The Value of Moodscope

In 2007, Jon Cousins started tracking his mood to help NHS psychiatrists decide if he was cyclothymic (a mild form of bipolar disorder). After a few months of tracking, he started sharing his scores with a friend, who expressed concern when his score was low. Jon’s mood sharply improved, apparently because of the sharing. This led him to start Moodscope, a website that makes it easy to track your mood and share the results.

I was curious about the generality of what happened to Jon — how does sharing mood ratings affect other people? In January, Jon kindly posted a short survey about this. More than 100 people replied. Continue reading “The Value of Moodscope”

The Parable of the SAMe

SAMe is a drug well known to help depression. For example, “a popular dietary supplement called SAMe may help depressed patients who don’t respond to prescription antidepressant treatment, a new study shows.” But there’s something important few people know about SAMe.

While talking to a Seattle woman about how Vitamin D3 first thing in the morning helped her with depression, she told me the following story:

When I was 47, I just wanted to be healthier. I kept gaining weight. I knew what foods are healthy. I just didn’t seem to eat them. A naturopath suggested SAMe. I tried it — Twin Labs SAMe. That was really fabulous for me. For the first time I got a glimpse of what being not depressed was like. Cravings weren’t there any more. Went from a size 24 to a size 14. Lost 70 pounds. I’m 5′ 8″. I didn’t feel deprived. I was eating plenty of food. going to yoga. Feeling really great.

Then Twin Labs discontinued it. It was made in Japan. I tried every other SAMe out there, eight different brands. None of them worked. I gave each of them a month. I tried different dosages.

I started slipping back into depression. Not being able to cope. I was sleeping more. Sugar cravings returned.

[why did Twin Labs stop making it?]

It wasn’t a good seller for them. So fucking wrong. I wrote letters to try to get them to start making it again. I did a campaign. People found pockets of what was left in the country and sent it to me. But it finally ran out.

The moral(s) of the story? 1. So much for word of mouth. You might have thought it would make the good SAMe sell well, better than the bad SAMe. Apparently not. 2. So much for the placebo effect. 3. Clinical studies (e.g., of SAMe) may higher-quality versions of what they are testing than the versions available to the rest of us. 4. So much for quality control in the supplement industry — except maybe in Japan. There can be substantial quality variation among supplements, undetected by the industry. I have to believe the companies selling the useless SAMe didn’t realize it. Surely they thought that good SAMe would be a better product for them than bad SAMe.

This resembles the Vitamin D3 story I have been telling. Tara Grant said she’d heard countless times that Vitamin D is good. She hadn’t heard once that it must be taken in the morning. I’ve heard countless times that SAMe is good. This was the first time I heard about huge quality control issues. In both cases individual self-observation uncovered a crucial truth that an industry had overlooked. They didn’t want to miss it. The Vitamin D Council didn’t want to miss the time-of-day effect. They just did.

This also resembles what I said about ultrasound machines: A lot of them are broken, unbeknownst to their operators and the people (often pregnant women) being scanned. The countless “experts” (doctors) who recommend ultrasound don’t seem to know this.

Which is why personal science (trusting data, not experts) is more valuable than experts want you to think.

Ten Interesting Things I Learned From Adventures in Nutritional Therapy

A blog called Adventures in Nutritional Therapy (started March 2011) is about what the author learned while trying to solve her health problems via nutrition and a few other things. She usually assumed her health problems were due to too much or too little of some nutrient. She puts it like this: “using mostly non-prescription, over-the-counter (OTC) supplements and treatments to address depression, brain fog, insomnia, migraines, hypothyroidism, restless legs, carpal tunnel syndrome, and a bunch of other annoyances.” In contrast to what “the American medical establishment” advises. Mostly it is nutritional self-experimentation about a wide range of health problems.

Interesting things I learned from the archives:

1. Question: Did Lance Armstrong take performance-enhancing drugs? I learned that LiveStrong (Armstrong’s site) is a content farm. Now answer that question again.

2. “If you return repeatedly to a conventional doctor with a problem they can’t solve, they will eventually suggest you need antidepressants.”

3.  “When I mentioned [to Dr. CFS] the mild success I’d had with zinc, he said it was in my mind: I wanted it to work and it did. When I pointed out that 70% of the things I tried didn’t work, he changed the subject. Dr. CFS’ lack of basic reasoning skills did nothing to rebuild my confidence in the health care system.” Quite right. I have had the same experience. Most things I tried failed. When something finally worked, it could hardly be a placebo effect. This line of reasoning has been difficult for some supposedly smart people to grasp.

4. A list of things that helped her with depression. “Quit gluten” is number one.

5. Pepsi caused her to get acne. Same here.

6. 100 mg/day of iron caused terrible acne that persisted for weeks after she stopped taking the iron.

7. “In September 2008 I started a journey that serves as a good example of the limits of the American health care system, where you can go through three months, 15 doctor visits, $7,000 in medical tests, three prescriptions and five over-the-counter medications trying to treat your abdominal pain, and after you lose ten pounds due to said pain, you are asked by the “specialists” if you have an eating disorder.” I agree. Also an example of the inability of people within the American health care system to see those limits.  If they recognized that people outside their belief system might have something valuable to contribute, apparently something awful would happen.

8. Acupuncture relieved her sciatica, but not for long. “By the time I left [the acupuncturist’s office] the pain was gone, but it crept back during my 30-minute drive home.”

9. Pointing out many wrongs does not equal a right. She praises a talk by Robert Lustig about evil fructose. I am quite sure that fructose (by itself) did not cause the obesity epidemic. For one thing, I lost a lot of weight by drinking it. (Here is an advanced discussion.) In other words, being a good critic of other people’s work (as Lustig may be) doesn’t get you very far. I think it is hard for non-scientists (and even some scientists) to understand that all scientific work has dozens of “flaws”. Pointing out the flaws in this or that is little help, unless those flaws haven’t been noticed. What usually helps isn’t seeing flaws, it is seeing what can be learned.

10. A list of what caused headaches and migraines. One was MSG. Another was Vitamin D3, because it made her Vitamin B1 level too low.

She is a good writer. Mostly I found support for my beliefs: 1. Of the two aspects of self-experimentation (measure, change),  change is more powerful. She does little or no self-tracking  (= keeping records) as far as I could tell, yet has made a lot of progress. She has done a huge amount of trying different things. 2. Nutritional deficiencies cause a lot of problems. 3. Fermented food is overlooked. She never tries it, in spite of major digestive problems. She does try probiotics. 4. American health care is exceedingly messed-up. As she puts it, “the American medical establishment has no interest in this approach [which often helped her] and, when they do deign to discuss it, don’t know what the #%@! they’re talking about.” 5. “Over the years I’ve found accounts of personal experiences to be very helpful.” I agree. Her blog and mine are full of them.

Thanks to Alexandra Carmichael.

More Her latest post mentions me (“The fella after my own heart is Seth Roberts, who after ten years of experimenting . . . “). I was unaware of that when I wrote the above.

Sleep, Mood, Restless Legs and ADHD Improved By Internet Research

At the SLD forums, Anima describes using several  safe cheap treatments to improve his mood and sleep. First, he tried wearing blue blocker (amber) glasses in the evening. They made him fall asleep more easily and reduced or eliminated hypomania. However, he was still depressed. Second, he tried getting twenty minutes of sunlight early in the morning. His mood improved. But he still had trouble synchronizing his sleep/wake cycle with the sun — that is, being awake during the day and asleep at night. He would stay up an hour later every night and wake up an hour later every day, meaning that half the time he was asleep during the day and awake at night. Finally, he tried adjusting when he ate:

I recently found the missing key to this: meal timing.  I saw a talk that Seth gave where he talked about curing his problem with waking too early by skipping breakfast.  My problem was difficulty waking.  I read an article that suggested that our circadian rhythms are not just tied to light, but to food times as well.  I used to eat late at night and never eat breakfast.  I started eating breakfast immediately upon waking (ick) and stopping all food at least 12 hours before I wanted to wake.  Basically, I did what Seth did only opposite.  It worked. . . . I was even able to adjust my cat’s circadian rhythm — he used to wake me up too early for his breakfast — by gradually moving his supper time.

In another post he describes using B vitamins to treat his restless legs syndrome and ADHD:

I have been taking a supplement with all the B vitamins in amounts much higher than typically recommended. I have also been taking Epsom salt baths for magnesium. I have not experienced restless legs AT ALL since starting. This is quite remarkable to me, because it was such a problem. My ADHD is also much improved.

The idea of treating restless legs syndrome with niacin (a B vitamin) came from Dennis Mangan. Anima had noticed that ADHD and restless legs syndrome often occur together.

He makes some reasonable comments about psychiatrists:

Why are psychiatrists still acting like neurological problems exist in isolation, when clearly they are all related? [In the sense that you can use what is known about how to cure Problem X to help you cure Problem Y, if X and Y often occur together.] I used to take Lamictal, Depakote, Adderall and Ambien every day. That doesn’t include all the meds I tried that didn’t work. I’m currently wearing amber glasses at night and taking a B complex, flax oil (SLD-style) and bathing in epsom salts three times a week. My mood is more stable than it was on medication, and my ADHD is controlled about the same. My sleep is much better. My psychiatrist told me that I would be on medication for the rest of my life. When I told him that I was using dark therapy and light therapy and had stopped taking my medication, he told me that I was “playing with fire,” and that I would end up in a mental institution or commit suicide if I didn’t resume my medication, despite the fact that I had stopped taking it for longer than it would be effective. I asked him if he had read the research on dark therapy. He hadn’t, but he assured me that it is pseudoscience. I guess the definition of “pseudoscience” is any treatment that doesn’t make him money. I puckishly asked him if I seemed manic or depressed, and he was forced to admit that I did not.

The ability of this psychiatrist to ignore contradictory evidence in front of him resembles what happened to Reid Kimball. He told a UCSF gastroenterologist that he was successfully managing his Crohn’s with diet. In my experience, Crohn’s can’t be managed with diet, the doctor said at the end of the appointment.

Is Health Data Ever Harmful?

In yesterday’s post I described how searching the medical literature helped me avoid a dangerous surgery with no obvious benefit. The surgeon I consulted, who recommended the surgery, said that published evidence backed her up. I could not find that evidence, however. Others found evidence that contradicted her recommendation.

Among the comments on that post were similar stories: Searching/reading the medical literature had been helpful. Learning what had happened (in research studies) was better than relying on an expert (a doctor). Here is an example:

A little over two years ago, I was “depressed”. My psychiatrist wanted to prescribe an SNRI [serotonin-norepinephrine reuptake inhibitor]. I related, once again, my poor experience with an SSRI and asked for evidence that an SNRI would be any more effective. He said there was evidence that SSRIs [selective serotonin reuptake inhibitors] worked. I pointed out the 2004 meta-analysis that showed no meaningful difference between SSRIs and placebos. Then I asked whether there was any better evidence for SNRIs. Since he wasn’t able to provide any, I told him that since we know that extremely low Vitamin D blood levels, poor diet, no exercise, and no social life can cause depression (all things I had at the time), I’ll try fixing those things first and then resort to drugs if that fails. It did not fail and I quit seeing him.

None of the stories in the comments described the opposite outcome: Knowing the data made things worse.

Are there exceptions? Is it always helpful (or at least not harmful) to know what happened (i.e., know research outcomes)? Has anyone reading this had an experience where knowing health research data was harmful?

Bipolar Disorder: Good Results With Blue-Blocker Glasses

At the Shangri-La Diet forums, Anima writes:

I have been diagnosed with ADHD and Bipolar II disorder.  I am also a Non-24, a chronic circadian rhythm disorder where one’s body thinks a day is longer than 24 hours. . . .I’ve been using amber safety glasses (around $3 in the hunting section of the sporting goods store) for dark therapy.  I put them on 3 hours before I want to go to sleep.  They block blue light, allowing dark therapy without the dark.  I also wear an eye mask while I sleep.  The glasses make me look like a big weirdo, but they really work.  It’s easier to get to sleep, and they prevent hypomania (the milder form of mania that people with Bipolar II experience) better than any medication I have tried.  It makes sense that almost anyone could benefit from them, because our ancestors were not exposed to blue light after dark. Continue reading “Bipolar Disorder: Good Results With Blue-Blocker Glasses”

Morning Faces Therapy: Personal Account

Five years ago I heard from someone that he had been successfully using my discovery that seeing faces in the morning improved my mood the next day. Recently I asked him to write about his experiences with it. Here’s what he wrote:

I’m a male professional in my 30s and have had mild to moderate depression since my early teens. I am a considerable rationalist and skeptic, so when I read about Seth’s morning faces therapy in a New York Times article about 5 years ago, my first thought was to doubt its effectiveness. But it was so easy and simple to try, with nothing to lose, that I gave it a shot. To my surprise, it really worked, and the change was quite noticeable. Continue reading “Morning Faces Therapy: Personal Account”

Poor Replication Rate in Psychiatric Genetics Research

With the ability to measure individual genes has come interest in learning what they do. Perhaps Person X is depressed and Person Y is not depressed because Person X’s genes differ from Person Y’s. A whole generation of psychiatry researchers now believes this is plausible. There are “general reasons to expect that GxEs [gene by environment interactions] are common,” says a new review paper in the American Journal of Psychiatry. By “common” they mean large enough and common enough to do research about. Continue reading “Poor Replication Rate in Psychiatric Genetics Research”

Van Gogh Defense Project: Rationale

A colleague I’ll call John has decided to start tracking his mood for a long period of time (years). He explains why:

A few years ago, after a severe manic attack, I was diagnosed with bipolar disorder. The attack was preceded by an intense period of stress, then two weeks of elevated mood, increased social activity (hanging out and meeting people), and racing thoughts (hypomania). Then I skipped a few nights of sleep, wandered down roads in the middle of the night, and eventually became psychotic, in that I could no longer distinguish between reality and imagination. I was chased by cops on several occasions, and was involuntarily committed to the mental health wing of a hospital for a month. It put a massive dent in my life.

Family, medicine, and time helped me recover. Being out of control like that was fun only for the first two weeks. Having my life turned upside down was not fun either. As I recovered I became increasingly interested in finding ways to prevent a relapse. One doctor said: You have a vulnerability. You need to protect yourself. I agreed.

Looking back on the experience, I realized there was a rise in odd behaviors two weeks before I started to skip nights of sleep and fell into psychosis. There was an even longer buildup of stress, anxiety, and fear in the months before the mania hit. During the last two weeks before the mania, my behavior was different from what is normal for me. I felt elated and had a sense of general “breakthrough”. I suddenly felt no fear and anxiety. I felt on top of the world. I was constantly taking notes because ideas and thoughts were running through my head. I scheduled meetings and social activities almost constantly throughout these two weeks and shared my experiences as my new self. As I started to sleep less and skip nights of sleep, others later told me I seemed agitated and down.

Maybe it is possible to catch these early warning signs and take counter measures before they worsen into mania or depression. This is why I have started to track my behavior starting with mood and sleep. If I can get a baseline of my behavior and know what is ‘normal’ for me, it will be easier to notice when I am outside my normal range. I can alert myself or be alerted by others around me who are monitoring me. Long-term records of mood will also help me experiment to see which things influence my mood. This may give me more control over my mood.

Mood tracking might be a good idea for anyone to do, but it may be especially helpful for people with a bipolar diagnosis. Everyone has mood variation. For bipolars, however, mood swings can be more extreme (in both directions, up and down) , have far worse consequences (psychosis on one end and suicide on the other), change more rapidly, and be more vulnerable to environmental triggers like stress. The good news is that the first changes in mood can happen hours or days before more extreme changes. This gives people a chance to take countermeasures to prevent more extreme states.

The project name refers to the fact that Van Gogh had bipolar disorder.

The Rules of the Tunnel by Ned Zeman

I loved Ned Zeman’s new book The Rules of the Tunnel, which I read during a long plane flight. Not only does it combine three of my favorite subjects — high-end magazines, bipolar disorder, and the crappiness of modern psychiatry — but it’s very well-written and revealing. I haven’t enjoyed a book so much in a long time.

Zeman once wrote for Spy, as did I. Long ago, I met him at a Spy party. I suppose I could have gotten a free copy of his book but I bought it. I wanted something great to read on the plane.

Morning Faces Therapy For Bipolar Disorder: A Story (Part 2: First Two Months)

In the 1990s, I discovered that if I see faces on TV early in the morning, I feel better (happier, more eager, more serene) the next day, but not the same day. Faces Monday morning, for example,  make me feel better on Tuesday but not Monday. I studied this effect extensively. The results suggested that a circadian oscillator controls our mood and sleep and needs morning face exposure to work properly.  Absence of morning face exposure, this theory says, increases your risk of depression — a view not compatible with the “chemical imbalance” explanation of depression but one supported by the strong association between depression and insomnia.

I told friends about this. One of them had devastating bipolar disorder. As he describes here and here, he got great benefit from looking at faces in the morning. After I posted his account of his experience, a man I’ll call Rex wrote me that he was going to try it. At 29, he was diagnosed with bipolar disorder. At 32, he slit his wrists. He is now 37.Since then he’s been in and out of mental hospitals. Now he lives at home. I wanted to follow his use of morning face therapy “prospectively” — before knowing what would happen. I posted this, about his background, around the time he started. Continue reading “Morning Faces Therapy For Bipolar Disorder: A Story (Part 2: First Two Months)”

Harvard Psychiatrist Joseph Biederman and Parents: “Should Be Left in a Room Together”

Joseph Biederman is a professor of psychiatry at Harvard. He recently received a far-too-mild sanction for behavior that included this:

Biederman was then placed in charge of the institute and began a study of 40 children between 4 and 6 years old who were given Risperdal [made by Johnson & Johnson] and Lilly’s Zyprexa, another antipsychotic. At the time, Harvard and MGH [Massachusetts General Hospital] rules forbid researchers from running trials with [drugs] if they receive more than $10,000 from a company that makes the drug.

It was eventually revealed that Biederman had received at least $1.6 million from drug companies, including far more than $10,000 from Johnson & Johnson and far more than $10,000 from Lilly. One comment on the quoted article made the excellent point that bipolar disorder had a usual onset age of onset of 18 years or more and had never been found in young teenagers (e.g., 14-year-olds). Yet Biederman suddenly claimed it appeared in 6-year-olds. In a good expression of how I feel about Biederman’s behavior, another comment said he should “be left alone in a room with the parents of the children [he] treated”.

Welcome to the Sausage Factory: Multiple Fraud in a Paxil Study

Dr. Jay Amsterdam, a professor of psychiatry at the University of Pennsylvania, recently lodged a very interesting complaint against five authors of a 2001 study that compared Paxil to another drug and placebo for treatment of bipolar disorder. The paper reports research paid for by SmithGlaxoKline, the makers of Paxil.  For a subgroup of patients, it says, Paxil worked better than the other drug and better than placebo. Paxil supposedly had fewer side effects than the comparison drug. Amsterdam accuses the five academic authors of plagiarism — meaning they put their names on a paper they didn’t write (like a student who buys a paper). He also says the paper grossly misrepresents the results (because the subgroup analysis was completely ad hoc and the side effects description utterly wrong). So if they did write it . . .

The paper has been cited hundreds of times.  Given the actual results — Paxil had worse side effects than the other drug, and the subgroup result means little — this is no small matter.

As Spy magazine has said, if you cheat your customers, don’t fire anyone. Email included with Amsterdam’s complaint suggests he was upset because he was not an author on the paper. Why? Well, the study was done at many sites and there could be only one author per site — according perhaps to SmithGlaxoKline. At Penn, the work (enrolling subjects) was first given to a junior faculty member named Laszlo Gyulai. However, Gyulai couldn’t enroll enough subjects. Amsterdam was asked to help and paid for doing so. He ended up enrolling more subjects (12) than Gyulai (7). Yet Gyulai was an author and he was not! This greatly bothered him. He considered it  “misappropriation” of his data, said Gyulai had engaged in “the theft and publication of a professor’s data”, and wanted Gyulai censured. Perhaps Gyulai had considered Amsterdam’s non-authorship okay because many professors who contributed subjects were not authors. Whatever the reason, it appears that authorship was determined by the firm that did the ghostwriting, Scientific Therapeutics Information, presumably following orders from SmithGlaxoKline.

I don’t know why Amsterdam waited ten years to complain. Since 2001, however, the ghostwriting problem has become much clearer. In 2001, Amsterdam complained to his department chair, Dr. Dwight Evans, about the situation. In 2010, Amsterdam learned that Evans had benefited from ghostwriting. That’s how common it was.

There’s also this:

POGO [Project on Government Oversight], in a letter to President Obama [related to Amsterdam’s complaint], asked that he remove Amy Gutmann, president of the University of Pennsylvania, from her position as chairman of the Presidential Commission for the Study of Bioethical Issues, until the two cases involving Dr. Evans are fully investigated and resolved.

Chairman! Another indication how common and tolerated ghostwriting is. It is as if an obesity expert, appointed head of the most important obesity committee in the country, charged with recommending how to stop the obesity epidemic . . . is fat.

Perhaps British journalistic phone-hacking has been more common than misrepresentation of results by med school professors but the latter, I’m sure, has done more damage.

Attachments to the Amsterdam complaint. Pharmalot weighs in. Some of the accused defend themselves.

Morning Faces Therapy for Bipolar Disorder: Follow-Up Questions

In May I posted a friend’s story about how he used my morning-faces discovery to improve his life. It helped enormously (“It felt like a giant headache was just lifted off me”). I asked him some follow-up questions.

What time of day do you look at your face in a mirror? For how long?

I look at my face in a mirror for an hour starting at about 6:20am (Daylight Saving Time). It doesn’t feel weird or vain to me. I usually listen to C-SPAN, Comedy Central, or music during the therapy.

You wrote: “I’m able to enjoy life and relate to others in ways that I never could my entire life.” Could you elaborate?

In my letter I said that my initial reaction to the face therapy was that it felt like a giant headache was just lifted off of me. That “headache” was the weight of depression and anxiety on my mind. My whole life I have been burdened by that weight, under its shadow to one degree or another. Another angle on this:  Your initial reaction was “I felt great – cheerful and calm, yet full of energy”. I am quite certain that before the therapy I was never in that state of mind. But I’m not just talking about typical enjoyment—hearing the music, conversing and laughing, a fine meal, etc. In The Simpsons episode “Barting Over”, Homer is twirling slowly high in the air on a skateboard, and a novel idea pops into his head: if he buys two kinds of nuts separately, he can combine them at home to get “mixed nuts”. That sensation of weightlessness, with little solutions to little problems just popping up, is new to me. When you add up hundreds of those solutions, you find life itself less burdensome. You make more room for appreciation, gratitude, friendship, and so on. You begin to get an inkling of what a full human life could be.

People “automatically reject the idea”, you wrote. What happens?

“That’s the most ridiculous thing I’ve ever heard” was the comment of a woman in the bipolar support group. Some in the group of the if-it-sounds-crazy-enough-I-believe-it persuasion would nod their support. My sister theorized that it was all just meditation (!) and finished by saying, “I get enough faces at work.” My dental hygienist was somewhat persuaded by the fact that a newborn can recognize its mother’s face within hours of birth.

Do you continue to see a psychiatrist and/or a psychologist? If so, are they curious about how well you are doing without meds? If they’re not curious, how do they explain it?

My psychiatrist and psychotherapist are glad that I’m doing well, but they are not curious about the face therapy, the bright lights, or the fish oil. They are skeptical toward alternative treatments. I gather they think that my improvement is due to remission, or an upswing in the illness’s cycle, or the accumulated years of talk therapy. Or they abandon reason altogether, saying, “Whatever works for you.”

Why do you need to go to bed “early”? What happens if you don’t? What makes it difficult or discipline-requiring to go to bed “early”?

If I go to bed late, I need to take an hour nap the next day, which is a drag. At 10pm I’m almost never tired enough, plus I usually feel that I haven’t accomplished enough for the day. At your suggestion, I am trying to reset my circadian rhythm by getting 2 hours of morning light from approximately 7:30am to 9:30am.

What effect does the early morning bright light therapy have? How do you do it (e.g., equipment, time of day)? Why did you start it?

As I recall, the lights helped me to wake up early, fairly rested and alert. I started in 1997 at your suggestion with a bank of four GE F40SP65-ECO tubes, 40 watts each, 48 inches long. I now cover half of the bank to reduce the intensity. I get thirty minutes of exposure starting at about 6:50 am (Daylight Saving Time).

In 1997, what made you decide to try the faces?

I was primed for the idea that a big change might help. Six months prior, I had made a somewhat beneficial switch to Depakote after taking lithium for 11 years. Also, you claimed that you already had good experimental results with several people, and that Andrew Gelman at Columbia University was impressed with your work.

“I hadn’t needed Moban since 1999,” you write. Why not?

From 1999 to 2003, the face therapy was so effective that I didn’t need an antipsychotic (e.g. Moban).  From 2003 to 2006, when I didn’t use the face therapy, I kept certain habits that I had adopted during that therapy: keeping a fairly normal sleep schedule, avoiding fluorescent lights at night, and getting a decent amount of social interaction.

With the benefit of hindsight, why do you think it did not keep you out of the hospital in 2003?

When I told my psychiatrist in 1999 that I was going to use the face therapy instead of medications, he exclaimed, “That’s like taking off a cast and trying to walk right away!” Indeed, for 12 years my mind had been numbed with psychiatric drugs. Although the face therapy was seemingly miraculous, it couldn’t restore all that was lost.  Yet with little support from others I was trying to “walk”: I had the goals of getting a job and a social circle; I had a dream of leading the way for all depressed people. It was unrealistic to expect that I could do much more than crawl through life. By 2003, I needed the hospital because I was in over my head.

Why did back pain and stress put you back in the hospital? Why did they lead to a suicide attempt?

My mental state deteriorated because of lack of sleep, which in turn was due to back pain and stress. Both back pain and stress are manageable—given enough time and attention. Unfortunately, at the time I was overwhelmed with many new problems and many lingering old problems. I had just moved. The house had far more traffic noise and housemates than I was accustomed to. I didn’t have the money or strength to move again; I was falling out with an old friend; my wrists and feet were injured. If I went back to the mental health system, I would be more handicapped than ever. The situation seemed hopeless.

Why did publicity related to The Shangri-La Diet make you try this again?

I actually thought that Diane Sawyer might call me after saying to herself, “Wow, what else has Professor Roberts discovered?” So I wanted to shape up my mood fast! I assumed that the Shangri-la Diet in its way must be about as great as the face therapy. I didn’t suspect that the media would treat your diet like any other—as an offbeat fad.

You wrote: “In August of 2010, dissatisfied with my low energy level, I decided to go off medications completely again.  What did you do? 

I had been “stabilized” on 250 mg of Depakote, which is a sedating anti-manic drug, and 20mg of Prozac, which is an antidepressant that can induce mania. About once a month, I got rid of the sedation by skipping the Depakote for a few days. On one occasion, when I tried to skip the Depakote for 9 successive days, I became slightly hypomanic and had trouble sleeping. Over the course of several months, I reduced the Prozac to 10mg, and even to 5mg, but still I couldn’t stay off the Depakote for more than about 7days without problems.

You wrote: “Getting off just the two drugs was tricky, because of the difference in half-lives.” What was “tricky” about it?

I was boxed in by the difference in the drugs’ half-lives. Prozac has a plasma half-life of about 10 days, while Depakote has a half-life on the order of only 10 hours. I considered splitting the enteric-coated Depakote, but never did. I decided that the only way out was to stop taking the Prozac, but continue taking the Depakote for 10 days until the Prozac was out of my system. So I tolerated being depressed and sedated until I could stop the Depakote, too.



Worse Than Placebo? Forest Laboratories’s Shameful Marketing

While Forest [Laboratories] applied to the FDA for pediatric use of Celexa [the anti-depressant] and was eventually denied, the company admitted it had marketed the drug to doctors by hiring speakers to tout its benefits for young patients. Forest also admitted it had suppressed the negative results of research in Europe that found Celexa was no more effective in treating depressed children and adolescents than a sugar pill. Fourteen young patients in that study attempted suicide or contemplated suicide, compared with five in the placebo group, court records show.

From this article. Is Forest Laboratories worse than other big drug companies? Probably not. What’s horrible is how this sort of thing — suppression of negative results — keeps happening. It suggests that the evaluation of drugs should be taken entirely out of the hands of drug companies.

“Stuff of Seth”: Faces/Mood and Anticipatory Waking

After trying the Shangri-La Diet, Jazi yechezkel zilber found that other aspects of my research (“stuff of seth”) were relevant to his life:

Years ago, I was part of a community where people would be up early praying etc. For an hour and then eat together. I noticed that going there in the morning was good for me, but was puzzled by the effect. I hypothesized it was the social effect per se.

At some point, I stopped this (what the hell do I have with religion and prayer?) and noticed that I got depressed. I remember that the depression came with a delay. It was funny to see it, as I could not make sense of it. But this I remember well. The depressive effect was not the same day as not going to the prayers but tomorrow (or later?).

I was not having early awakening then. Afterwards, I started having periodically early awakening, I cannot remember the frequency, but it was there and annoying. Now when going to the community, I had two hours between awakening and eating. Whereas at home I would eat immediately after waking. Another thing that puzzled me was how I came to wake up naturally *before* my scheduled wake-up time. I used to wake up much later. With food anticipation it makes perfect sense. I woke up two hours before conditioned feeding.

The Amish have extremely low rates of depression — and eat communal breakfasts. The story about early awakening reminds me of a student who told me when you told us this in class I didn’t believe it but lately I started waking up too early and was puzzled until I realized I had changed my breakfast.