Personal blog of Dr Alex Mendelsohn

Author: Alex Mendelsohn (Page 1 of 4)

I had a severe reaction to an antidepressant which, overnight, turned me from someone who had no anxiety symptoms whatsoever, to someone who had all of them. I then spent 8 months learning psychological methods (a lot of which I came up with myself) to 'reanimate my Frankenstein brain'. I then returned to my physics PhD where I finished the last 3 years of my PhD in 20 minute intervals, meditating in between to keep myself functional. After I finished, I collapsed from exhaustion, due to the slow progression of my physiological illness. I spent a harrowing couple of years in an indescribable hell, before we eventually got to medications that finally started to work. I am still recovering, but the closest to remission since that awful night in November 2015.

The time psychiatry forgot about notation: the 12-hour lithium level

This article is about the recently published article Dr Aftab and I have published in the Psychiatric Times: Future Proofing Lithium Pharmacokinetic Research


I know that lithium pharmacokinetics is not exactly the sexiest subject in the world. I definitely know that the proper use of notation isn’t.

However, improper (or lack of) use of notations in research can cause an otherwise good research paper to be uninterpretable.

Continue reading

On the big questions

I received an email from a very nice person seeking advice and help about their future career choice. I replied saying that I don’t usually give advice because of how complex individuals can be. One piece of advice that might work for one person, may be detrimental to another. However, what I did do was speak from my own experiences – hoping that themes within them apply to their personal situation. I noted that what I wrote could be complete rubbish!

The email correspondence between us helped me to get some of my thoughts down on paper. And, I would like to put them up on my blog just in case someone else finds value in my experiences. This is the fourth of five blog posts.

This blog post discusses Alex’s personal experiences with anxiety and how it affected their perception of the “big questions” in life. They came to the realisation that framing decision-making based on their mood state rather than logical frameworks made more sense for them. They also believe that answering small questions can lead to a better understanding of the bigger picture. Alex suggests that the big question of “what is free will?” may not be the correct question to ask based on their experience with mental illness.


When I became severely anxious overnight, suddenly, some of the big questions became extremely important. But funnily enough, they all seemed to revolve around death and dying. After my severe reaction, I have given no thought at all as to whether free will exists or the hallmark of a life well lived.

Continue reading

Identity

I received an email from a very nice person seeking advice and help
about their future career choice. I replied saying that I don’t usually give
advice because of how complex individuals can be. One piece of advice that
might work for one person, may be detrimental to another. However, what I did
do was speak from my own experiences – hoping that themes within them apply to
their personal situation. I noted that what I wrote could be utter rubbish
!

The email correspondence between us helped me to get some of my thoughts
down on paper. And, I would like to put them up on my blog just in case someone
else finds value in my experiences. This is the second of five blog posts
.

Alex used to define themselves solely through their work as a physicist, but found it harmful to their mental health as they would take criticism of their work heavily. They also identified other risks to this philosophy, such as becoming stuck in a role and going against moral convictions. After counselling sessions, they started defining themselves outside of their job as well, and explored various interests and hobbies. This change in identity allowed them to take more calculated risks and feel a greater sense of freedom.


Before my rare severe reaction to an antidepressant, I used to define myself through what I did. i.e. “I am a physicist”. This, I found, was quite dangerous for my mental wellbeing. I would take criticism of my work really heavily – it was one of the many factors that contributed to my growing depression (which ultimately led me to take an antidepressant that caused my severe reaction). I was unable to separate who I was from what I did.

Continue reading

Reframing the career choice question

I received an email from a very nice person seeking advice and help about their future career choice. I replied saying that I don’t usually give advice because of how complex individuals can be. One piece of advice that might work for one person, may be detrimental to another. However, what I did do was speak from my own experiences – hoping that themes within them apply to their personal situation. I noted that what I wrote could be utter rubbish!

The email correspondence between us helped me to get some of my thoughts down on paper. And, I would like to put them up on my blog just in case someone else finds value in my experiences. This is the first of five blog posts.

Alex shares their thoughts on career choice, based on their personal experience. They changed their perspective from “what do I want to do with my life?” to “who do I want to work with for the rest of my life?” after undergoing counselling. They realized that finding a job with people who share similar values and interests is more important than the job itself. Alex encourages readers to consider the people they will be working with when making career choices, and to prioritize finding a work environment that aligns with their values and personality.


Up until my severe reaction to an antidepressant, I viewed the ‘career’ question as: What do I want to do with my life? After around a hundred sessions of counselling or so, this question changed to: Who do I want to work with for the rest of my life?

Continue reading

How I think physicists can help psychiatric education

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 editionLithium 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.

Continue reading

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

Continue reading

Breaking the connection with my smartphone

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.

Continue reading

Nearly a year on, Bupropion is still not available

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.

Continue reading

Previous article clarifications

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.

Continue reading

How I found Amdisen’s original research papers

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.

Continue reading
« Older posts