Friday, July 31, 2009

Extended-Release Injectable Paliperidone Approved in the US for Schizophrenia

A news release posted today by
The US Food and Drug Administration (FDA) today approved paliperidone palmitate (Invega Sustenna) extended-release injectable suspension for the acute and maintenance treatment of schizophrenia in adults. It is the first once-monthly, long-acting, injectable atypical antipsychotic approved in the United States for this use.

Bold emphasis in the text is mine.

To read the entire news release, please click here.

Also see:

FDA Approves INVEGA® SUSTENNA™ for the Acute and Maintenance Treatment of Schizophrenia

FDA Approves First Monthly Atypical Antipsychotic for Schizophrenia

Monthly Shot Treats Schizophrenia

International Symposium on Mood Disorders - Halifax

Friday, October 2nd!

Please click on the image to enlarge it.

Schering-Plough Wins Panel’s Backing on Antipsychotic (Update 2)

An article posted on July 30th by
By Catherine Larkin

Schering-Plough Corp. won a U.S. panel’s backing to introduce a new antipsychotic drug that would compete with Eli Lilly & Co.’s Zyprexa and AstraZeneca Plc’s Seroquel.

Outside advisers to the Food and Drug Administration voted 9-1, with two abstentions, that the drug’s benefits outweighed its risks for adults with schizophrenia, and 12-0 in favor of its use in treating manic or mixed episodes of bipolar disorder. The FDA usually follows the recommendations of its advisers, though it isn’t required to do so.

Asenapine [molecular structure shown], a fast-acting tablet that dissolves under the tongue, would help patients who can’t swallow pills or have side effects such as weight gain on other treatments, the advisers said. Merck & Co. offered to buy Schering-Plough on March 9 to get asenapine, to be marketed as Saphris, and six other drugs targeted for sale by 2012.

“We believe that the opportunity for Saphris is underappreciated, as we think an antipsychotic with little to no weight gain and no cardiovascular safety issues is a lay-up blockbuster,” Jon LeCroy, an analyst at Natixis Bleichroeder in New York, said today in a note to clients. “We are modeling 2013 sales of $650 million.”

Positive Expectations

Investors anticipated a positive recommendation from the advisory panel meeting in Silver Spring, Maryland, after FDA staff voiced their support for Schering-Plough’s data in briefing documents released this week. The agency delayed asenapine last year and is now scheduled to make a decision on approval by Aug. 20.

To read the complete article, please click here.

Also see:

FDA Approves Saphris to Treat Schizophrenia and Bipolar Disorder (August 14th, 2009)

Monday, July 27, 2009

Scientists try to stop schizophrenia in its tracks

An article posted on July 26th by ABC News:
Seeking to block voices, 'odd thoughts,' scientists try to stop schizophrenia in young people

By Malcolm Ritter, Associated Press

PORTLAND, Maine — She was sociable and happy in high school. But in college that changed abruptly: Depressed and withdrawn, some days she couldn't get out of bed.

And that wasn't all.

"I had really odd thoughts," recalled the woman, now 21, who asked that her name not be used. While walking across campus at the University of Southern Maine, "sometimes I'd feel like people were just right behind me (who might) jump me or something."

She knew it wasn't true, but she couldn't shake the feeling.

Sometimes, while driving, she saw imaginary, shadowy people on the sidewalk. And now and then, out of nowhere, there would be a woman's voice in her ear during class, or random soft noises like knocking or the fizzy hiss of a newly opened soda can.

When she visited the university health service and talked about feeling depressed, a nurse practitioner saw another problem: a possible case of schizophrenia in the making.

This schizophrenia "prodrome" — the early signs — involves a troubled mental state usually found in teens and young adults. It can lead to psychosis, the loss of touch with reality that marks not only schizophrenia, but also some forms of depression or manic-depression. The prodrome can linger for weeks, or years, before it gives way to psychosis — or mysteriously disappears without a trace.

Researchers have known about this warning phase for decades, but they're still working on how to treat it. Now they're calling in tools like brain scans, DNA studies and hormone research to dig into its biology. They hope that will reveal new ways to detect who's on the road to psychosis and to stop that progression.

In the prodrome, people can see and hear imaginary things or have odd thoughts. But significantly, they understand these experiences are just illusions, or they have a reasonable explanation.

In contrast, people with psychosis firmly cling to unreasonable explanations instead. When someone interprets an odd halo of light over a bedroom doorway as an urgent message from a dead relative, "that's when they have gone over to the psychotic side," said Dr. Thomas McGlashan, a Yale University psychiatry professor.

Some early signs of the prodrome are subtle. "Sometimes kids will (say) light seems different," and windows are too bright, said Ann Lovegren Conley, the family nurse practitioner at USM who spotted apparent prodromal symptoms in the student on her campus.

That can signal "this is not just typical depression or situational stress," Conley said. "There's something more here."

After hearing the student's story, Conley put her in touch with the Portland Identification and Early Referral program, called PIER, one of about 20 clinics in the United States that focus on treating prodrome cases. PIER has trained her and thousands of other school nurses and counselors, pediatricians and others in greater Portland in how to spot them.

PIER emphasizes non-drug therapies for its patients, ages 12 to 25, although about three-quarters of them take anti-psychotic medication.

The treatment regimen includes group meetings in which patients and families brainstorm about handling the condition's day-to-day stresses. It also focuses on keeping patients in school and in touch with their families and social networks.

With a grant from the Robert Wood Johnson Foundation, the PIER approach is also being tried in California, Oregon, Michigan and New York.

Even before treatment begins, a patient's encounter with someone who understands can be dramatic. McGlashan recalled that one young woman at the Yale clinic burst into tears when being asked about symptoms, explaining, "I thought I was the only person in the world who was having these experiences."

Or, when asked if they've felt like the television was speaking to them personally, young clients may reply, "How did you know?" McGlashan said.

Studying the schizophrenia prodrome has been tough for the small but growing group of researchers in the area, because the condition is relatively uncommon. A typical community may get only one new case per 10,000 people each year,* and only a fraction of those people would end up in a research study.

A federally funded project kicked into gear this year to uncover biological signals that will help identify people headed toward psychosis. There's already early evidence, for example, that combining brain scans with a standardized interview can greatly help, said Tyrone Cannon of the University of California, Los Angeles.

Such research should also point the way to better treatments, by exposing the biological roots of psychosis, Cannon said. He's the principal investigator of the project, which is being carried out at several medical centers.

When it comes to treating the prodrome, scientists say they have some promising approaches but no firmly proven treatments to prevent psychosis from appearing.

Low doses of anti-psychotic drugs dampen symptoms. But it's not clear whether those drugs can actually prevent psychosis. Side effects like serious weight gain are a problem, especially since many treated patients would never have developed psychosis anyway. What's more, the weight gain can turn young people away from anti-psychotic drugs, even if they move on to become psychotic and clearly need them.

Researchers are finding promise in psychosocial treatments, like those aimed at helping patients learn to manage stresses in their lives or understand and interpret their symptoms. Efforts to help young people complete their education, hold a job and stay connected to peers will help them avoid unemployment and social isolation later on, whether they progress to psychosis or not, experts say.

In fact, keeping up social contacts may help manage the prodrome. "We're convinced that if they start closeting themselves, coming home after school and just spending time in their bedroom, that will accelerate any process toward psychosis," McGlashan said. "If you dim your social life, it makes it easier for your brain to hallucinate and develop strange ideas."

The PIER program, which began eight years ago, hasn't yet published detailed results on its effectiveness. Its goal is to cut the rate of hospitalizations for first episodes of psychosis in Portland. Dr. William McFarlane, who directs it, says early analyses of the results look promising but that it's too early to draw conclusions.

And results from other locations trying the PIER approach won't be available for a couple of years, says Jane Lowe of the sponsoring Johnson foundation.

Still, in Portland, McFarlane said, "we see kids getting better every day."

One of them was the college student Conley referred. With the help of individual counseling, antidepressants and an anti-schizophrenia drug, "gradually I opened up to people," the young woman said.

She started playing tennis, joined a sorority and began exercising in the school gym. She wasn't sad all the time any more. And she stopped hearing and seeing things that weren't there.

On the Net:

* This statistic represents 94 people per year in Nova Scotia; not an insignificant number, particularly as it relates to the individuals, families, friends, and coworkers who are affected.

Sunday, July 26, 2009

Taser guidelines: Adopt B.C. blueprint

An editorial published in today's edition of The Chronicle Herald:

IT ISN’T the first report on Taser use and abuse, and it won’t be the last. But retired B.C. judge Thomas Braidwood’s 546-page tome on the sub­ject deserves to be adopted as the gold standard for law enforcement and policy makers nationwide.

Mr. Braidwood has become a fixture in the na­tional news firmament as he presides over the in­quiry into Canada’s most infamous Tasering fiasco — the videotaped confrontation that led to the death of Polish immigrant Robert Dziekanski at Vancouver airport in 2007. Part 1 of his analysis, Restoring Public Confidence: Restricting the Use of Conducted Energy Weapons, was released last week. The second phase of the inquiry, focusing on the circumstances of Mr. Dziekanski’s demise, has been adjourned until late September.

In his report, Mr. Braidwood finds no shortage of actors to upbraid. In a stinging rebuke to Taser International Inc., he asserts that Tasers can in­deed kill — a reasonable conclusion, given the stun gun’s track record, that is still firmly rejected by the weapon’s manufacturer.

Mr. Braidwood also finds fault with the B.C. gov­ernment for adopting Tasers without independ­ently testing them first and for the lack of uniform standards governing their use. But, significantly, he does not advocate shelving them. We agree with this view: Overall, Tasers can do more good than harm if they are deployed with restraint.

On that score, Mr. Braidwood sets an eminently sensible threshold that the stun gun use should be confined to violations of criminal law, not provin­cial or municipal statutes. Furthermore, offering “active resistance" to a police officer — running away or mouthing off — should not be considered a Taserable offence. But if a subject is inflicting or threatening bodily harm, then Tasering is justified. Uniform standards and clear rules of engagement should help eliminate the use of the Taser as an easy compliance tool and prevent outrageous acts such as the Amherst police subduing an obstrep­erous diabetic last year over the objections of para­medics who had called for assistance.

Also of particular relevance to Nova Scotians following the inquiry into the death of schizophren­ic Howard Hyde in Halifax police custody, was the warning that Tasering “an emotionally disturbed person is, in most cases, the worst possible re­sponse."

For police officers who have been issued a Taser, it does makes sense to have a defibrillator handy too, although this could be an expensive proposi­tion. In all, there are 19 recommendations in the report, which B.C. has pledged to immediately adopt. The findings should also be embraced by every other jurisdiction and the RCMP, which, in fairness has tightened its Taser-use protocols.

Certainly, Nova Scotia need look no further than the Braidwood report for inspiration to establish its own provincewide guidelines.

Bold emphasis in the text of the editorial is mine.

Also see:

Safe use is key

Saturday, July 25, 2009

B.C. stun gun report applies here, too

An opinion piece published in today's edition of The Chronicle Herald:
By Marilla Stephenson [pictured]

WHILE THE DEATH of Howard Hyde in a Dartmouth jail remains an incident of confusion and contradiction, the report from a British Columbia public inquiry this week was crystal clear: stun guns can kill.

The fatality inquiry called into Hyde’s death by the Nova Scotia government and the B.C. inquiry are different in many ways but they also have much in common: both deal with the death of a disturbed man who had earlier been Tasered by police officers.

The two men died about a month apart in 2007.

Robert Dziekanski died on the floor of the arrivals area of the Vancouver International Airport in October 2007 after officers used a stun gun to subdue him. The Polish man, who spoke no English, had been wandering the terminal for hours before becoming disruptive and exhibiting erratic behaviour. The RCMP were called in to deal with him, eventually delivering five Taser shocks before he collapsed and died.

Hyde died 30 hours after he had been Tasered by Halifax Regional police officers in November of the same year. The medical examiner ruled that his death, after a scuffle with guards at the jail a day after being arrested, was a result of "excited delirium" caused by paranoid schizophrenia.

The fatality inquiry into the Hyde case has different parameters from the B.C. inquiry. Judge Anne Derrick has not been tasked to assign blame in her findings.

In B.C., former judge Thomas Braidwood found that stun guns can kill or cause serious injury. As a result, the B.C. government has ordered the use of stun guns to be "severely restricted," but stopped short of an outright ban on the weapons, which have often been used to bring unruly suspects under control.

"Conducted energy weapons are unique — they are the only weapon designed to cause intense pain and to incapacitate through an electrical current," Braidwood said at a Vancouver news conference.

In releasing his report on Thursday, Braidwood noted that Tasers were introduced without prior independent government testing, relying instead on information from the manufacturers, the Canadian Press reported.

Braidwood issued 19 recommendations, including that police only use the weapons when someone is causing or is about to cause bodily harm. He said 25 people have died in Canada after being subjected to electrical shock from a stun gun.

He undertook a detailed review of existing research into Tasers. He concluded they are a better option for police than guns, noting the threat of a Taser has enabled some police forces to resolve up to 80 per cent of incidents.

But he also found that they can cause heart irregularities and are an especially high-risk weapon for those who are medically or emotionally compromised, particularly if they receive repeated shocks.

"Deploying a conducted energy weapon against an emotionally disturbed person is, in most cases, the worst possible response," said Braidwood.

Among his recommendations is a call for additional training to help police officers deal with emotionally disturbed people.

These findings will be of particular interest to the family and friends of Hyde, who have heard testimony at the Halifax inquiry from police officers and medical officials that seems, at times, at odds with common sense.

The inquiry has been told of procedural errors relating to Taser use by the officers involved in the incident, acknowledgement that written reports about Hyde’s time in custody are in conflict with what appears on security tapes, and a written doctor’s order that called for Hyde to receive a psychiatric assessment.

That never happened. Communication about Hyde’s condition appears to have been minimal among the police, medical staff who cared for Hyde after he was initially Tasered, and corrections staff. While the confusion that existed is apparent from testimony at the inquiry, there seems to have been little effort made to seek clarification.

One day later, Hyde was dead. Suggestions that jurisdictional limitations and ignorance of proper procedures may have prevented Hyde from getting the help he needed are far from good enough.

Bold emphasis in the text of the article is mine.

Also see:

Hyde lawyer: Adopt Taser guidelines

CACP launches new Canadian Police/ Mental Health Liaison Information website

A posting on the Canadian Mental Health Association, Ontario's website:
July 23, 2009

The Canadian Association of Chiefs of Police recently launched a new Canadian Police/Mental Health Liaison Information website in recognition of the key role that police services play in ensuring that individuals living with mental illnesses are not inappropriately criminalized. This website provides a broad range of resources targeted at police service personnel, mental health service providers as well as program developers, policy makers and researchers from within both disciplines.

Front-line workers can access basic information about mental illness and tips for responding. For communities involved in implementing or managing a collaborative police/mental health response initiative, this site offers program and policy development guidelines and sample agreements and memorandums of understanding. Researchers will find a comprehensive bibliography as well as relevant research reports. Finally, there are educational resources available for police who are assuming a leadership role in this area of mental health.

For more information about the Canadian Police/Mental Health Liaison activities, contact Dr. Dorothy Cotton or Terry Coleman by email at

See Canadian Police/Mental Health Liaison Information website, at

Note: The Police and Mental Health Research Reading List posted on the Canadian Police/Mental Health Liaison Information website has not been updated since May 31st, 2007.

Mental Health Commission of Canada 2008-2009 Annual Report: "Out of the Shadows - Forever"

An email to the SSNS received today from the Mental Health Commission of Canada:
It is our pleasure to provide you with a copy of our inaugural Annual Report, documenting the nineteen months since September 2007 when the Commission became operational. This Annual Report shows the extensive progress that has been made towards achieving the mandate that has been set out for the Commission, which is to promote mental health in Canada, to change the attitudes of Canadians toward mental health problems and mental illness, and to work with stakeholders to improve mental health services and supports.

We appreciate the support and contributions from many committed organizations and passionate people from across this country participating on boards and committees, in public and online consultations, in working groups and research teams, and in so many other important ways.

Please spread the word; let everyone know that this groundbreaking work is underway. There will be increasing opportunities for Canadians to get involved as the Partners for Mental Health program is launched.

Michael Kirby
Mental Health Commission of Canada

About the Mental Health Commission of Canada

The goal of the Mental Health Commission of Canada is to help bring into being an integrated mental health system that places people living with mental illness at its centre.

To this end, the Commission encourages cooperation and collaboration among governments, mental health service providers, employers, the scientific and research communities, as well as Canadians living with mental illness, their families and caregivers.

Genes for Psychosis and Creativity

The abstract of a research report posted online on July 6th by the journal Psychological Science:
Genes for Psychosis and Creativity: A Promoter Polymorphism of the Neuregulin 1 Gene Is Related to Creativity in People With High Intellectual Achievement

By Szabolcs Kéri

Semmelweis University, Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest H1083, Balassa u. 6, Hungary


Why are genetic polymorphisms related to severe mental disorders retained in the gene pool of a population? A possible answer is that these genetic variations may have a positive impact on psychological functions. Here, I show that a biologically relevant polymorphism of the promoter region of the neuregulin 1 gene (SNP8NRG243177/rs6994992) is associated with creativity in people with high intellectual and academic performance. Intriguingly, the highest creative achievements and creative-thinking scores were found in people who carried the T/T genotype, which was previously shown to be related to psychosis risk and altered prefrontal activation.

Posting of this abstract is for the purposes of research into psychosis.

Also see:

Genetic link between mental illness, creativity: Study

Friday, July 24, 2009

New Taser rules for B.C.

An article posted online yesterday by
The B.C. government will restrict the use of stun guns by police, following the release of a report by the Braidwood Commission in Vancouver on Thursday.

Effective immediately, all police, sheriffs and corrections officers in B.C. have been directed to severely restrict the use of conducted energy weapons, in accordance with recommendations from the inquiry, Solicitor General Kash Heed said.

The B.C. government also will immediately raise the threshold for use of the electric stun guns to match former judge Thomas Braidwood's recommendations.

That means Tasers should only be deployed when all of the following criteria are met:
  • The officer is enforcing a federal criminal law.
  • The subject is causing bodily harm or will imminently cause bodily harm.
  • No lesser-force option has been or will be effective in eliminating the risk of bodily harm.
  • De-escalation and/or crisis intervention techniques have not been or will not be effective in eliminating the risk of bodily harm.
  • In addition, the government will move to ensure all police using stun guns have access to defibrillators, said Heed.
Conducted energy weapons will now undergo regular testing and police will be required to report all use of the weapons to the province, said the statement.

In addition, B.C. will work with the federal government during contract negotiations to incorporate Braidwood's recommendations into future contracts with the RCMP for policing in the province.

Report based on speculation, says Taser manufacturer

Meanwhile, both the provincial RCMP and the Taser manufacturer issued written statements in response.

Taser International Inc. of Scottsdale Ariz., said it appears that "politics has trumped science."

It said the recommendations in the report are based largely on speculation and ignored key facts.

It is the opinion of Taser International, the statement said, that the inquiry's recommendations do not "meet the realities of modern day law enforcement."

The RCMP, however, said it welcomed the report from the first phase of the Braidwood Inquiry.

The force said it would "review and assess the findings, conclusions and recommendations" in the report.

The statement said the RCMP believes that Tasers, when used appropriately by officers who are well trained, can be a useful tool that contributes to officer and public safety.

Braidwood made a total of 19 recommendations to the B.C. government.

The commission inquiry was called after the death of Robert Dziekanski, a Polish immigrant who was stunned by RCMP officers at Vancouver International Airport on Oct. 13, 2007. The commission finished its first phase of testimony in May.

Also see:

Tasers need stricter control, B.C. inquiry finds

VIDEO: Thomas Braidwood releases preliminary findings from Taser inquiry (Runs 15:43)

Judge: Tasers can kill

Wednesday, July 22, 2009

Hyde transfer order confused cop

An article published in today's edition of The Chronicle Herald:
Note instructed police to ensure mentally ill man got psychiatric help, inquiry hears

By Michael MacDonald, The Canadian Press

An inquiry into the death of a mentally ill Nova Scotia man who died in jail is zeroing in on a police officer’s flawed interpretation of a form that instructed police to ensure Howard Hyde received psychiatric help.

Hyde, a 45-year-old musician who suffered from schizophrenia, was arrested on Nov. 21, 2007, amid a domestic dispute and was later taken to the Halifax police station, where he was Tasered twice while trying to escape.

The inquiry has heard that Hyde stopped breathing after he was shocked a second time, but he was revived by an officer who performed CPR and then taken to hospital. Const. John Haislip, a rookie officer at the time, testified that his supervisor, Staff Sgt. Don Fox, told him to make sure Hyde was taken to court once he was cleared as medically stable.

Haislip testified that Fox told him Hyde was in hospital for treatment of possible physical injuries, not mental health issues.

"He advised me that he had not been brought there for that; that if he was medically stable and medically cleared, then we had a duty to get him to court," he told the inquiry.

The doctor who examined Hyde, Dr. Janet MacIntyre, determined he was well enough to be discharged, but she included a note on a Health Information Transfer form that made it clear police should return Hyde to hospital if he did not receive a psychiatric assessment.

Haislip testified he was aware that once Hyde was turned over to sheriff’s officers at the court or correctional officers at the jail, he would no longer be in his custody. He admitted that it was unclear to him who would be responsible for getting Hyde to a psychiatrist. He said the doctor’s instructions, which referred specifically to police doing the job, probably should have been changed.

When asked if Fox’s directions had left him confused, he responded: "I guess it’s fair to say, yes."

The transfer form is a key piece of evidence in the inquiry.

Earlier testimony from other Halifax police officers indicates there was a general lack of understanding of how the form was supposed to be used, who was supposed to fill it out and what authority it provided.

Const. Steve Hillier testified that he didn’t even know the form existed until Tuesday, even though he was Haislip’s partner on the day Hyde was released from the Queen Elizabeth II Health Sciences Centre.

Hyde was eventually taken back to the police station for booking.

Haislip said he relayed MacIntyre’s instructions to a senior officer at the station, but he was given no assurances they would be acted on.

The officer said he assumed officials would see the form and get Hyde assessed.

However, Hyde was later transferred to the Central Nova Scotia Correctional Facility in Dartmouth, where he died the following morning after struggling with correctional officers.

Nova Scotia’s chief medical officer listed the cause of death as excited delirium due to paranoid schizophrenia. He concluded the use of the stun gun was not a factor.

In earlier testimony, another officer said he placed his right foot on Hyde’s back for more than 30 seconds as officers struggled to restrain him after the multiple Taserings at the police station.

Const. Christopher MacMahon said he didn’t lift his foot off Hyde until another officer said it appeared he had stopped breathing and was turning blue.

MacMahon insisted he did not place any pressure on Hyde’s back as three other officers struggled to control him in a hallway off the station’s booking room.

He said he wanted to stop Hyde from attacking the officers.

"I placed my right foot on his back should he flip over," he explained. "I put it there as a precautionary measure should he roll over and try to resist."

After watching a surveillance video of the incident, MacMahon estimated he kept his foot on Hyde’s back for 37 seconds.

Outside the hearing room, Kevin MacDonald, a lawyer for the Hyde family, said it would be reasonable to assume Hyde was out of breath after struggling with the officers and any amount of weight placed on his torso could have affected his breathing.

"I believe that is significant," he said.

"Mr. Hyde had just been through quite a struggle and it wouldn’t be unreasonable to say he was out of breath and any amount of weight on Mr. Hyde’s torso when he’s in the prone position, with hands cuffed behind his back and feet up towards his rear end — I think that is a significant issue."

Hyde’s struggle with police began after a special constable told him he had to use a serrated cutting tool to remove the string that was holding up his shorts.

Photograph of the Queen Elizabeth II Health Sciences Centre courtesy of the Capital District Health Authority.

Monday, July 20, 2009

Limited scope

A letter to the editor published in today's edition of The Chronicle Herald:
The current investigation into the death of Howard Hyde is being conducted under the Fatality Investigations Act of Nova Scotia and is not a public inquiry under the Public [Inquiries] Act of Nova Scotia.

The difference is not merely a play on words because the outcomes can be completely different. Under the Fatalities Act, the findings of Judge Anne Derrick shall not contain any findings of legal responsibility. The judge may make recommendations to the Attorney General to help prevent whatever caused the death of Mr. Hyde from happening to someone else, but the scope of the inquiry is not as in-depth as a public inquiry would be.

In a public inquiry such as the Nunn Commission and the Westray Mine disaster, the scope of the inquiry was much more in-depth and a public inquiry is usually requested by the government.

The public should be better informed as to the difference between a fatality inquiry and a public inquiry. The main issues in this fatality inquiry are centered around the use of a Taser and how Mr. Hyde was treated while suffering from a mental illness.

A public inquiry should have been called by government because of the current controversy surrounding Taser use and mental illness awareness. This incident may have been the opportunity to equal the Nunn Commission in its recommendations, which went to government for implementation. This fatality inquiry is not a public inquiry and therefore will be limited in its findings, which is unfortunate.

Jim Hoskins, Halifax

Saturday, July 18, 2009

Understanding Complex Interactions Key to Preventing Alcohol Abuse

An article published in the July 17th edition of Psychiatric News:
A genetically associated characteristic — the level of response to alcohol — connects genetic vulnerabilities with the environment to reveal the complicated process through which alcohol use disorders develop.

By Jun Yan

Like other mental illnesses, alcohol use disorders (AUDs) develop through interactions of multiple genetic vulnerabilities and environmental factors over a long period. By understanding these interactions, psychiatrists can devise and apply targeted, effective, and efficient prevention methods.

These were the messages of Marc Schuckit, M.D. [pictured], in his Adolf Meyer Award lecture at APA's 2009 annual meeting in May in San Francisco. Schuckit is a professor of psychiatry at the University of California, San Diego, and director of the Alcohol and Drug Treatment Program and Alcohol Research Center at the Veterans Affairs San Diego Healthcare System.

His lecture, "How Alcoholism Develops: Identification of Genetic and Environmental Influences in a 25-Year Longitudinal Study," examined groundbreaking research by him and his colleagues on the intricate dynamics between genes and environment that reveal much about AUDs as well as other mental illnesses.

To read the entire article, please click here.

Photograph by David Hathcox

Thursday, July 16, 2009

Province Releases Report on Suicide, Attempted Suicide

A July 15th media release from the Nova Scotia Department of Health Promotion and Protection:
A new report will better position government and its partners to help Nova Scotians at risk of attempting suicide.

The report, Suicide and Attempted Suicide in Nova Scotia, was released today, July 15. Its purpose is to help those who work in the areas of suicide prevention, intervention and support.

"Suicide is a very complex and sensitive public health issue," said Dr. Robert Strang, Nova Scotia's chief public health officer. "We need to talk about it more and better understand it to ensure the right programs and supports are in place to help Nova Scotians."

The report describes the conditions surrounding suicide and attempted suicide in Nova Scotia. The data is based on hospital and vital statistics records of suicides and suicide attempts from 1995 to 2004. It examines demographic factors, how people attempt suicide and complete suicide, and the types of health-care services used by Nova Scotians at risk.

"This report is a baseline we can use to evaluate future efforts on this important issue, and we've made good progress since 2004," said Dr. Strang. "We've developed a suicide prevention framework to reduce suicides and attempted suicides, we're doing additional research with the medical examiner's office, and we fund our community partners who work with Nova Scotians."

Dr. Stan Kutcher, Sun Life Financial chair in adolescent mental health, a partnership with the IWK Health Centre and Dalhousie University, said that even though suicide and suicide attempt rates are decreasing, and Nova Scotia is experiencing lower suicide rates than most Canadian provinces, there is more to be done.

"Improving care for people with mental disorders, enhancing the capability of health care and education professionals to identify people at risk, promoting overall good health and resiliency, and improving access to good mental health care, can all help further reduce Nova Scotia's suicide rates."

Highlights of the report include:
  • the rate of hospitalizations for suicide attempts declined by 30 per cent over the 10-year period
  • 55 per cent of those hospitalized were female
  • Lower income was associated with higher rates of both hospitalizations for suicide attempts and suicide deaths
  • The rate of suicide death declined from 11 to nine individuals per 100,000
  • Nova Scotia's suicide rate was lower than the national average, nine out of 100,000 individuals compared to 11 out of 100,000
  • 84 per cent of suicide deaths were male
  • 55 per cent of suicide deaths were previously diagnosed with a mental disorder
The report is available online at

Media Contact:

Rachel Boomer
Health Promotion and Protection

Also see:

Panel: Report says programs to prevent suicide working

Wednesday, July 15, 2009

Grand Jury Begins Kings Hospital Investigation

From yesterday's edition of the Brooklyn Daily Eagle:

By Daily Bulletin Staff

JAY STREET — Kings County District Attorney Charles J. Hynes today announced that a grand jury investigation has begun regarding the infamous death of Esmin Green [pictured], who died on the floor of Kings County Hospital Center's psychiatric emergency room.

The case was referred to the District Attorney following an investigation by Commissioner Rose Gill Hearn from the Department of Investigation (DOI).

Green, 49, arrived at the hospital by ambulance at 6:30 AM on June 18, 2008. She was diagnosed with schizophrenia and psychosis, and ordered to be admitted involuntarily that morning, according to the DOI report. She was still awaiting care 24 hours later when she collapsed from a blood clot and died on the floor of the psychiatric emergency room.

DOI's findings revealed that there was a breakdown in Green's care during four medical shifts on June 18 and June 19, 2008. Personnel failed to administer blood work and an EKG, failed to monitor vital signs, and doctors failed to conduct a medical examination, according to the report.

The grand jury is expected hear evidence throughout the summer.

Green’s family had announced last month that they still wanted criminal prosecution against hospital employees after their wrongful-death action against the city was settled for $2 million.

They got their wish, with the results of a recently-released comprehensive report by the Department of Investigation (DOI) portraying in detail how hospital staff in the psychiatric ward ignored Green before she died in June 2008. It also says that some staffers falsified records to conceal their incompetence.

Green’s death was captured on a hospital security camera. Green slumped over onto the floor of the waiting room after having not received any care for 24 hours. She died from a blood clot.

The top lawyer for the city, corporation counsel Michael Cardozo, contacted the DOI and they undertook an investigation of Green’s death.

The DOI’s report names doctors and nurses who failed to assist Green. They found that Green received no attention from a physician and little attention from nursing staff for more than 10 hours, until they realized that she was dead.

To read the entire article, please click here.

Also see:

Brooklyn jury to probe Kings County psych ward death of Esmin Green

Tuesday, July 14, 2009

Officer denies he doctored his report in tasering death

An article published in today's edition of The Globe and Mail:

By Oliver Moore

A police officer involved in the tasering of paranoid schizophrenic Howard Hyde could not explain why so much of his report was essentially identical to one written earlier by a colleague, but denied the suggestion he had "doctored" it.

The inquiry into the jailhouse death of Mr. Hyde also heard yesterday an allegation the unco-operative prisoner was sworn at during a rapidly escalating situation at police headquarters and told he would be "doing the ... dance next."

An altercation broke out immediately after and Mr. Hyde, who had been off his medication and acting erratically before his arrest, was tasered repeatedly. He died 30 hours later in a Dartmouth jail.

The inquiry into the November, 2007, death began hearing witnesses last week. Halifax Regional Police Constable Jonathan Edwards, the arresting officer, was on the stand all day yesterday.

Constable Edwards was one of many officers involved in the struggle that broke out during the booking. The fracas ended with the 45-year-old prisoner not breathing and having to be revived in a hallway. After he had accompanied Mr. Hyde to hospital, Constable Edwards returned to the police station to write up the incident.

A lawyer for Mr. Hyde's sister and her husband questioned the officer again and again yesterday about numerous similarities between his account and one drafted an hour earlier by Special Constable Gregory McCormick, the man who actually used the taser on Mr. Hyde.

"I am going to suggest today that you went in and used and doctored Special Constable McCormick's statement to create your own," Kevin MacDonald said. "These are identical words, they're his words ... you used his words."

Constable Edwards repeatedly denied having cribbed his colleague's report.

The inquiry also walked through the lead-up to the tasering, with Constable Edwards offering new details on the alleged risk posed by Mr. Hyde.

He testified that the booking room struggle brought the prisoner within reach of a drawer full of knives and other weapons. The drawer was unlocked and the one immediately above it was missing, he said, allowing a clear view of these weapons.

The prisoner received his first tasering seconds later.

Constable Edwards acknowledged that his notes or other paperwork do not include mention of concern over Mr. Hyde arming himself during the struggle. The officer explained the late revelation by saying he had a lot on his mind in the aftermath of the incident.

It was not clear why weapons were stored in an accessible drawer, though Constable Edwards said that is no longer the practice.

Also heard for the first time was his allegation that Mr. Hyde had earlier tried to reach for a cutting tool held by another officer, who intended to sever the drawstring of the prisoner's shorts.

That was not recorded by surveillance cameras, but some audio around the alleged incident was captured. It was then, during the rapidly building tension, Mr. MacDonald suggested, that one of the officers told Mr. Hyde he would be made to "dance."

I must note my disapproval of the media continuing to label Mr. Hyde as a "schizophrenic". In the above article, he is labelled as a "paranoid schizophrenic".

To the media:
Mr. Hyde lived with schizophrenia. He experienced schizophrenia. He had schizophrenia. Just because Mr. Hyde lived with schizophrenia, that does not completely define him as a person. Does living with diabetes totally define a person? Does the media report that a diabetic did this or did that?

Monday, July 13, 2009

11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study)

An article published online today by The Lancet:

By Jari Tiihonen, Jouko Lönnqvist, Kristian Wahlbeck, Timo Klaukka, Leo Niskanen, Antti Tanskanen, and Jari Haukka

The introduction of second-generation antipsychotic drugs during the 1990s is widely believed to have adversely affected mortality of patients with schizophrenia. Our aim was to establish the long-term contribution of antipsychotic drugs to mortality in such patients.

Nationwide registers in Finland were used to compare the cause-specific mortality in 66,881 patients versus the total population (5.2 million) between 1996, and 2006, and to link these data with the use of antipsychotic drugs. We measured the all-cause mortality of patients with schizophrenia in outpatient care during current and cumulative exposure to any antipsychotic drug versus no use of these drugs, and exposure to the six most frequently used antipsychotic drugs compared with perphenazine use.

Although the proportional use of second-generation antipsychotic drugs rose from 13% to 64% during follow-up, the gap in life expectancy between patients with schizophrenia and the general population did not widen between 1996 (25 years), and 2006 (22·5 years). Compared with current use of perphenazine, the highest risk for overall mortality was recorded for quetiapine (adjusted hazard ratio [HR] 1·41, 95% CI 1·09–1·82), and the lowest risk for clozapine (0·74, 0·60–0·91; p=0·0045 for the difference between clozapine vs perphenazine, and p<0·0001 for all other antipsychotic drugs). Long-term cumulative exposure (7–11 years) to any antipsychotic treatment was associated with lower mortality than was no drug use (0·81, 0·77–0·84). In patients with one or more filled prescription for an antipsychotic drug, an inverse relation between mortality and duration of cumulative use was noted (HR for trend per exposure year 0·991; 0·985–0·997).

Long-term treatment with antipsychotic drugs is associated with lower mortality compared with no antipsychotic use. Second-generation drugs are a highly heterogeneous group, and clozapine seems to be associated with a substantially lower mortality than any other antipsychotics. Restrictions on the use of clozapine should be reassessed.

Annual EVO Financing (Special government subsidies from the Ministry of Health and Welfare, Finland).

To download the entire article, please click here (PDF).

Posting of this abstract is for the purposes of research into schizophrenia.

Sunday, July 12, 2009

Exploding the barriers

A letter to the editor published in today's edition of The Chronicle Herald:
It is both disheartening and frustrating to know of our huge deficiencies in mental health awareness and treatment in this province. But with more stories making their way to the surface and into the public eye, I believe we are on the cusp of exploding the barriers surrounding the topic forever.

For many families and sufferers dealing with mental illness, it’s a double-edged sword, so to speak. You want to stand up and demand more, but fear usually prevents many of us from doing so. And who could blame us? Sadly, many believe exposing one’s mental illness is a sign of weakness or failure. But the truth is, mental illnesses are just like any other illness requiring treatment. So why are we not dealing with them as such?

With one in every five people on this planet suffering from some form of mental illness, I know that you know someone who struggles. One of the campaign slogans for the Canadian Mental Health Commission is "Out of the Shadows Forever." I really like it. But it is up to us to make it happen. I believe we will. I will. Will you join me?

Karen Parker, Head of St. Margaret’s Bay

Housing First ACT Team

To understand 'housing first' and Assertive Community Treatment (ACT), the following is an excellent overview.

From the RainCity Housing and Support Society's website:

Housing First ACT Team

In response to the growing challenge of homelessness in Canada, the Mental Health Commission of Canada is sponsoring Research Development Projects on Mental Health and Homelessness. These projects will take place in five cities across Canada, including Vancouver, with services beginning in September 2009 and ending on March 31, 2013.

Each project is designed to answer questions about what services and supports best achieve housing stability and improved health and well-being for persons who are homeless and living with a serious mental illness.

In Vancouver, the research will also have a focus on people with a concurrent substance addiction. It will be conducted on four service models:
  • An Intensive Case Management team with rent supplements
  • A staffed building with clinical and support services
  • The usual care provided in the community

RainCity Housing’s ACT team

RainCity Housing’s role in the Vancouver Project Team is developing the ACT team. The ACT team is based on the Pathways to Housing model from New York which incorporates a ‘housing first’ approach into the Assertive Community Treatment model.

Housing first is a recovery-oriented supportive housing approach that offers homeless people living with a mental illness immediate access to rent supplements so they can live in the same kinds of apartments that are typically available to people that don’t have a mental illness.

The rent supplements are provided without requiring participation in psychiatric or substance use treatment and will be available to clients throughout the course of the project. Self-determination, choice and harm reduction are at the centre of all considerations with respect to the provision of housing and ACT services.

ACT is a well researched evidence-based transdisciplinary model that includes a broad array of clinical and support services. The team will support 100 clients at a client-staff ratio of 10:1. 80% of the work will occur in the community and crisis support is available seven days a week, 24 hours a day. Program staff are closely involved in hospital admissions and discharges. Clients will be randomly assigned to the ACT team by the research team.

The Healthy Minds Cooperative

From the Healthy Minds Cooperative website:
The Healthy Minds Cooperative is a member owned and democratically controlled not-for-profit enterprise. Its shareholders are people who possess lived experience with mental illness, and/or an interest in the topic of mental health.

What is the Healthy Minds Co-op about?

The Co-op is about people who have mental illness/mental health issues helping themselves.

It is made up of people who are committed to improving mental health in their communities. Many of its members have experience with mental illness or mental health issues, and know there is a need for change in the system and society. HMCo-op provides public education to reduce the stigma of mental illness offers peer support and facilitates connections to community services.

The Co-op has identified five areas of priorities, they are:
  • Better access to mental health services
  • Public education regarding mental illness
  • More participation of those with lived experience in the design, development, delivery and evaluation of mental health services
  • Providing peer-support and advocacy for consumers and their families
  • Developing better connections to existing community services

To contact the Healthy Minds Cooperative, call (902) 404-3504 or send an email to

Proceedings of the Senate Subcommittee on Cities

I saw this on CPAC yesterday. It was a very informative session to view, in my opinion.

From June 5th, 2009:
Today we are having a round table discussion about national strategies on poverty, housing and homelessness. As you know, last June, after quite a number of hearings, we produced an issues and options paper on this subject. Many of the people who came before the committee, both on our road trips and here in Ottawa, said let us have a national strategy on poverty; let us have a national strategy on housing and on homelessness.

We will explore further today how we should develop our recommendations relevant to the federal government dealing with these issues. We will consider whether it should be called a national strategy or whether another approach should be taken.

To read the entire transcript, please click here.

Saturday, July 11, 2009

Howard Hyde Death Inquiry: System failing mentally ill

An editorial published in today's edition of The Chronicle Herald:
THE SYSTEM for dealing with mental health emergencies in Nova Scotia broke down almost totally in the tragic case leading to the death of Howard Hyde.

A judicial inquiry into the circumstances of the Dartmouth man’s death in November 2007 has so far heard just a few days of testimony. Even so, it’s already abundantly clear that both better training for police officers on how to handle mental health cases as well as a stronger commitment across the justice system to properly deal with mental health issues are urgently needed.

When Mr. Hyde, who weeks earlier had stopped taking his medications to treat his schizophrenia, became violent on the night of Nov. 21, his common-law wife appropriately called the mental health emergency help line.

Mr. Hyde never got the help he needed.

Records show dispatch informed the officers of the mental health nature of the call. Mr. Hyde’s widow has testified she told at least one officer of her husband’s schizophrenia and the fact he’d been off his medications. Despite that, the officer who arrested Mr. Hyde told the inquiry he doesn’t recall any evidence at the scene that would have led him to reasonably assume a mental health problem.

After Mr. Hyde was Tasered twice at the police station after trying to escape and had to be revived using CPR, he was taken to the QEII emergency. The doctor who examined him obviously believed Mr. Hyde had mental health issues, as she gave the officers directions to return him to hospital if he could not get a psychiatric evaluation.

Her instructions were ignored. Instead, Mr. Hyde stayed in police custody, made a court appearance and then spent the night in the correctional facility in Burnside. When his wife called there to inform them of Mr. Hyde’s mental health condition, she testified staff told her they couldn’t deal with her because of confidentiality concerns.

The next morning, Mr. Hyde collapsed after a physical struggle with jail staff. He was pronounced dead at hospital shortly afterwards.

The police have admitted they could use more training on dealing with mental health issues.

There are still weeks of testimony left for Judge Anne Derrick to hear. The inquiry cannot find anyone liable, criminally or civilly.

Still, it’s clear the system badly mishandled a case involving mental health. Since Mr. Hyde was hardly the first or last person with mental health problems to come in contact with law enforcement, we look forward to Judge Derrick’s ideas on how to best fix what’s broken.

Wednesday, July 8, 2009

Canadian hospital pioneers mental-health treatment

An article published is yesterday's edition of The Globe and Mail:
By Anne McIlroy

A Canadian psychiatric hospital will be the first in the world to use a combination of genetic testing and brain imaging to help determine the best course of treatment for patients with schizophrenia, depression, bipolar disorder and other mental illnesses.

A few dozen patients will take part starting in the fall, and the experimental program will slowly ramp up to include 100 people, says James Kennedy, director of the neuroscience research department at the Centre for Addiction and Mental Health in Toronto. If it proves successful, the program will be a step toward giving psychiatrists more precise tools to assess patients with common psychiatric conditions.

“It is a small revolution, a great opportunity to change, in a fundamental way, how we treat patients,” says Dr. Kennedy, who along with his colleague, Sylvain Houle, is leading the new research initiative.

To read the entire article, please click here.

Also see:

CAMH combines genetics with brain imaging to personalize treatment for mental illness and addictions

I thank John Devlin for bringing this article to my attention.

Saturday, July 4, 2009

Strengthening Families Together (SFT) Online Project

The Schizophrenia Society of Ontario has posted a series of videos adapted from the Strengthening Families Together (SFT) program developed by the Schizophrenia Society of Canada. To view the videos, please click here.

In-person delivery of SFT by the Halifax Chapter of the Schizophrenia Society of Nova Scotia will resume in the fall of 2009 in both Halifax and Windsor. To register for either of these 10-week SFT sessions, please contact contact Donna Methot at (902) 462-8658 or send an email to

Friday, July 3, 2009

Gene clues to schizophrenia risk

An article posted July 1st by BBC News:
Scientists have identified thousands of tiny genetic variations which together could account for more than a third of the inherited risk of schizophrenia.

They also showed the condition is genetically similar to bipolar disorder also known as manic depression.

The findings came from work by three separate teams, who analysed DNA from thousands of people.

The studies - the biggest ever into the genetics of schizophrenia - appear in the journal Nature.

The findings suggest that schizophrenia is much more complex than previously thought, and can arise not only from rare genetic variants, but common ones as well.

It is hoped the work could lead to new diagnostic tests and treatments for the condition.

To read the entire article, please click here.

Also see:

Common polygenic variation contributes to risk of schizophrenia and bipolar disorder

Hoopla, and Disappointment, in Schizophrenia Research

Thursday, July 2, 2009

men-tal'-i-ty magazine ... has a website. Please click here to visit it.

I thank John Devlin for bringing this website to my attention.

Evergreen Child and Youth Mental Health Survey

Posted yesterday on the Teen Mental Health Blog:

Canada has a proud history of valuing health care as part of the fabric of this country and a basic right for all citizens. However, despite our commitment to overall health care, our attention to mental health care is overdue.

In Canada, approximately 1 in 5 children and adolescents experience some form of mental disorder. Most major mental disorders begin prior to the age of 25, making this period a critical time for the promotion and treatment of mental health problems.

One of the key initiatives of the Mental Health Commission of Canada is to develop a Mental Health Strategy for Canada. As part of the strategy the Child and Youth Advisory Committee of the Mental Health Commission of Canada will support the development of a framework specific to the needs of child and youth mental health.

We need your help!!

We invite all Canadians to share their thoughts and opinions in an online survey about values and principles relating to child and youth mental health.


The survey [please click here] will take about 30 minutes to complete (but you can save your answers and come back to it at any time).

It is important that we get the thoughts and opinions from as many different people as possible. Please pass this information along to your network, family, friends, or anyone who you think should join this consultation.

Consultation on the Ratification of the United Nations Convention on the Rights of Persons with Disabilities

Submission Deadline, Friday, July 31st!

From the Human Resources and Skills Development Canada website:

Minister’s greeting

Welcome and thank you for visiting our consultation Web site.

Canada’s signing of the United Nations Convention on the Rights of Persons with Disabilities in March 2007 demonstrates our government’s commitment to advancing the rights of persons with disabilities.

Human Resources and Skills Development Canada is seeking input from Canadian organizations, individuals residing in Canada, and any Canadian citizens residing abroad who are interested in sharing their views on the ratification, implementation and reporting of the Convention. In particular, we encourage people with disabilities and those who are familiar with disability issues to participate and have a voice in this consultation. Your experience and knowledge on these issues make your contribution essential to this process.

You will be able to provide your comments through the consultation Web site until July 31, 2009. Web-based consultations are an innovative way to reach people across Canada by providing them with a means of participating from the comfort of their own home or office. The Web site features many resources and background information, which are meant to guide you as you fill out the consultation questionnaire. Among others, you will find links to the full text of the Convention, as well as an illustrated and simplified text version.

I strongly encourage you to create a link to the consultation Web site from your own Web site, and to share the link freely with others who may have an interest in taking part in this consultation.

Thank you for your participation, and I look forward to receiving your feedback.

Yours sincerely,

The Hon. Diane Finley, P.C., M.P.
Minister of Human Resources and Skills Development

Wednesday, July 1, 2009

Dedicated group

A letter to the editor published in today's edition of The Chronicle Herald:

I was touched by Heather Amos’s June 20 story subtitled "Mother: With no services to help her daughter, she’ll continue to run away," about Kim Clark and her daughter Koral Lynn [pictured].

I would like Ms. Clark to know that there is a dedicated group of community leaders who are volunteering their time to raise funds so that her daughter will have a place to heal and recover.

The Mental Health Foundation of Nova Scotia is in the early stages of our province’s first-ever capital campaign for mental health. The Opening Minds Capital Campaign is raising funds for the construction of new residences that will be home to individuals who have experienced a period of stability and are ready to begin their transition back into the community.

If you’ve driven down Pleasant Street in Dartmouth lately, you will have noticed a dramatic change in the skyline as Simpson Hall at the Nova Scotia Hospital site comes down to make way for these new residences.

We’re also creating a dedicated fund for mental health care programs throughout Nova Scotia so that patients have access to services and support closer to the place they live.

I would like to commend Ms. Clark for fighting for a better quality of life for her daughter and thank her for sharing her story.

Our group of volunteers is committed to a better quality of life for the one in five Nova Scotians who have a mental illness. For more information, visit

Greg Grice, Regional President
Atlantic Provinces, RBC
Chair, Opening Minds Capital Campaign

Admit you have an illness

An article published in today's edition of The Chronicle Herald:

By Christine Stapleton {pictured]

IN 1957, the American Medical Association accepted alcoholism as an illness. At about the same time, alcoholism found a place in the American Psychiatric Association’s Diagnostic and Statistical Manual — the hallowed handbook that doctors use to diagnose mental illness (and that insurance companies use to deny your claim).

In other words, alcoholism is an illness. It is a mental illness. People who have alcoholism, like me, are not weak or lacking discipline. In fact, most of the alcoholics I know — in recovery and still drinking — are very strong and very disciplined. That’s how we convince ourselves that we are in control and what makes us so annoying.

Learning that alcoholism is a legitimate illness helped me immensely. It gave me some self-esteem, hope and the final word in conversations with know-it-alls who believe we could quit drinking if we really, really tried: "Well I guess you know more than the American Medical Association because the AMA decided that alcoholism is an illness 50 years ago."

Depression is different. There are a lot of people who admit that depression is a real illness. They feign sympathy and tell you about someone else’s struggle with depression.

But you can tell by their zealous enthusiasm that they don’t really believe it. I hate to admit this: I was among them.

I knew that Hippocrates declared depression a real illness several thousand years before the American Psychiatric Association.

Folks that I admired — Michelangelo, Eric Clapton and the guy who played Beaver’s brother, Wally — all suffered from depression. But when dealing with someone with depression, I privately thought: "Get a grip already, will ya?"

When I was diagnosed with a depression — a major clinical depression — what helped me more than the manuals and medical endorsements were the aw-shucks comments from friends: "I’ve been on antidepressants for years." Or, "Actually, I am on two antidepressants." Or, "I have to be on either antidepressants or hormones or I’m a mess."

Really? Who would have guessed?

The moral is simple: Do whatever it takes to accept and forgive yourself for being mentally ill.

Also see:

Accepting problems hard, but worth it