Larry DiBello talks about New Meds, Exercising, and Over-the-Counter Meds

Larry DiBello, who drove up from his home in Delaware County, never disappoints.

He's wearing his name tag from The Friends Hospital Resource Center. Friends is the oldest psych hospital in the nation.

He was asked to work for the Resource Center 15 years ago by Ruth Seegrist, who became a fiery mental health advocate after her schizophrenic daughter gunned down people at the Springfield Mall in 1985.

Larry projected very helpful slides on the wall. He interspersed his talk with personal examples.

His dad told him, Son, you can go to any school you choose, as long as you can get there by subway. Larry chose Temple University where he studied pharmacy.

The first job he took was for Eli Lilly. It was very stressful, he said. He and his wife Anna were raising four children and the work was very demanding.

Larry began to suffer from depression. His psychiatrist put him on the tricyclic Tofranil.

He found another chemical that made him feel much better than the Tofranil.

"Beta-endorphins," he said, "which are made by our own bodies."

He became a runner who ran in marathons. He joked that he's now a physical wreck with two metal knees, a spinal fusion and a newly sprained ankle. He did have us chuckling.

He rides a stationery bike today while listening to music, for half an hour at a time, about four times a week.

WHY AREN'T THERE MORE NEW MEDS FOR BEHAVIORAL HEALTH CONDITIONS?

Larry said there's not enough money in it for the drug companies. There's more money to be found in oncology, cardiology and other specialties.

The new paradigm for research into mental illness is neuroimaging techniques.

The whole direction of research is changing, he said.

TWO NEW ANTIDEPRESSANTS

VIIBRYD. There are 23 subtypes of serotonin. Viibryd works on one of the subtypes that had never been targeted before. No sexual side effects. SSRIs notoriously affect the libido.

When Larry worked in the Medical Division of Lilly, he set up clinical trials. Met some outstanding psychiatrists such as Gary Gottlieb, who was the head of Friends but moved to the prestigious Mclean Hospital, associated with Hahvahd, in Boston.

We've added him to our Top Doc List.

There's no science to drugs for mental illness. You give them to people and see what happens.

In our group, people complain they're guinea pigs.

Indeed, in our group, a few people actually turned into these adorable creatures and haven't been seen since.

A la Gregor Samsa.

Larry advises us to HELP OUR PSYCHIATRISTS in our painfully short visits.

Mood charting. The idea of charting your mood from 1 to 10 is a terrible one. Simply do 0 to 3.

Bring the chart in to your doctor. '0' means no mania or depression. Also list what was going on in your life at the time.

Gary Sachs, MD, originated the charting. 

Bring a list of questions to your doctor.

He advised patients not to read the printouts that come with your meds. It's an agreement, he said, between the pharm companies and lawyers to avoid litigation.




BRINTELLIX (vortioxetine) is a new antidepressant, introduced about a year ago. I had never heard of it, which means no one in our group takes it. It's a multi-modal drug which means it hits various neurotransmitters.

Here are dual-acting antidepressants.

The dual-acting and Brintellix do not seem to precipitate mania. Welbutrin, Cymbalta, Effexor.

The new drug has no withdrawal effects, which most drugs have, with the exception of Prozac which has a long half-life.

In the pharma trade, it was well-known that if you want people to take your drug, use an XY or Z in the name. Examples are Celexa, Paxil, Lexapro, Zyprexa, Prozac.

ATYPICAL ANTIPSYCHOTICS

SAPHRIS, for schizophrenia and bipolar. Take this sub-lingually - under your tongue - it doesn't go thru your bloodstream. Less side effects.

Most drugs are metabolized by the liver, which may take a beating by the drug. Tylenol has the most liver side effects of any drug.

Drug trials need 5000 patients in a double-blind placebo study.

LATUDA is a unique drug b/c it has less memory impairment and you have an easier time remembering new things vs other antipsychotics. Larry predicts it will become very popular.

CLOZARIL is considered a 'dirty drug' 

A dirty drug is an informal term used in pharmacology to describe drugs that may bind to many different molecular targets or receptors in the body, and so tend to have a wide range of effects and possibly negative side effects. Today, pharmaceutical companies try to make new drugs as selective as possible to minimise binding to antitargets and hence reduce the occurrence of side effects and risk of adverse reactions. - Wiki

Larry said Clozaril is the single most effective drug for mania. I'd also heard the same about Zyprexa. The two of them have terrible side effects, says the blogger.

SEROQUEL has a 'new, hot use.' It's added to antidepressants to boost their efficacy. It's also used as a sleep aid.

600-900 mg antipsychotic

100-300 mg Yawn, I'm going upstairs to bed

ABILIFY is another add-on for depression.

ALSO, amplify your antidepressant response with FOLIC ACID.

Mad rush for handouts, reminiscent of when Apple introduced its new iPhone.

NEW DOSAGE FORMATS

Many older drugs have been revamped to make them more effective.

Sinequan (for sleep, no hangover of side effects), valproic acid, Trazodone (the newer model lets you sleep longer)

TITRATION is a psychiatrist's secret. "Start low and go slow."

A teaspoon of sugar contains 5,000 mg. Imagine if your new drug is as strong as this. You can't jolt your brain with this all at once.

Antidepressants take forever to work, said Larry. Do not stop abruptly b/c you'll go into withdrawal.

POLYPHARMACY, many drugs, is usually the standard treatment.

Two anti-manic drugs work better than one.

WHY ANTICONVULSANTS HELP MANIA (Lamictal, Depakote, Tegretol, Klonopin)

When a person has a convulsion, their brain has big spikes of GABA.

Same with mania.

FOLIC ACID. Large doses are available in DEPLIN.

FISH OIL is good for mania and anxiety. Take 1400 mg, available in triple-strength from Walgreen and Walmart.

Fish oil is composed ot EPA, which is not stored in your body; and DHA, which is.

OTC MEDS

For diarrhea, take Equilacten, not Kaopectate, which isn't very good.

For sleep, take 2 Benedryl at nite. You can also take Melatonin, sublingual, 1 to 5 mgs.

In appreciation for Larry's MARVELOUS talk, we gave him a

Larry couldn't get over the Giant Upstairs Classroom, which is free for nonprofits. We have superb help from Elyse Bonner, Robin Franklin and Suzanne.

Margaret sings in the Abington Presbyterian Choir. Wonder what they're singing for their Xmas Concert.

After the meeting, we always schmooze downstairs in the Coffee Shop, similar to the famous Algonquin Round Table in NYC. 

 Was happy to see Noam and Janice.

 Here's Betsey my paddleboat companion, chatting with Chris.

I drank a small hot chocolate. My blood sugar went thru the roof. Can't a girl ever get a break? So I'm going on my bike now and watch Bill Moyers interview the late Doris Lessing.

Actually, he's interviewing Henry Giroux, a brilliant American, who is super-critical of our society, where greed has become the bottom line. He says to Moyers, 'Say, you and I are on the program Survivor. Our mission is not to help one another, but to destroy each other.'

This is what our society is now about.

I learned at our after-hours table about the book The White Hotel. It's on my reading list now. Will read it after The Patron Saint of Liars by Ann Patchett.

I believe Doris Lessing, author of A Golden Notebook, which we also discussed at table, will be on now. The reception upstairs was terrible so I'll watch it online. She just died at 94, a Nobel winner.