Karl Rickels, MD: Pioneering New Meds for Mood Disorders and Anxiety

Karl Rickels, MD, Stuart and Emily Mudd Professor of Human Behavior and Professor of Psychology at University of Pennsylvania. Office phone: 215-746-6417.

We had a great turnout to welcome Dr Rickels, who has been at Penn since 1955. He's the founder of the Mood and Anxiety Clinic at Penn, as well as having being instrumental in the introduction of various medicines for psychiatric problems.

What a storied career he's had. Born in Berlin, he obtained his medical degree in Germany before coming to the US to study at Penn. And then, lucky for us, decided to stay.

During WW2, the 18-yo Karl was drafted. Virulently antiNazi, his dad told him to sign up under Rommel to fight in Africa. If you're taken prisoner, he told his son, you'll be treated better by the British than by the Russians.

Sure enough, he was a POW and quartered in America, where got a taste of the American life.

I asked Dr Rickels if he'd ever experienced anxiety himself.

Yes, he said, in his easy-to-understand German accent. Rommel asked him to put power-switches into a motorboat and Karl was so anxious he kept making mistakes.

He could've used some Valium which he helped develop, along with other Benzos.

Erwin Rommel "The Desert Fox" (1891 – 1944). His death at age 51 was by cyanide. He was implicated in a plot to kill Hitler and had an agreement that if he killed himself his family would be spared. Rommel won the respect not only of his soldiers, but also of his enemies. From Wiki:

His Afrikakorps was never accused of war crimes. Soldiers captured during his Africa campaign were reported to have been treated humanely. Furthermore, he ignored orders to kill captured commandos, Jewish soldiers and civilians in all theaters of his command.

Dr Rickels was relaxed as he spoke and answered questions. He told me he was recently in Stockholm where he received a lifetime achievement award. "I'm known as the Pope of Anxiety in Europe," he said.

The man was just speaking the truth, not bragging.

Earlier that day I'd emailed him about our Tracey. She'll be married next May - in fact she and her friend Holly are going shopping today for a bridal gown - and wants to have a child by age 37.

Dr Rickels brought me the name of a Penn specialist, specifically for Tracey, who helps women w/psychiatric problems to have children.

I shared the name with Tracey this morning - Dr. Deborah Kim - at 215-573-8802.

Dr Rickels said if a pregnant woman suffers from depression, she can get free TMS treatments at Penn - they received a grant for this - TMS being transcranial magnetic stimulation -

The only problem with this treatment, said Dr R, is a person needs to get the 'zaps' for an entire month, about five days a week.

We've had two of our free Saturday programs which discussed TMS: Dr. Terrence Boyadjis from West Chester and John O'Reardon, then at Penn.

I asked Dr Rickels why O'Reardon left Penn for the University of Dentistry and Medicine of New Jersey and Rickels said it was a better job. O'Reardon was only an asst professor, if I remember correctly.

ND member Johannes, born in the Netherlands, and a Lithiuanian folk dancer, asked a question about the safety of lithium.

Rickels said it's still a great drug but there are many reports of its kidney damage. Get your lab tests, advised the doctor. There are many other mood stabilizers if you need to go off. Read my lithium post here.

When Dr Rickels first walked in, I recognized him immediately from the cover of his book.

I introduced him to many people in our group, including Ingrid, who still has family in Germany. I urged her to tell Karl about her late father, the chef at the Germantown Cricket Club,which has grass tennis courts.

Dr Rickels still plays tennis and golf at 88.

Here's an eye-opening statement by Dr Rickels.

When you take a new antidepressant it works IMMEDIATELY! However, the patient does not feel the effects until several weeks later.

Why that is, no one knows.

Rickels was one of the docs responsible for the introduction of the new drug Viibryd, a combination of an old SSRI and the anxyolitic Buspar.

Patients have reported to feel the drug's effects within a week. Apparently it's not the placebo effect.

"In the last 40 years," said Dr Rickels, "nothing new has happened in the field of psychopharmacology."

It's hoped however that these newer drugs like Viibryd will affect different neuroreceptors to help depressed patients.

 Dr Rickels discussed the importance of the doctor-patient relationship. Because of his personality - kind, understanding and laid back - patients feel so comfortable with him they talk about their problems, including sexual side effects they may be having from their meds.

"We're on a journey of mutual interest," he tells patients. "I treat every patient like a human being."

When he was in private practice, which he loved, he would help patients with problem-solving, viewing problems logically which, in their altered states of depression or hypomania, they were unable to do.

The combination of meds and psychotherapy, he stressed, is always the best for the patient. Therapy may be in the form of cognitive therapy or interpersonal therapy.

He also mentioned, as did my former psychiatrist Larry Schwartz, a student of Donald Klein, if a family member does well on a particular drug, you should try that drug.

Here I am, sitting here sipping delicious decaf coffee, even tho my living room is 81 degrees. Dr Rickels said he stops drinking coffee at 4 in the afternoon.

Let's have a cup together now:

When Dr Rickels was a resident in family practice, he helped a man who had a phobia about driving over bridges. He prescribed Milltown, an early antianxiety drug, before the advent of the benzos, which
Rickels, "The Pope of Anxiety," helped develop.

Then he advised him to do simple exposure therapy. Have his wife drive him over the bridge. And practice driving over the bridge when you're at home or in other places. Finally, with the help of the drug, drive over the bridge yourself.

Then, when you've mastered bridge-crossing, you can slowly lower the dose.

Rickels is a proponent of taking the least amount of drugs possible. "Regretfully," he said, "this is not always possible."

Also, regretfully, he acknowledged, drugs are prescribed on a trial and error basis.

He understands!

Today Dr Rickels teaches residents at Penn. He loves being around young people. He was just in the Poconos visiting family members. He sure gets around from his home base in Gladwyne, PA.

A patient of his is on Abilify which helps her a lot. But it costs her $600 a month and she can't afford it. 

Dr Rickels told her to substitute one of the older antipsychotics - Compazine -

 which helps her as much as the Abilify.

Honestly, how many doctors would've thought of doing that?

Larry Schwartz gave me an Abilify kleenex box

I had it upstairs on my pink file cabinet for years but got rid of it so this pic is from the net.

"Mike" had a question about his ADD which prompted Dr Rickels to tell this story about mothers who would call him complaining that they suspected their children of having ADHD.

Have them drink lotsa Coca-Cola, he said, and if it calms them down, then bring them in. They would respond well to stimulants. Mike had mentioned he could drink five cups of coffee before bed and sleep like a baby.

Unlike many of us, which is why I called the Abington Hospital Sleep Disorder Center and asked for a guest speaker in November.

Although Dr Rickels has worked as a paid consultant for most of the drug companies, he is still critical of them. For example, when testing their new drugs they don't compare them with older drugs that might in fact equal or surpass the efficacy of the new drug in question.

The NIH - National Institutes of Health - of Bethesda, MD - is setting up a new program of "translational science." NIH will fund the beginnings of research into new psychiatric meds and then have the drug companies take over.

Drug research costs a fortune, but we desperately need new meds that work. As the doctor said, nothing new has happened in 40 years.

Dr Rickels also spoke about the newer ECT - electroshock therapy - as a good way to treat intransigent depression. It's helped many of our members but certainly not everyone.

I asked a question about a friend of mine. "Janet" is about 30 and has a 5-year-old daughter. Her symptoms of bipolar d/o have decreased since she had the child.

Does this often happen, I asked.

In half the cases, he said. In other words, having a child is no guarantee of lessening of symptoms, and of course we know about the dreadful postpartum syndrome. One of our members could not bond with her daughter for months b/c of her psychosis. Her mom cared for both of them.

Earlier today, I called the Brain and Behavior Research Foundation in Great Neck, NY, and made a donation in honor of Dr Rickels.

May he continue helping people like us for a long long time.

Serendipitously, Charlie Rose had one of his Brain Series shows on last nite.

Frederick Goodwin, Peter Whybrow, Helen Mayberg, Eric Kandel and Andrew Solomon
appeared. I fell into bed and watched it for five minutes and then woke up for the last five minutes. We can all watch it here.

The day after the talk Dr Rickels emailed to thank me for our gift from Kremp Florist:

If you know what kind of fleurs these are, you will get a free bouquet!