Finding someone who accepts responsibility

The update on my saga wrt the new medication. Yesterday I met with my doctor. He gave me a copy of a letter that the insurance company had sent him on the 14th, indicating that the prior authorization request was approved. I brought the letter to the pharmacy. The pharmacist was on the phone with the insurance company for 45 minutes and still couldn't get the request released.

I called today. The first person said that everything was approved and that pharmacy should just call the insurance company's help line if they're having difficulty. I explained that it seemed that there were two authorization requests in play here, one for the med itself, the other for the quantity. It appeared that the quantity had been approved, but not the med. (Imagine the tortured soul who came up with that rule.) The agent forwarded my call to the prior authorization line, which turned out to be an automated system that told me what I already knew, that one request had been approved.

I called back and eventually got to a supervisor who threaded his way through the events and explained that the approval had been for an increased quantity of a class of drugs, not for the drug itself. We still needed approval for the drug. But, mirabile dictu, he realized that I am a patient waiting for a medication. He arranged to have the pharmacy give me a five-day supply while he and my doctor worked things out. I thanked him for taking responsibility and helping me in a very direct way.

Now, this evening, we'll find out if the medication makes a difference.

This week's depression links - 2/28/08

• Antidepressants Only Benefit The Severely Depressed, Study

  the difference in effect between drug and placebo was only clinically significant in those patients who were very severely depressed at the start of their treatment and this effect was more likely due to a weaker response to the placebo than a stronger re

• Ask your dentist: dental health, inflammation, and depression :: Rebuild from Depression Blog

  There are schools of thought that “inflammation” is the underlying cause or at least common bond between heart disease, diabetes, and depression.

• Bout of depression good for soul

  This reminds me of the old story about a person ingesting a small amount of arsenic every day in order to build an immunity to it. I don't know if the story is true and I am less certain that it's a good idea.

• Depression the great excuse of our times | NEWS.com.au

  Depression has become the great excuse of our times and what is a genuine condition has been corrupted into a nifty carry-all excuse.

• Modafinil augmentation of SSRI therapy in patients...[CNS Spectr. 2006] - PubMed Result

  CONCLUSION: Twelve weeks of modafinil augmentation relieved excessive sleepiness, reduced fatigue, and improved patients' overall clinical condition, including mood.

• PLoS Medicine - Initial Severity and Antidepressant Benefits: A Meta-Analysis of Data Submitted to the Food and Drug Administration

  Drug–placebo differences in antidepressant efficacy increase as a function of baseline severity, but are relatively small even for severely depressed patients. The relationship between initial severity and antidepressant efficacy is attributable to decr

• Psychologist Seeks Stone Age Solutions to Depression

  What the author doesn't mention is that the life span of our stone age ancestors was probably in the mid-30s.

• Psychology Today: Lose Some, Win Some

  Apparently, skipping a night's sleep can alleviate symptoms in severely depressed patients. It doesn't work and even has a negative effect on mild-moderate depression patients.

• Researchers Explore The Antidepressant Effects Of Ketamine

  Ketamine, a drug used in general medicine as an anesthetic, has recently been shown to produce improvements in depressed patients within hours of administration.

• The Medicated Americans: Antidepressant Prescriptions on the Rise: Scientific American

  A study of antidepressant use in private health insurance plans by the New England Research Institute found that 43 percent of those who had been prescribed antidepressants had no psychiatric diagnosis or any mental health care beyond the prescription of

• The gut-brain barrier in major depression: Intestinal mucosal dysfunction with an increased translocation of LPS from gram negative enterobacteria (leaky gut) plays a role in the inflammatory pathophysiology of depression – Source: Neuro Endocrinology L

  It is suggested that patients with MDD should be checked for leaky gut by means of the IgM and IgA panel used in the present study and accordingly should be treated for leaky gut.

• What the media misses about antidepressants

  A different view of the recent news that antidepressants are often no more effective than a placebo. In this writer's view, because patients respond uniquely to each medication, it's worth trying SSRIs on the chance that it might just save a life.

• Your Wandering Mind on Depression: A History of Depression (Part One)

  If you experience depression in early adulthood your risk for future depressive episodes increases with the number, severity and length of each depressive episode.

• » Blog Archive » Mindfulness with Jon Kabat-Zinn

• Delicious Links Builder by InternetDuctTape.com

  This list was created using Delicious Links Builder

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I was looking for an argument, but I keep getting Hit on the Head lessons*

So, nearly three weeks ago, my doctor wrote a new prescription for me. I brought the prescription slip to our local pharmacy. When I returned an hour later to pick up the medication, the pharmacist said that the insurance company needed prior authorization (the doctor must say that I really need this specific medication at this dosage.) Thus started an egregious violation of the Strange Sketch Act:

• I've spoken with my doctor's office at least four times. In addition, the pharmacy has spoken with the doctor's office two or three times. The folks at my doctor's office have sent the prior authorization forms to the insurance company.
• I've received one phone call from the insurance company that says that my request was approved. I've kept the message on my answering machine.
• I've spoken with the insurance company at least a half dozen times. One time they said that the quantity of the medication was approved, but not the medication itself. Last Wednesday, I submitted an online query, detailing it all in four-part harmony. The email response that's promised within 48 hours has yet to arrive.
  
• s been approved, and c) the pharmacy won't be able to place the order.
• The insurance company's web site reports the following:
  
  
  
• I've spoken with the pharmacy in person and on the phone at least 10 times. They've not been able to place the order because the insurance company hasn't approved the request. Today, the pharmacist called the insurance company who, in turn, told the pharmacist that they haven't received any information from my doctor regarding the prior authorization.
• The pharmacist called my doctor's office. My doctor won't be in until this afternoon. I'll call everyone again later today and I'll bet you a nickel that a) my doctor's office will report that they've submitted the request, b) that the insurance company will either claim that they haven't received the request or that it'

* Bowing with reverence to the Monty Python argument sketch (in video) and in text.

Depression links - 2/20/08

• Johns Hopkins: Depression|Anxiety on acceptance commitment therapy ( Wednesday, Feb 20 at 10:30 PM )

  ACT therapy suggests that, rather than attempting to challenge and change negative thoughts and beliefs (as cognitive therapy advocates), we should accept and feel our negative thoughts and feelings (in effect, embrace our pain) in an attempt to defuse th

• Does psychotherapy help older people with depression? ( Tuesday, Feb 19 at 09:21 AM )

  Despite stronger evidence of psychotherapy helping younger people, "all of these complications make it hard to say whether psychotherapy could be beneficial among older people," Wilson said.

• Something in the way he moves ( Tuesday, Feb 19 at 08:24 AM )

  Depressed people experience longer resting periods more frequently and shorter ones less frequently than healthy people do.

• » Closing the Circuit: Helen Mayberg's research could revolutionize depression treatment « Brain Fitness Revolution at SharpBrains ( Tuesday, Feb 19 at 08:19 AM )

  If we knew that a particular brain pattern indicated what type of treatment a patient would best respond to, it could save them years of unsuccessful treatment," says Mayberg. It could also eliminate the need for drug treatment for some patients, and help

• Fighting the Darkness: My Secret Battle with Depression: The misunderstanding of depression continues ( Tuesday, Feb 19 at 08:06 AM )

  Back in ancient times, people believed that supernatural forces caused mental illness and some tried to rid sufferers from the illness by cutting holes into the afflicted person’s head in order to let the evil spirits out. The Greeks later explained men

• Is Mindfulness-based Cognitive Therapy Effective? - World of Psychology ( Tuesday, Feb 19 at 08:05 AM )

• C. E. Chaffin's Blog: Day 8, ECT #2; Roaches ( Tuesday, Feb 19 at 06:40 AM )

• Plumbing the Depths Of Depression - washingtonpost.com ( Tuesday, Feb 19 at 06:01 AM )

  break out the male Wistar rats and the injection needles

• As depression symptoms improve with antidepressants, hopelessness can linger ( Tuesday, Feb 19 at 04:26 AM )

  People taking medication for depression typically see a lot of improvements in their symptoms during the first few months, but lagging behind other areas is a sense of hopefulness, according to new research from the University of Michigan Health System.

• How to be depressed ( Saturday, Feb 16 at 06:25 AM )

  # Everything is pass/fail # I can read minds! # I can read the future, and see the whole world! # Let's apply a label! # If I feel bad, I am bad # I should do this, I should do that! # I'm responsible for everything # Bad things are worth extra points # G

• Atypical Depression Research -- Neurotransmitter.net ( Friday, Feb 15 at 05:37 AM )

  An overview of the research associated with atypical depression (AD), which is defined as mood reactivity and at least two of the following: weight gain, hypersomnia, leaden paralysis and interpersonal rejection sensitivity

• Mindfulness-Based Cognitive Therapy for Depression ( Thursday, Feb 14 at 08:42 PM )

  The liberation in realising that we are not our thoughts is one shared by cognitive therapists and Buddhists alike.

• Psychiatric Rating Scales for Depression -- Neurotransmitter.net ( Thursday, Feb 14 at 06:40 PM )

  Several evaluation tools to help with the assessment of symptoms of depression

• Dr Shock MD PhD: Magnetic Seizure Therapy less cognitive side-effects compared to ECT ( Thursday, Feb 14 at 05:09 AM )

  This research showed that chronic treatment with high-dose MST resulted in less cognitive impairment than ECT and that high-dose MST did not significantly differ from the effects of anesthesia alone.

Michael Moore is a rose-colored-glasses optimist

So I go to the doctor on Thursday and explain what's been going on, that I've been sleeping very poorly, waking at 2 or 3 in the morning and then trying to make do for the rest of the day. The doctor prescribes a medication that might help. It's fast-acting and short-lived so that I can take it at 2 or 3 and still wake at a decent hour.

I bring the prescription to the pharmacy. They say that it'll be ready in a half hour. I come back a half hour. They tell me that the insurance company needs pre-authorization, meaning that the doctor has to explain why I need this medication and why the others that we've used haven't worked.

That was Thursday night. I called the doctor's office on Friday. They said that they'd received the fax from the pharmacy and would send out the information to the insurance company.

It's now Tuesday afternoon, nearly five days later. The doctor's office claims to have sent the material to the insurance company. The insurance company is, like, nuh-uh. The pharmacy says that they'll sell the medication to me for $420 if I wanted to go without the insurance.

Oh, did I mention that it took four days to get a refill on another medication?

This week's depression links - 2/7/08

• ScienceDirect - Pain : Combined effects of major depression, pain and somatic disorders on general functioning in the general adult population ( Thursday, Feb 07 at 10:51 PM )

  The presence of pain increases risk of associated MDD. The number of pain locations experienced, rather than the specific location of pain, has the greatest impact on general functioning. Not only chronic pain, but pain of any type may be an indicator of

• depression linked to an autoimmune thyroid condition may have poor prognosis ( Thursday, Feb 07 at 04:31 AM )

  Research published in BMC Psychiatry this week suggests that some patients with depression may be suffering from a subtle autoimmune thyroid condition, which could hinder their recovery.

• Depression linked to earlier death: study ( Wednesday, Feb 06 at 04:10 AM )

  "The study lacked information on causes of death, and it is not clear why patients with a history of depression had a higher mortality rate, the researchers note."

• Metapsychology Online Reviews - Philosophy - Review - Shyness ( Wednesday, Feb 06 at 04:08 AM )

  that his main concern is that the new DSM metamorphosed normal behaviors into sicknesses, that shyness is a good example of this phenomenon and that this is a bad thing.

• Happiness: Enough Already | Print Article | Newsweek.com ( Tuesday, Feb 05 at 07:25 PM )

  Another in the theme of the pursuit of happiness as a false goal: "once a moderate level of happiness is achieved, further increases can sometimes be detrimental" to income, career success, education and political participation ...

• Insomnia patients often denied sleep treatment when they have mental health conditions ( Tuesday, Feb 05 at 03:18 AM )

  “Insomnia can cause you to have anxiety and depression, and depression and anxiety can cause you to have insomnia. It’s a chicken-and-egg type of story. But research has shown that if one of the conditions is left untreated it can exacerbate the other

• Relax Like A Pro: 5 Steps to Hacking Your Sleep | The Blog of Author Tim Ferriss ( Tuesday, Feb 05 at 03:14 AM )

  2. Use ice baths to provoke sleep....The result: it’s like getting hit with an elephant tranquilizer. Don’t expect it to be pleasant at first.

• New antidote to depression « No turning back ( Monday, Feb 04 at 03:48 AM )

  Doctor Xanthe prescribes this to counter depressants. She guarantees this game makes one euphoric.

• C. E. Chaffin's Blog: At Rope's End ( Sunday, Feb 03 at 02:18 AM )

  In California we'd rather let the mentally ill be shot by the police on the street than force them into treatment. Protecting the victim's right to be crazy is much more important than intervening for their welfare.

• Why Serotonin Can Cause Depression And Anxiety ( Saturday, Feb 02 at 10:47 PM )

• Achieve a Deep, Uninterrupted Sleep: Nighttime Habits | Health | Reader's Digest ( Friday, Feb 01 at 09:09 PM )

  Some helpful tips on sleep, but if I tried to remember 24 things before going to bed, I'd not sleep a bit.

• Factors Associated with Alexithymia in Patients Suffering from Depression ( Friday, Feb 01 at 09:03 PM )

  Alexithymia is very common among patients with depressive disorder.

• Dr Shock MD PhD: DSM V citeria for Depression for Dummies ( Friday, Feb 01 at 08:53 PM )

• RCPsych: Cognitive behavioural therapy website versus information website for depression ( Friday, Feb 01 at 08:21 PM )

  After 6 months, the effects of both interventions had declined, but the benefits of the CBT intervention remained significant, whilst those of the information website did not. After 12 months, the pattern of decline was maintained.

• How To Really Talk To Your Therapist: Four Collaborative Steps ( Friday, Feb 01 at 07:44 PM )

  - Take ownership of your therapy - Plan out what to say in advance - Keep your wits about you - Enlist a third party to consult with you and your therapist

• Psychiatry24x7.com - Data on circadian rhythms discussed by researchers at Northwestern University ( Friday, Feb 01 at 07:17 PM )

  there are two general ways in which disrupted circadian rhythms could lead to depression: (i) disorganization within the circadian system could itself lead to neurobiological dysfunction and (ii) a circadian disturbance of the normal sleep-wake cycle coul

• Acupuncture for Treating Depression ( Thursday, Jan 31 at 10:48 PM )

  Two randomized, controlled, clinical trials suggest that electroacupuncture may reduce symptoms of depression as effectively as amitryptiline, a tricyclic antidepressant medication.

• Write Out Of Depression ( Thursday, Jan 31 at 10:25 PM )

  "After you've written about your dream and your impressions about it, write for five more minutes about whether there are any ideas about your waking life that you'd like to take away from this exercise -- maybe even insights about handling your depressio

• Furious Seasons ( Thursday, Jan 31 at 10:16 PM )

  Depression has four different elements; physical, mental, emotional, and spiritua

On numbers

My psychiatrist and psychologist conferred last week and, among other things, recommend that I use the Beck Depression Inventory to assess my symptoms. For the past year, and recording the numbers since April, we've used a 1-7 scale to assess my mood, energy, and cognitive abilities. The scale is based on a similar scale used to assess pain - 1 is great; 7 is incapacitated.

It's a puzzle that they haven't recommended the BDI before. They've probably used it as part of interviews; I suspect that the hospital and Social Security folks used BDI or something similar in their evaluations. Nevertheless, I've been carefully recording and reporting our numbers for all this time and it seems strange that they're only now introducing the BDI as a tool for regular use.

I had an appointment with my psychologist yesterday and will see my psychiatrist on Thursday. The major issue of late, as I've mentioned before, has been my bad sleep and the toll that it takes on my resilience.

In spite of the tiredness and the nearby troubles, I've been able to get stuff done on a daily basis, something that wouldn't have happened even two or three months ago. Some of the tasks are as simple as being able to throw something away. Others involve more analysis and skill, such as setting up a home network for our two computers. I've been using Remember The Milk as a way to plan and track completion of tasks. There's a Firefox extension that integrates RTM with GMail, making it handy to look at the day's business in a single page. It's just nerdly enough to be fun.