The Anxious Physicist

Personal blog of Dr Alex Mendelsohn

Welcome

January 6, 2022 /

Hello to everyone who happened upon this blog. My name is Alex Mendelsohn*. There isn’t much here in the form of sunshine and flowers (unfortunately, I couldn’t find those emoji’s – all I could find were these red flags: 🚩🚩🚩). Instead, you are free to feast on a collection of thoughts from a physicist going through severe mental illness. Yippee!**

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How I think physicists can help psychiatric education

October 20, 2023 /

I believe that physicists can help with the education process of both clinicians and research psychiatrists. However, I can only go on my experience of being treated by psychiatrists and the papers I have read within the psychiatric literature. I have very little knowledge of how psychiatrists are trained or of psychiatric research culture.

This blog post was adapted from notes I sent to one of the editors when constructing my Lancet Psychiatry article in the May 2023 edition –“Lithium Story: Eight Guidelines, Eight Recommendations“.

The blog post discusses how physicists could contribute to the education and practice of both clinicians and research psychiatrists in the field of psychiatry. Alex draws from their own experiences as a patient, as well as their understanding of physics and its approach to learning and problem-solving.

For Clinicians: Alex suggests that physicists could assist clinicians in gaining a deeper understanding of the concepts and guidelines they use in psychiatric practice. He highlights that physicists are skilled at questioning assumptions and embracing unconventional perspectives, as seen in the field of physics where concepts are constantly reevaluated. This approach could help clinicians question their own understanding and challenge existing guidelines, leading to a more profound comprehension of psychiatric practices.

For Researchers: Physics, according to Alex, deals with analyzing simple systems using straightforward mathematical models, while biology, including psychiatry, deals with complex systems and intricate mathematical models. Alex believes that physicists’ education equips them to find simplicity within complexity and identify patterns in data. He notes that physicists are encouraged to embrace their mistakes and revisions, which is vital for progress. Alex highlights his Lancet Psychiatry article that exemplifies a physics-like approach to psychiatric research, emphasizing evidence-based arguments and clear definitions. He argues that psychiatric researchers could benefit from adopting a culture that values clarity, experimentation, and the acceptance of being wrong.

Clinicians

It was clear to me during my lithium treatment that clinicians would be using words to describe certain practices, without understanding the meaning behind those words. For example, using the phrase “morning trough1 level” to apply to a 12-hour level approximately halfway between peak and trough lithium concentrations in my bloodstream. I believe physicists can help clinicians to think about the meaning behind guidelines.

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Bupropion UK supply update: GSK announces the return of Zyban in December 2023

September 15, 2023 /

This is an update to a previous post titled: Nearly a year on, Bupropion is still not available

I was worried the previous post might cause confusion to those who came across it hoping for the return of bupropion. Below, I’ve tried to go into a little detail about the potential reasons for the announced return – but please bear in mind I might have easily misinterpreted certain details, and an announcement from a secondary source does not mean resupply is confirmed. I’ve also given an update on the current availability of bupropion in the UK.

UPDATE: Zyban might be back in stock already, GSK‘s medications out-of-stock page has removed Zyban, and the NCSCT has put a notice up on October 16th saying that Zyban is back in stock and being supplied – check with your local pharmacy to confirm if this is in fact true.

UPDATE #2: GSK‘s medications out-of-stock page now says that Zyban will return in late November 2023

So, a notice popped up about a week ago in the form of an exclusive article by David Lipanovic of the Pharmaceutical Journal. It announced that bupropion will once again be supplied to the UK starting around December 2023.

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Breaking the connection with my smartphone

September 15, 2023 /

Alex claims that while smartphones are undoubtedly useful, they are also one of the fiercest opponents he has encountered in terms of mental health. The short, sharp, and seemingly never-ending rewards they offer can be intoxicating and almost impossible to remove once latched onto. Alex tried several methods to separate himself from his attention-sucking device, but nothing worked. He then tried using a screenless mp3 player, but the battery life was too short. Alex then decided to use a smartwatch as a proxy mp3 player to help break his connection with his smartphone. He was initially concerned about the battery life, but the expensive model he bought had a large battery that allowed him to use it throughout the day without needing to charge it constantly. Alex claims that he is finally free of the grip of his smartphone, although he still needs to use it occasionally.

Smartphones are the devil.

Okay, bit harsh. Smartphones are undoubtedly very useful. The “I got lost” excuse for arriving late is not valid anymore – a quick few taps in your mobile map app of choice and you can instantly find out where you are (and where you should be).

In terms of good mental health, however, smartphones are one of the fiercest opponents I have encountered. It isn’t necessarily the magnitude of the effect they have on my mood. It is the smartphone’s ability to cling to my brain like a leech. They are almost impossible to remove once latched. The short, sharp and seemingly neverending rewards smartphones offer are intoxicating. And this is putting it mildly.

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Nearly a year on, Bupropion is still not available

August 18, 2023 /

Update: GSK announced UK and EU resupply of Zyban (bupropion) for December 2023, see this blog post for more details

This blog post discusses the continued shortage of the antidepressant and smoking cessation medication Bupropion, also known as Zyban, due to nitrosamine impurities. Alex notes that GSK has not yet issued a recall order for Zyban, despite doing so for other medications with similar impurities, and that the brand name has been discontinued in the US. The FDA has determined that the US withdrawal was not due to safety reasons, and GSK has not given an estimated recovery date. The UK government is aware of the supply shortage, and the Medicines and Healthcare products Regulatory Agency is blocking imports into the UK. Alex expresses concern about the possibility of GSK withdrawing the product altogether, and the lack of transparency in the industry.

It has been just over eight months since GSK announced they were halting the supply of Bupropion (the brand name is “Zyban”) due to nitrosamine impurities. Since my previous blog post about the supply shortage, I have heard very little.

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Previous article clarifications

July 31, 2023 /

The blog post discusses Alex’s experience as a psychiatric patient and their past experience as a physics researcher. They express concern about readers misinterpreting their writing as advice and clarify that they are not in a position to make recommendations. The post revisits and clarifies statements made in previous articles about the psychiatric system, particularly a Physics World article and a Lithium Story article.

In the Physics World article, Alex discusses their frustrations with the psychiatric system compared to the scientific rigour in physics. They acknowledge that their emotional state at the time influenced their writing, leading to oversimplification of complex issues. Alex clarifies certain statements made in the article, specifically regarding psychotropic drugs treating symptoms and the difficulty in diagnosing patients based solely on symptoms.

In the Lithium Story article, Alex discusses their experience with taking lithium as part of their treatment. They clarify certain points, including the dosing regimen they found most effective, their decision to trial lithium over other medications, and their concerns about potential renal effects. Alex also emphasizes that they are no longer taking lithium but found it helpful during their treatment journey.

Throughout the blog post, Alex emphasizes the importance of clear and precise language, drawing a comparison between the clarity in physics literature and the ambiguities they encountered in some psychiatric research papers.

Alex invites feedback and criticism, acknowledging their limited knowledge of psychiatry and their ongoing recovery as a mental health patient. They encourage constructive input with proper citations and references to support claims.

One of my worries when writing articles about the psychiatric system is that a reader will interpret arguments I make as a form of advice. I want to make clear I am not in the position to make any recommendations. I write from my current experience as a patient and past experience as a physics researcher to hopefully add a few insights where psychiatric research, lived experience and physics meet.

So, when someone seemingly mis-read and mis-interpreted my Lithium Story article, I was a little distressed. I re-read the opening paragraph of my article. While I was telling a story of my opinions at the time, I could see how it might have been possible to interpret it as a recommendation for twice daily dosing. This was not my intention. I am not against once daily dosing.

I realised this was an opportunity to look back and clarify past statements I have made in both my Physics World and Lancet Psychiatry articles.

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How I found Amdisen’s original research papers

July 3, 2023 /

Alex describes his experience of taking lithium and his search for information on its pharmacokinetic properties. He wanted to calculate his peak serum concentration and find out his approximate lithium half-life using the exponential decay formula. However, he found that there was no semi-log plot in the literature and no mention of the dual half-life of lithium. He searched for papers on simulations of the pharmacokinetic curve and found references to multi-compartmental models. Eventually, he found a chapter on lithium pharmacokinetics in a book and learned that the two half-lives he observed corresponded to the alpha and beta phases of lithium removal from blood vessels after peak concentration, which could be described using multicompartment models.

When I first started to take lithium, I wanted to calculate my peak serum concentration using my 12-hour sample value. I knew it was going to be a very rough estimation, but for me, doing the calculation made me feel less anxious about toxicity.

My plan was to use the exponential decay formula 1 to find the peak concentration (assuming the peak occurred around five hours). I wanted to find out, given I knew my serum creatinine levels, what my approximate lithium half-life was. I went looking for data in the lithium pharmacokinetic literature to figure this out.

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I also hung my washing outside last winter – it was a terrible idea

June 16, 2023 /

The blog post describes Alex’s attempt to save money on energy bills by hanging clothes outside to dry during the winter in the UK, using a rotary airer under a gazebo to protect the clothes from the rain. He experienced several setbacks, including the realization that the heating bill, not the electricity bill, was the primary concern, the clothes taking up to three days to dry in single-digit temperatures, and the rotary-gazebo airer failing during a storm. Additionally, Alex‘s dog used the gazebo as a toilet during rainstorms which caused problems. Ultimately, the author found that using a dryer was more cost-effective than the rotary airer method.

I am very fortunate that the current cost of living crisis in the UK only mildly affects me. It means I can afford to be creative when coming up with money-saving ideas without the consequences most would suffer if the idea didn’t work.

By the end of the summer of 2022 (I’ve just had 40-degree Celsius heatwave flashbacks, eurgh) the intensity of my generalised anxiety lowered to the point of being able to go outside and hang my washing out on my own.

I wanted to prepare for the winter ahead and the astronomical energy bills. After about ten minutes of solid googling, I discovered that the primary energy culprit in the home was dryers.

If I had persisted for at least ten more minutes of googling, I would have discovered that the electricity bill was not the one to be worried about – it was the heating bill. This was reason number one why hanging my clothes outside in winter was a terrible idea.

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How imprecise language can lead to the loss of scientific knowledge: part 2

May 19, 2023 /

This blog post is in reference to my article in the May 2023 edition of the Lancet Psychiatry – Lithium Story: Eight Guidelines, Eight Recommendations. It is adapted from notes I sent to one of the editors when constructing the article

The blog post discusses the issue of imprecise language in scientific literature, specifically in the context of lithium pharmacokinetics. Alex provides two examples of unclear messaging from the literature and suggests solutions to improve clarity. Example 3 involves the lack of specificity about the timing of serum concentration values mentioned in a paper by Grandjean and Aubry, while Example 4 highlights a graph by R Hunter that is misleading due to the use of two scales on the x-axis and unclear labelling of subjects. Alex suggests that authors should provide clear and concise statements to remove ambiguity in their writing and improve the accuracy of their research.

In a previous blog post, I looked at two examples of imprecise language in a Grandjean and Aubry paper about lithium pharmacokinetics (which I used in my May 2023 Lancet Psychiatry article). In this post, to show that the problem is not limited to a single paragraph in a single review paper, I have included a couple more examples of unclear messaging.

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How imprecise language can lead to the loss of scientific knowledge: part 1

April 12, 2023 /

This blog post is in reference to my article in the May 2023 edition of the Lancet Psychiatry – Lithium Story: Eight Guidelines, Eight Recommendations. It is adapted from notes I sent to one of the editors when constructing the article.

The blog post is a criticism of the clarity and precision of the language used in lithium pharmacokinetic literature. The post focuses on a specific paragraph of the Grandjean paper that contains two examples of imprecise language. Alex explains the implications of the authoritative and inaccurate language used, which can lead to a false sense of understanding and clarity in a reader not familiar with the subject, and may cause a slow deterioration of the original research finding citation to citation, decade to decade. Alex also argues that imprecise language can cause the loss of scientific knowledge, using as an example the case of Amdisen and colleagues, who proposed taking patient serum concentrations at 12 hours in the 1970s, and soon after became standard practice worldwide, but with time the original research finding has been lost.

It might seem strange to say from someone writing a blog post criticising clarity and precision of language, but I personally find it very difficult to write clear and precise language. Goodness, if you could see my first-year PhD report!

But, because I had to work very hard to clarify the muddled thoughts in my head, I recognised mistakes in lithium pharmacokinetic literature similar to those I used to make in my writing.

In the Lancet Psychiatry article, I focus on the paper “Lithium: updated human knowledge using an evidence-based approach” by Etienne Marc Grandjean and Jean-Michael Aubry. It is an extensive collation of knowledge on lithium treatment. However, producing a paper with such breadth of knowledge, can in turn, lead to unclear and imprecise language given how much the authors are required to understand.

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Last winter I decided to disregard GMT and stay at BST: why isn’t this a thing yet?!

March 26, 2023 /

The blog post describes the experience of dealing with the time shift that happens twice a year due to daylight saving time. Alex decided to stick to British Summer Time (BST) and adjust half of the clocks in their house to GMT, instead of adjusting their medication schedule. Initially confusing, Alex became accustomed to this change and felt that their mood was significantly better due to the later daylight hours of BST. Alex argues that year-round daylight saving time could be a better option than switching back and forth between BST and GMT.

There are very few upsides to living with a severe mental illness. One of them is quite a bit of free time. Previous times the clocks have gone back have been a nuisance to me. Especially since I started taking antidepressants. For whatever reason, my brain is very sensitive to the time I take them. If I take my dose late, even by only half an hour, my reality is thrown from side to side like a ship in rough seas.

To be taken safely, my medications have to be taken a set time apart (therefore at fixed intervals in the day). This means that twice a year the time I take my medication shifts by an hour each day. Why don’t you take your medication at the same time all year round? I hear you ask…

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