Thursday, March 06, 2008

Mental Illness, Meds, and Rep. Kennedy

**UPDATE** Kennedy's House bill passed. Now comes the hard part, getting another bill passed in the Senate (see Projo).

“If you have diabetes, no one holds it against you,” Kennedy said during the three-hour debate yesterday afternoon. But Kennedy said the mentally ill are still too often stigmatized, in part by insurance rules that often impose higher fees or tighter treatment limits on mental-health patients than on those suffering from physical maladies.
“It’s your fault if you wander around in the streets and you’re homeless” because of addiction or mental disease, declared Kennedy, who has framed the mental-health parity debate as a question of civil rights.

Original post:

Rep. Kennedy (our District Federal Rep) has been working in Congress for health parity for those suffering from mental illness and mental health issues. There are currently two bill versions in the House & Senate. His Dad, Sen. Kennedy, is working on the Senate side. The Senate bill is somewhat more restrictive.

"...they [both bills] require that insurers who offer any treatment for mental illness must use the same basic rules that they apply to the treatment of cancer or broken bones or other physical ailments. For example, a managed health-care company cannot impose a higher copayment for a session with a clinical psychologist than it charges the same patient for a visit to the internist." ( Projo)

The House debate and vote on the Kennedy-Ramstad bill is scheduled for Wednesday. I hope the staff keep me updated. Rep. Kennedy suffers from bi-polar, a truly debilitating condition that is incurable but can be treated. The meds can be hard, though, & often have debilitating side effects. Mental illness is often accompanied by drug/alcohol addictions (self-medicating).

When speaking to him last week he also pointed me to an N.Y. Times article in regards to the mother of all mental illnesses- schizophrenia. Schizophrenia, a most cruel illness striking young people just entering adulthood, cannot be cured. Over two million Americans have it with twenty-four million worldwide. Symptoms, though, are often be controlled with drugs making for a very profitable industry (billions). Although it would be nice if the National Institute of Health would fund more projects to actually comes up with a cure or even an explanation for this illness and others. Presently, we're not even sure how the current meds (all based on lowering dopamine- a brain receptor) work.

One new drug on the horizon promises safer & more effective treatment. It's LY2140023 & currently in the testing stage. Rather than decreasing dopamine, it's focus is on reducing glutamate, a different neurotransmitter in the brain. Glutamate ties together the brain’s most complex circuits. Even if this med eventually fails, it opens up a whole new treatment area not focusing solely on dopamine.

"...it was slightly less effective overall than Lilly’s schizophrenia blockbuster Zyprexa, but also appeared to have fewer side effects — an important finding, since Zyprexa can cause severe weight gain and diabetes. More testing is needed and FDA approval is at least three or four years away."

The actual study is published in the scientific journal Nature Medicine.

"People say that there are drugs to treat schizophrenia,” says Dr. Carol A. Tamminga, professor of psychiatry at the University of Texas Southwestern, in Dallas. “In fact, the treatment for schizophrenia is at best partial and inadequate. You have a cadre of cognitively impaired people who can’t fit in." (Times citation)

While newer antipsychotic drugs have been developed, the older generics are still frequently prescribed because they are cheaper & often effective: e.g. haloperidol or Haldol. However, long-term use often results in facial tics & involuntary hand movements (hand rolling). The newer ones (atypicals) help treat other symptoms of schizophrenia; e.g. withdrawal, lack of energy and motivation, and the inability to experience pleasure, more effectively. But these drugs may also can have serious side effects (weight gain, tics, heart problems, diabetes, etc.). There have been no new drugs on the market since Zyprexa in 1996 with 2005 sales of over 4 billion dollars. The overall cost of schizophrenia to the USA in 2002 was estimated to be $62.7 billion, with $22.7 billion excess direct healthcare expenses- read this as to why you should care.

"Another glutamate drug, meanwhile, has been shown in preclinical studies to reverse mental retardation in adult rats, a finding that previously appeared
impossible, Dr. Insel said. "(Times citation)

Wow! Remarkable possibilities. These new drugs also hold promise for those suffering from Parkinson's Disease.

I heart Rep. Kennedy.

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