The Anxious Physicist

Personal blog of Dr Alex Mendelsohn

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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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The errors of Matt Hancock: A Yoda-inspired analysis

March 4, 2023 /

With the ongoing uncertainty regarding one of my medications not looking to end anytime soon, I have tried to distract myself with other absurdities going on in the world. In this blog post, I have combined two: ChatGPT and Matt Hancock. I hope that regardless of your political background, you agree that the UK health secretary during the covid-19 pandemic, Matt Hancock, made many mistakes (some with terrible consequences). I have been in and out of the loop of his, frankly, bizarre story. So, I asked ChatGPT to write an article for me by the wisest person I could think of… Yoda.

Mistakes, Matt Hancock made, hmmm? The Conservative politician, he was, yes. Many errors, he made, hmm? Mistakes, let us discuss.

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The pharmaceutical industry just stopped producing the only antidepressant that has worked for me

February 28, 2023 /

The blog post discusses the recent stoppage of the production of Bupropion (Zyban) and Varenicline (Champix) due to the detection of impurities that could increase the risk of cancer. Alex, who suffers from chronic depression, argues that the benefits of the antidepressant outweigh the minimal risk of cancer. Alex also criticizes the lack of availability of alternative treatments for depression and smoking cessation, particularly MAOIs and the lack of supply of smoking cessation drugs in the UK. Alex questions the logic of discontinuing acute treatments for smoking cessation due to a small risk of cancer over a few months.

Imagine the scenario. Potential impurities are found in some HIV retroviral drugs that produce a small increase in the probability of contracting cancer over their lifetime. I think the last thing you would expect would be the immediate stoppage of the production of the antiretroviral drugs in question. Leaving a patient vulnerable to imminent death as HIV progresses to AIDS is of greater importance than a tiny increase in lifetime cancer risk.

Yet, in the world of mental health treatment, this type of scenario has recently unfolded with the stoppage of the supply of Bupropion (Zyban) in the UK, leaving me and many others without the drug keeping them out of depression.

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I don’t like calorie tracker apps

January 31, 2023 /

Alex discusses his negative experience with calorie tracking apps. He attempted to use several apps to track his calorie intake but found that they all had fixed daily calorie targets, which he believes are not helpful for most people. He also found that the apps did not track calories accurately and only focused on how many calories were left to consume. Alex believes that these types of apps can contribute to mental health problems and eating disorders. He argues that apps need to be regulated to prevent coercing healthy and vulnerable people into obsessive behaviour. In the end, Alex decides to go the old-fashioned way and simply remember his calorie intake, believing that as long as he keeps his average calorie intake just below his calorie deficit and exercises regularly, he will lose weight.

I went into the Christmas period with the goal of not putting on weight. Long story short, I failed. In the past, I have been very fortunate to have a metabolism quick enough to remove the excess fat from my waist. It only required a slight modification in diet. In the last few years I have made the definitely new discovery, that, erm, metabolism slows with age.

No matter, I thought. I shall jump on the bandwagon with all the other health-focused people in January – hoping I don’t fall off before February. First stop, counting calories.

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Why I am using a pen name (for now)

December 31, 2022 /

Alex has had negative experiences with clinicians in the past and has struggled to find a psychiatrist they trust. After finding a psychiatrist and a combination of medications that have helped ease their symptoms, they plan to share their experiences through various platforms. However, they wish to remain anonymous for now as they criticize aspects of psychiatry, psychotherapy, and neuroscience and do not want their current psychiatrist to discontinue their service. Once their symptoms have improved and they feel safe enough, they plan to reveal their true identity while keeping the pen name Alex Mendelsohn. They hope to use their unique perspective to help others and prevent similar negative experiences from happening to others.

In the past, I have been refused treatments that eventually worked, and had interactions with past clinicians that unintentionally drove me towards suicide, rather than away from it.

It took me a very long time to find a psychiatrist I trust. Once I did, we landed on a combination of medications that have progressively eased my symptoms over the last couple of years. I take one of these medications off-label (this means that the medication is licensed for another condition, not the one I am taking it for). My current psychiatrist is the first I have met willing to prescribe this medication.

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