiences at Horsham Clinic. One person complained about the psych ward of Abington Memorial Hospital. Apparently it's one big unit - Horsham has a variety of different bldgs - and so you'll be in there with people with dementia which is quite unsettling for a depressed person.
When Dr. Shlewiet came in, I introduced him as Basem Shlewiet and asked the audience, Where dyou think he's from originally?
Then as a hint I said, Think of the most troubled country that's always in the news.
Yes, Syria. (Don't forget that the late Steve Jobs was half-Syrian.)
In the next issue of our Compass mental health magazine, we'll feature Profile of a Psychiatrist and it will be Dr Shlewiet.
Dr Shlewiet completed his residency training at Einstein Medical Center in
Philadelphia, and his Child Fellowship at the Children’s
Hospital of Philadelphia. I told him over the phone that
Einstein is where I had my kidney transplant in 2011. He
was unaware of all the people my age - in our sixties -
whose kidneys have been compromised due to lithium use.
This will be one of the themes in the upcoming Compass.
If you're on lithium, and Dr Shlewiet emphasized this, you must get regular lab tests. Lithium may also knock out your thyroid function, which it did mine. I take Synthroid, a synthetic thyroid hormone.
He mentioned that in May the new DSM-V will come out. Read this Times article about it.
This is the Diagnostic & Statistical Manual by which psychiatric diseases are coded. When I had bipolar d/o - it went away 12 years ago - my code was 296.62.
The doctor emphasized the importance of getting a correct diagnosis. Less than half the people in our group know their diagnosis. Not good!
Dr Shlewiet used slides to project information. Super-informative. Wish I could've photographed them.
I remember thinking to myself when the meds appeared on the screen: They are like my friends.
Dr. Shlewiet did emphasize to try psychotherapy first before you go on meds, but only if your depression is mild to moderate.
He also emphasized that research shows that therapy in combination with medications work best.
MONOAMINE OXIDASE INHIBITORS, the earliest antidepressants, were developed in the 1950s but fell out of favor b/c of their eating restrictions and interactions with other meds. Our "Sally," who's on Nardil, has hip pain and her family doc can barely prescribe anything helpful for her. Sally, who I'd been urging for years to seek a consultation with another psychiatrist, will see Dr. Shlewiet.
Look, all I'm interested in doing is referring our people to good psychiatrists that will help them and treat them with respect! We have at least 50 psychiatrists from all over the Philly area on our Top Doc/Top Therapist List. It is only available by speaking with me over the phone. We don't mail it out.
FROM WIKI: The older MAOIs' heyday was mostly between the years 1957 and 1970.
The initial popularity of the 'classic' non-selective irreversible MAO
inhibitors began to wane due to their serious interactions with sympathomimetic drugs and tyramine-containing
foods that could lead to dangerous hypertensive emergencies. As a
result, the use by medical practitioners of these older MAOIs declined.
When scientists discovered that there are two different MAO enzymes
(MAO-A and MAO-B), they developed selective compounds for MAO-B, (for
example, selegiline, which is used for Parkinson's disease), to reduce the side-effects and serious interactions.
Here are some interesting things Dr. S mentioned:
Topomax really doesn't work for bipolar d/o. I remember when I saw my last psychiatrist, Larry Schwartz, from whom I learned a lot, that he told me he had a patient who could not speak after he prescribed her Topomax.
It's often prescribed as an adjunct with psychotropic
medications to control weight gain.
The popular antidepressant Effexor works as an SSRI on lower doses. SSRI's were developed in the 1980s and changed the course of medicine.
The first of the TRICYCLIC DRUGS (named for their three interconnected rings of atoms) was imipramine (brand name Tofranil), discovered in the early 1950s.
My info comes Dr Shlewiet and from Wikipedia and other online sources.
Lots of bad side effects with tricyclics, including dry mouth, constipation, weight gain, and cardiac problems, which Dr S noted was the worst problem.
"Tricyclics have a narrow therapeutic window," he said.
The 1980s saw the advent of the SSRIs such as Prozac, Celexa, Paxil, Luvox and Zoloft. They all have properties that combat OCD.
He mentioned that Paxil got in trouble b/c they
hid the suicide rates in their studies. “Glaxo
knew as early as 1989 that Paxil increased the risk of
suicidal behavior in patients by more than 8-fold compared
to patients who received a placebo," he said.
Later all antidepressants got a black box warning
relating to increased suicidal thoughts but not completed
suicide rates, he said.
Generally patients have to be monitored closely when
starting treatment and the first 2-3 months are most
crucial. Patients who are very depressed don’t have the
energy sometimes to kill themselves but as they get
better, their energy might increase while they are still
suicidal and they could end up committing suicide, he said.
SSRI = Selective Serotine Reuptake Inhibitors.
YOU FIGURE OUT WHAT THIS MEANS, I'm not a doctor: SSRIs are believed to increase the extracellular level of the neurotransmitter serotonin by inhibiting its reuptake into the presynaptic cell, increasing the level of serotonin in the synaptic cleft available to bind to the postsynaptic receptor.
Dr Shlewiet shocked the audience by saying the SSRIs don't work very well for folks with bipolar d/o.
The most profoundly depressed person with bipolar I know, who isn't getting any better, is on a slew of SSRIs. She feels loyal to her psychiatrist and doesn't wanna switch.
When weaning off the SSRIs, said Dr S, 20 percent of patients get "SSRI Discontinuation Syndrome." This doesn't happen with Prozac b/c of its long half-life. It also occurs with Effexor.
Symptoms include flu-like symptoms, nausea, insomnia, and hyper-arousal. Did you see the Ray Charles movie when he tried to withdraw from heroin? Kind of similar.
I remember one woman in our group who was very sick after discontinuing her SSRI and spent 6 weeks on her couch. Her then-husband had absolutely no sympathy for her.
There's also a condition called "Serotonin Syndrome" that results most from taking two medications that effect Serotonin where your body has too much serotonin."It's potentially life-threatening," said the doctor, "and you must go to the emergency room."
After reading about all these side effects, it's no
wonder people don't wanna go on meds. That's why you must
have a good psychiatrist you can reach in times of
Why do people get depressed?
"We don't really know why people get depressed," said Dr
Shlewiet, "but we have theories."
Genetics, family history, social and environmental
Two-thirds of depressed people, he said, do not get
There are so many reasons for this including stigma toward people with mental illness, which was not helped by the recent mass shootings in Newtown, CT. Here's my article in the Intell about it. There's also an excellent Radio Times program with Joseph Rogers, co-founder of the Mental Health Assn of Southeastern PA, who says the same thing. Joseph has bipolar d/o and said he takes meds including Risperdal. Listen to this excellent 50-minute talk.
Dr Shlewiet said that with proper treatment 80 percent of the people with depression can improve.
Sadly, that's not 100 percent. Other things can be tried including ECT and transcranial magnetic stimulation. Here's one of our Giant programs that featured Dr Boyadjis on TMS.
There's also microsurgery by Helen Mayberg, MD. This will be mentioned in our next Compass.
"After we treat for depression," said Dr S, "we often find out a year later that the person has bipolar d/o."
Don't we know it? According to statistics I've read, it takes 9 years for a bipolar individual to get properly diagnosed.
"In some patients with recurrent depression that is not
responsive to treatment, we could discover years later
that a person has bipolar disorder and not unipolar
depression. The first manic episode might happen later
after several depressive episodes." said Dr S.
"THERE IS NO WAY TO DIFFERENTIATE BETWEEN BIPOLAR DEPRESSION (or a Depressive Episode in a Bipolar patient) AND Unipolar REGULAR DEPRESSION," he said.
"Bipolar depression is harder to treat," he said.
"SSRI's don't work," he continued. "Research validates this."
His favorite drugs for bipolar depression are: LAMICTAL, SEROQUEL and ABILIFY.
We have a woman in our group, "LuAnn," who's in her early 80s. She comes from a family rife with mental illness, including suicides. LuAnn wasn't hit until she was 65 years old. She went from psychiatrist to psychiatrist, treatment-resistant, until she found a nurse-practitioner, who prescribed a lo-dose of Seroquel.
LuAnn has been fine ever since. Hallelujah!
Dr S said he finds Abilify - introduced 7 years ago - to be one of the better drugs. He said he tends to wait before prescribing a new drug. In drug trials, only a small sample of people have taken the drug. After its release, thousands of people will take it, showing how it works in the general population.
Abilify tissue box. Larry Schwartz gave me one. I finally threw it away. I prefer hankies, which I cut out from old shirts.
Question about the new antidepressant Prestiq: "It's very similar to Effexor with easier dosing."
He also discussed benzodiazepines. I volunteered that I'm president of the Klonopin fan club, having taken it for 16 years. I was lucky to wean off it in only five weeks. To prepare for this, I weaned off coffee. When I drink coffee, I only drink decaf.
Klonopin, he said, is sometimes used as an adjunct in
acute mania and should only be used for a short time.
He also said, which I hadn't known, that the benzos may contribute to depression, which does make sense if they're antimanic.
He spoke about the unmedicated bipolar individual. 25 percent of these individuals, he said, will end up with an early death. This may result from self-medicating with drugs and alcohol, they might die from an overdose or car accident, they may become homeless, or die from other impulsive behavior including suicide.
Although they're decidedly cheaper, they should have the same active ingredients as their brand name counterparts (as well as the same the mg amount,) although that is not always the case.
One of the manufacturers of Wellbutrin generic did not
have the correct dosing rendering the medication
ineffective and it was recalled.
For carbamazepine (generic Tegretol) it is much easier to monitor it since you can measure the blood levels and therefore it does not really matter if you take a brand name or generic.
We always give our speakers a nice gift.
I baked Dr S a whole-wheat loaf that morning and also gave him some crocus flowers in a porcelain Dutch shoe.
Here's his contact info:
Basem K. Shlewiet, M.D.
16 N Franklin St
Doylestown, PA 18901
Click on his website here.
Be sure to read about schmoozing in the downstairs coffeeshop.