Dr Mago - pronounced like "Ma, GO home," he said, was one of the most brilliant guest speakers we've ever had. Once a year, we give a donation to the Brain & Behavioral Research Foundation, - formerly NARSAD - and this year the donation will go to Raj.
Sign up for emails from BBR on their website. They're the largest non-government funder of mental illness and had underwritten some studies Raj did.
Indian-born Raj, has been a physician for 31 yrs and a psychiatrist for 26.
"I know what you're thinking," he quipped. "How young I look!"
He came to the US eleven years ago so he could do research. In India, there's virtually no funding for research.
The National Institutes for Health (NIH) is interested in funding projects for the future betterment of patients, not to alleviate immediate suffering, which is what Raj does.
He sees patients and counsels them if they wish. 80 percent are doing very well.
He's working on studies about SIDE EFFECTS of medication, something the medical profession is not interested in, he said. And the drug industry has no interest in funding or hearing about it.
He did a study on the side effect of EXCESSIVE SWEATING. I turned around in my seat and said to Ada, "That's what JD suffers from. He used to get drenched."
One of his patients used to take six shirts to work. Another one just decided to stay home rathan go out and be embarrassed.
NARSAD is the only one to fund these side effects studies. He also researches antidepressant-induced sexual dysfunction.
He prescribes Wellbutrin, Remeron and something he imports from Canada, which have no sexual side effects but they may not be as effective as other drugs.
A big study done at NIH showed that patients do not take their meds b/c of side effects from antidepressants.
The numbers were higher if the patient had bipolar d/o or schizophrenia. Reasons why: weight gain, tremors, cognitive dysfunction (can't think clearly). This is esp. true for people taking lithium and Tegretol.
When I was on lithium my memory was terrible. I couldn't remember what happened the prior day.
Fortunately, said Raj, when you stop taking these drugs, the brain recovers.
He's working on an e-Book about side effects.
See his website here.
One woman said she was diagnosed with schizoaffective d/o and asked for a definition. She said that her medication has enabled her to work.
When you have a depression, he said, you can have psychotic features. Patients may believe their insides are rotting or that they're dead.
When the depression is gone, the person remains psychotic and must remain on antipsychotic meds.
Hippocrates, the father of medicine, born in 460 BC in Kos, Greece, described bipolar disorder.There was no effective treatment. Bloodletting and ice baths were tried.In 1938 electroconvulsive therapy - ECT - was invented. Best and quickest treatment there is, said Raj.
From the back row, Gerri said that she had two treatments of ECT that worked real well, but the third treatment had no effect at all.
Gerri told me later that she found it interesting that "you're not treatment-resistant until you've tried the MAOIs." She had a consult with psychiatrist John O'Reardon at the New Jersey College of Medicine and Dentistry and he wrote a letter to her psychiatrist suggesting he triple her dosage.
She's doing great and is well enough to start a new job.
Said Raj, We really don't understand the mechanism of how ECT works. It does increase the availability of brain chemicals such as serotonin and norepinephrine.
People don't get ECT b/c of the stigma. You usually lose your memory from the 24 to 48 hours before and after treatment, which only lasts one minute.
He discussed the discovery of lithium by Australian physician John Cade (1912-1980)..
"Raise your hand," he tells them, "and swear you'll ask your patients - when making a diagnosis - if they've ever been manic."
Psychiatrists often do not take a complete history. Many people are diagnosed with depression, when they actually have bipolar disorder.
This is why, on average, it takes six years to get a correct diagnosis of bipolar d/o.
The psychiatrist should ask the patient: "Have you ever been overly happy or hyper or very irritable for many days at a time?"
The patient often fails to bring these symptoms to the doctor's attention.
Onset of bipolar disorder usually occurs as a teenager - 16, 17, 18.
We've all heard of antidepressant-induced mania. Eighty percent of these people would have eventually been diagnosed with bipolar disorder. Good to know!!!
Bipolar depression is difficult to treat. Many people grasp at straws, such as the unproven Fisher-Wallace device, he said.
Use things that are proven.
And, as Gerri knows, you're not treatment-resistant until MAOIs don't work on you.
People with bipolar are highly sensitive to stress.
Maintaining a ROUTINE will help.
Wake up at the same time every day
Take meds at the same time
Go out and be among people!
ACTIVITY LEVEL
He has depressed patients do very difficult things.
Baby steps: Do your laundry for half an hour. (This is extremely hard when you're depressed.)
Then he has them do something enjoyable, tho most likely they won't enjoy it when they're depressed.
BE EDUCATED CONSUMERS
If on lithium, get your lab work done every six months. Creatinine level shows how your kidneys are doing.
One out of about 200 people will get chronic renal disease. Well, that doesn't sound so bad, but I know about 20 people from both New Directions and other support groups who are either on dialysis or have gotten transplants.
Thanks, Sarah, for saving my life.
GENETIC TESTING to see how your liver metabolizes drugs.
This is important for people who are not responding to meds. One of Raj's patients was on a standard dose of imipramine which was not helping him. After looking at his liver enzyme results thru testing, Raj saw his liver was a slow metabolizer. He increased the imipramine and the patient is doing fine.
There's a crossover between bipolar disorder and attention deficit hyperactivity disorder. Up to 20 percent have both. He prescribes Ritalin (with caveats) and Adderall.
"The older I get," said Mago, "the more I believe in genetics." These disorders are encoded in our genetic makeup.
Oh! So it's not my mother's fault.
PERSONALITY DISORDERS, he said, arise in childhood, just as our personalities do. While they cause dreadful problems to the afflicted person, they cause more problems with the people surrounding them.
On Saturday, August 2, we're hosting Talya Lewis, a fully recovered woman with borderline personality disorder. She'll speak right here in the Thunderbolt Room of the Giant.
Yes, the room is named for the Thunderbolt roller coaster. The Willow Grove mall is built upon the ruins of Willow Grove amusement park. Good ole Giant honors its memory.
Nurse Cherry Ames (Harriet Rellis) was sitting in the front row. Said she had fibromyalgia before she had bipolar disorder.So, what do you take for the pain of fibromyalgia?
Two new meds were developed in 2013.
Fetzima.
Raj said he prefers this to the other drug
Vortioyetine or Brintellix.
Can't wait to tell a friend of mine who suffers from horrible chronic pain.
Other drugs that are helpful for chronic pain are two SNRI's Cymbalta, and Effexor.
DEPRESSION is more prevalent in women by two to one.
Nurse Cherry Ames made the point that more women should be studied. For some reason, more men enroll in studies.
Mago agreed, saying they need more minorities such as blacks and Hispanics.
Jimi Hendrix had manic-depression and sang about it. He died from an overdose, as do many people with bipolar disorder, who seek to quell their mental anguish through the use of drugs.
Dr Mago is doing a study on a morphine-like drug to help depression.
Medication, said Dr Mago, is the foundation of staying well. Think of it as building a house. You need a strong foundation: medication. Half of his patients get psychotherapy with Dr Mago.
CHECKLIST FOR HARD TO TREAT DEPRESSION
Get Levels of folate and B-12.
Determine if patient is an ultra-rapid metabolizer of meds.
Do they have bipolar d/o rather than depression?
Do they have sleep apnea? If so, it must be treated.
Do they have a thick neck? This indicates sleep apnea.
Do they fall asleep during the day?
We so appreciated Dr Mago coming out on a Saturday to speak to us. We gave him a beautiful orange Gerbera Daisy and as you can see, he bought some bargains at the Giant, including
on sale!I left the room while he was still chatting with people. Went downstairs to sit in the Coffeeshop and continue our discussion.
There's something about talking, for me, that makes me feel real good. Talking and listening.
Ed and his wife Sharon joined us in the Coffeeshop. Ed is one of the most interesting people I know. He's taught karate, among other things, and is playing golf tomro with his best friend from childhood.
Jim, above, is on lithium and knows to get tested. His dog passed away a couple months ago and he and his wife got a new one at a shelter. They loved the little guy.
"He'll eat anything," said Jim. Well, one day, the dog hopped up on the table and ate Jim's lithium. And overdosed. Fortunately the vet saved him.
Ron and I were talking about our grandchildren and how adorable and smart they are.
Here's what my Grace Catherine Deming said to me this morning before the Giant event. We met at Masons Mill Park in Upper Moreland, where I used to take her dad when he was a kid.
Bubby, she said at the park, the reason I'm touching my butt is not b/c I have to go to the bathroom, but b/c I fell yesterday and hurt it.
I'll make an egg omelet and spread it in the middle. Like crepes!
For dinner, Scott and I made grilled cheese sandwiches with our very own garden tomatoes. Rye bread, of course. I use mustard and mayo and added thin slices of sweet onion.
Scrumptious.
And tomorrow is another day. We'll go walking at Pennypack Trust in Huntingdon Valley. Y'all come!
Thank you, said Ed Quinn!
ReplyDeleteThanks so much, Ruth, for inviting me and for your kind words! There was a great turnout and the discussion was really vigorous. I was thinking later that it is amazing what a wide range of topics we discussed.
ReplyDeleteAll of us must work together to spread the messages that we talked about today, so that no one goes undiagnosed, misdiagnosed, or inadequately treated.
Best wishes to all of you,
Raj
Saul Miller: excellent mtg on Sunday
ReplyDeletereally important that he emphasized importance of meds, people to stay on meds and why, and that meds are foundation for therapy
not a bs artist, and not defensive when questioned re: such things as ECT
I truly wish I were able to attend your meetings and hear these great talks. I know I would be interested in what Dr. Mago has to say, and in his research.
ReplyDelete