Harmacy

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Back to the World of Me-Too Drugs: How Anti-Sanctions Will Deal a Blow to the Mental Health of Russians
Takie Dela
May 2, 2018

The ban on the import of drugs from the United States and other “unfriendly” western countries, tabled by MPs in the Russian State Duma, will worsen the mental health of Russians. Two psychiatrists discussed the consequences facing people with mental illnesses if brand-name drugs are replaced by domestic lookalikes.

The Big Picture
In early April, State Duma Speaker Vyacheslav Volodin announced the imminent expansion of countersanctions by Russia towards the US and other western countries opposed to the Russian Federation’s foreign policies. In particular, there are plans to introduce a ban on the import of drugs from the countries on the sanctions lists, but only on those drugs for which there are domestic counterparts. However, many foreign-manufactured psychotropic drugs have domestic counterparts, and they will be banned, therefore.

Russia is not a happy country in terms of psychiatry. Every fourth Russian suffers from mental illness at some point in his or her life, and between three and six percent of the populace needs to take medications regularly.

Due to severe conditions such as epilepsy, schizophrenia, clinical depression, and bipolar disorder, hundreds of thousands of Russians lose the capacity to work and are unable to adapt to society. Many of them commit suicide. Modern drugs are effective enough to let most patients lead full lives. Their well-being depends on drugs, which they must take for many years and, sometimes, their whole lives.

The drugs in question are antidepressants, antipsychotics, tranquillizers (sedatives), and normotics (mood stabilizers). Nearly all the brand-name drugs in the field are produced in Western Europe and the US. If theban is adopted, they will vanish from Russian pharmacies, since nearly all these drugs have counterparts (i.e., generics), with the same active ingredients, that are produced in Russian and Eastern Europe.

When discussing the possbile stop list, experts named two popular antidepressants: Paxil (France) and Cymbalta (USA). Many other drugs popular in Russia, including the antipsychotics Zyprexa (Eli Lilly, UK) and Seroquel (AstraZeneca, UK/Sweden), and the antidepressant Zoloft (Pfizer, USA), could be included in the ban. What would be the consequences for millions of patients?

Increasingly Ineffective Treatment
Mental equilibrium is a delicate matter, and selecting drugs to treat psychiatric conditions can much more complicated than selecting drugs to treat somatic illnesses. The optimal outcome is for the individual not merely to stop experiencing severe symptoms like obsessive suicidal tendencies and hallucinations, but also to remain capable of working and leading a social life, rather than turning into a lifeless vegetable.

People with clinical depression, which can last for years, know well the laborious process of choosing the right drug and the right dosage that will finally let them live a normal life. The process can take weeks and months.

Matters are even more complicated with bipolar disorder. The disease’s two opposite phases require different medications, and an unsuitable drug can even worse the outcome of the illness. Schizophrenia presents such a variety of symptoms that a veritable cocktail of drugs is sometimes needed, and attending physicians have to make sure the side effects do not outweigh the benefits of treatment.

“Current guidelines for pharmacotherapy recommend prescribing the brand-name drug and not substituting a generic without good reason,” says Maria Gantman, a psychiatrist at the Mental Health Center.

Dr. Gantman prescribes her patient brand-name drugs, which have undergone high-quality trials on thousands of patients and have a proven effect. Generics also undergo trials when they are licensed, trials that prove their similarity to brand-name drugs, but the evidentiary base is filled with too many gaps, she notes.

“Generics are usually less expensive, and we start off with them if the patient cannot afford the brand-name drug. The abrupt replacement of one generic with another can produce a change in the effect. Due to the peculiarities of their ingredients, generics may be absorbed at a greater or lesser rate and generate a different concentration of the active ingredient in the blood. The people who suffer most are those forced to switch from a brand-name drug they have been taking for years and that was laboriously selected for them to a generic,” explains Dr. Gantman.

She fears the Russian authorities will approach the issue in a perfunctory manner.

“For example, there is a drug that is effective in treating schizophrenia, Rispolept. There are Russian lookalikes, sold under the generic name risperidone. But if the brand-name drug is banned, it hard to imagine what lies in store for people who survive by taking Rispolept Consta (Belgium), which does not exist in this form as a generic in Russia,” says Dr. Gantman.

“The problem is that theRussian pharmaceutical industry hopelessly lags behind the western pharmaceutical industry. There are certain types of drugs Russia just cannot produce, because it does not have the resources, the equipment or the research,” continues Anatoly Shepenyov, a psychiatrist and psychotherapist. “Say, the antidepressant Cipralex (Denmark) cannot be synthesized in Russia. Folic acid is an indispensable drug, too. In Russia, it cannot be produced in the form needed for the synthesis of serotonin, that is, in the form needed for maintaining normal brain function.”

Side Effects
The side effects of psychotropic drugs are numerous and varied. Mental impairment, convulsions, fainting, anemia, and fever are only some of them. Predicting them ahead of them is impossible: they are the individual body’s reactions. A drug that simultaneously provides relief while not producing agonizing side effects is a valuable find for many patients.

Dr. Shepenyov illustrates the circumstances by mentioning the antidepressant Paxil (France). It has generics, for example, Rexetin (Hungary). Rexetin works, but its therapeutic effectiveness is lower. To get the same effect she would get from 20 mg of Paxil, thae patient would need to take at least 30 mg of Rexetin. As dosages increase, so do the side effects.

“The main difficult is not synthesizing the right substance, but isolating it in pure form. I’ll give you an example. The antidepressant must fit the receptor in the brain the way a key fits a lock. When generics are synthesized, a whole slew of impurities emerge, extra ‘keys,’ if you like. If you use this ‘dirty’ molecule, you won’t open the lock, but there will be something jammed in it,” notes Dr. Shepenyov.

The use of generics thus introduces the risk there will be a lack of therapeutic effect coupled with a slew of side effects that would never be produced by brand-name drugs. The liver also suffers more from the constant intake of “dirty” drugs.

“Take the most popular Russian-made antidepressant, Fluoxetine (a generic version of the US-produced Prozac). It is terrible in terms of side effects. Although its benefits are weak, patients suffer from phenomenal absentmindedness,” explains Dr. Shepenyov.

Withdrawal Syndrome
If western-produced drugs one day vanish from Russian pharmacies, thousands of patients will undergo withdrawal syndrome, the body’s physiological reaction to the absence of a substance to which it is accustomed.

“I felt terribly sick within a few days. I had a terrible chill, severe dizziness, nausea, weakness, and insomnia,” a female patient described her withdrawal from Paxil.

It is necessary to gradually reduce the dosage to avoid this effect, which means having a good supply of the drug and then just as gradually increasing the dosage of the new drug. This means weeks of enduring shaky health.

The Anti-Placebo Effect
“The anti-placebo effect is no less frequent and severe than the placebo effect. The patient knows she has taken another drug. This exacerbates her anxiety and could ultimately destabilize her condition. So, if an individual has taken the same drug for years and feels fine, there is no need to give her another drug. It’s risky,” says Dr. Gantman.

Both doctors are agreed that patient health should not be a geopolitical bargaining chip. According to Dr. Gantman, medical issues should be left out of the political games countries play, and she calls the State Duma’s plans to ban the imports of foreign-made drugs “profoundly unethical.”

“If Russian MPs adopt such a law, we should oblige them to be treated solely with Russian-made drugs, drive Russian-made cars, and use Russian-made telephones and computers. Those would be excellent sanctions that would finally force them to use their brains before making radical decisions without having the foggiest notion about either medicine or how the body functions,” concludes Dr. Shepenyov.

Translated by the Russian Reader

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Anastasia Plyuto
VK
May 12, 2018

A group picket was held on Saturday, May 12, 2018, in Petersburg’s Ovsyannikov Garden, to protest the Russian State Duma’s tabling of a bill that would ban the purchase of drugs abroad. Yes, we have heard that legislators have suggested removing the word “drugs” from the wording, but we know much freighted the phrase “and other goods” can be.

To increase the chances city authorities would authorize the picket, activists applied for several venues at once. The authorities waited until the last possible moment to render a decision, and so there was no time to inform the public about the planned protest. Around a dozen people were in attendance, including a diabetic who depends on imported insulin, and several people outraged by the politics and statements of our MPs.

One of the placards featured a toy pyramid for little children, which MP Iosif Kobzon gave to a teenaged cancer patient while visiting a hospital in Simferopol in 2015. In our view, the incident reflects the lack of understanding displayed by our bigwigs when it comes to the needs of patients.

There were few visitors in the garden, and nearly none of them had heard of the law bill, but no one, from schoolgirls to a seventy-year-old female pensioner, was left unmoved by the subject. They reacted with surprise, indignation, and complete support for the picketers.

meds-1“You want to ban imported drugs? Start with yourselves. Treat your ailments with oak bark!”

meds-2.jpg“Insulin addict. Bring it on! Deprive us of our doses, assholes. ‘Life in Russia is no picnic: you can survive without insulin.’ Insulin or formaldehyde? Neuroleptics or belladonna? You choose, Russia!”

meds-3“State Duma! By banning the import of drugs, you are killing people!”

meds-4“Ban yourselves from driving Geländewagens! Hands off the drugs!”

meds-5jpg“Viva asymmetrical responses! (Genocide)”

Photos by Mikhail Ryzhov and Anastasia Plyuto. Thanks to Victoria Andreyeva for the heads-up. Translated by the Russian Reader

Psychoactive

“It’s an Exhibitionist Move to Proclaim You Have an Illness”: Who Marched with the Psychoactivists on May Day
Ilya Panin
Takie Dela
May 2, 2018

At this year’s May Day demo in Moscow, almost three dozen people marched with placards inscribed with slogans on the harm caused by stigmatizing mental illnesses. Police detained the marchers at the head of the Bolshomoskvoretsky Bridge and took them to police stations. Only a few marchers in the group managed to avoid being detained. Takie Dela found out what the psychoactivists wanted to say by marching. 


“I was treated without my knowledge: you have a right to know your diagnosis.” | “People need hope, not neuroleptics.” Psychoactivists at this year’s May Day march in Moscow. Photo by Ilya Panin. Courtesy of Takie Dela

This year, a group of psychoactivists—artists and human rights defenders, researching mental illnesses, mental quirks, and the boundaries between normal and abnormal—brought up the rear of the traditional procession organized by the Federation of Independent Trade Unions (FNPR). The marches carried placards inscribed slogans like “Antidepressants are a girl’s best friend,” “We’re coming out of the psycho-closet and expect acceptance, not a 100 years of solitude,” “I know my own diagnosis. Do you know yours?” “The affective class,” and “Stop romanticizing and depreciating us.” Ekaterina Nenasheva, an organizer of the Psychoactive Movement, leafleted passersby with flyers detailing how to behave if your loved one suffes from depression, anxiety or panic.

The group had managed to cross the Bolshoi Moskvoretsky Bridge, from the police checkpoint and the metal detectors to Basil’s Descent, when the activists were detained by regular police and riot police (OMON). As witnesses testified, the police roughed up the activists and ripped their placarads. The law enforcers could not settle on a reason for apprehending the activists. Some of them were told it was because of what written on the placards, while others were told it was because the march had not been authorized.

The detainees were split up, loaded into paddy wagons, and taken to the Basmanny and Tagansky police stations. In the paddy wagons, policemen told the activists they should have vetted their placards with the rally’s organizer, the head of the Moscow Federation of Trade Unions. However, the rally’s website indicated all comers had been welcome to join the demonstration.

“We were asked to write statements and undergo preventive discussions. Each of us was assigned our own personal police officer, who said he was informing us that, by law, it was wrong to be involved in unauthorized rallies,” said Mikhail Levin.

The activists were released several hours later without having been charged with any offenses or fined. The detainees noted they had also been questioned by Center “E” (Extremism Prevention Center) officers, who photographed their placards.

Ekaterina Nenasheva
Artist, activist, organizer of the Psychoactive Movement and the May Day bloc


Katrin Nenasheva. Photo by Ilya Panin. Courtesy of Takie Dela

People who have mental illnesses still have no place to speak out and act. Organizing the May Day bloc was an attempt to create a discursive field for people who have mental illnesses or mental quirks. What does it do for them? According to the people who were with us yesterday, community gives them the important sense that they are not alone. There was a slogan to that effect on one of the placards: “You’re not the only one in the hood.”

It is believed that people with mental disorders can only be consumers of someone’s kindness, charity, tolerance, and pity. But they are completely capable of speaking out for themselves and being a social, political, and cultural force.

Mikhail Levin
Organizer of the Psychoactive Movement and the May Day bloc
It’s a slightly exhibitionist move to proclaim you have an illness. The guys and gals marched with very personal placards about their own quirks. We also want to demand reforms in psychiatric treatment and talk about the need for deinstitutionalizaton and our disagreement with plans to ban the import of certain medicines.

Marching with trade unions, with other workers, was an important statement. We wanted to say we also produce meaning, ideas, and work. This was the first attempt to do something like this, so it is fine that we are not a united fist, that we have different demands and opinions. What we wanted was just this: to bring together people with different mental makeups and show off this polyphony.

Sasha Starost
Artist, psychoactivist, organizer of the Psychoactive May Day bloc


Sasha Starost. Photo by Ilya Panin. Courtesy of Takie Dela

I have paranoid schizophrenia. I have been hospitalized five time; three of those were involuntary. In the psychiatric field, I’m involved on an institutional level as a simultaneous interpreter and translator. Our May Day bloc was conceived as the Russian version of Mad Pride.  On the whole, however, we are more inclusive than Mad Pride, because in recent years they have shifted very hard towards antipsychiatry, and that is not for everyone. Yes, there is the system, and it is really poor organized. It contains neuropsychiatric residential care facilities and neuropsychiatric dispensaries in which nothing goes to plan and the rules are not followed, but this does not discredit the idea of psychiatry, the presence of illnesses, and the possiblity of treating them.

If we have taken the step of vetting our bloc, the demo’s organizers would have found excuses for not letting us march. I’m totally convinced that the cops saw a bloc of young people, some of them had tattoos, and they were carrying placards with slogans too boot. In their minds, there was a clear like with youth rebellions, and their immediate reaction was to remove us right away.

Alyona Agadzhikova
Media artist, journalist, photographer, organizer of the Psychoactive May Day bloc
Since childhood, I have had a few mental illnesses (OCD, agoraphobia accompanied by panic attacks, and  anxiodepressive disorder) and so for a long  time there was nowhere I could go and no one to go with me, because people’s awareness of mental health in Russia is somewhere around nil. So, I write and talk a lot about the visibility of people with similar quicks. I’m not afraid to say I have mental illnesses. I want the people in my life to pay attention to their own states of mind and offer help to people having trouble. I want the hate speech to disappear from the Russian language. People who do dumb or bad things should be not called psychos and schizos, and they do not need psychiatric treatment. All of these things have nothing to do with each other. Fortunately, things have been getting better lately, thanks to psychoactivists, journalists, and blogger doing outreach work on the rights of people with mental quirks and bringing the topic of psychiatry out of the gray zone.

What happened on May 1 was unprecedented, of course. It was the first Mad Pride in Russia, and it did not end the way everyone expected. We had come out to tell people that we people with mental illnesses existed. The people in our midst, the other marchers in the May Day demo, smiled at us, applauded us, and took our pictures. After reading our placards, several people decided to join our bloc. But then, twenty minutes or so later, a mob of riot police (OMON) and Russian National Guardsmen came running at us. They ripped our posters and our banner, confiscated all our placards, and dragged people away. Some people they practically dragged over the pavement, while they took other people by the arm. Many peole had severe panic attacks, including me. Fortunately, I always have my pills along. Otherwise, I simply would have passed out right there on the spot. That is how I react to unexpected, stressful circumstances.

My panic attack continued in the paddy wagon, but it was no longer so intense because I had taken a tranquillizer. But I suffer badly from claustrophobia, so I asked to be released from the cage, which opens from the outside. Fortunately, the riot  police immediately agreed. I think it had something to do with the fact that there have been precedents at the European Court of Human Rights, cases in which transporting claustrophobics in so-called cages and glasses has been deemed torture.

While we drove to the Basmanny police station, the law enforcers were keen to ask me why I was so nervous, what Psychoactive was about, who had diagnosed me, and why we had marched.

When I had described in detail how a panic attack works, one of the riot policemen  said, “Oh that’s nonsense. Try doing a five-kilometer cross-country run. Your heart is pumping so hard, it makes your head spin.”

I replied immediately.

“It’s the same feeling, only imagine you haven’t run five kilometers, that these feelings come on for no reason at all,” I snapped back.

The riot police exchanged glances and said, “Yeah, that’s harsh.”

Miroslava Podlesnykh
Ceramicist, animal rights advocate

Miroslava Podlesnykh. Photo by Ilya Panin. Courtesy of Takie Dela

Mental quirks and mental disorders are a topic means a lot to me, something I tried to live with for a long time without paying attention to it. Ultimately, however, I realized that living a full-fledged life meant accepting myself the way I was. I realized that if I wanted to changed the world I had to get a move on, to be around people who shared my values and views, to be part of a community.

The arrests were particularly hilarious when you could hear the announcers in the background talking about peace, labor, unity, and May, while the police were detaining a group that was just gaining the strength to assert itself, because this was an incredible effort for them. I know what a person who suffers from sociopathic disorders feels like in a crowd. Going on a demo is a huge effort, a big step towards a partial recovery.

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The psychoactivist community emerged in January 2018. Their projects have included Psychoactive, which focused on communication and creativity, and I’m Burnt Out, which dealt with emotional burnout. They also have their own brand of clothing and accessories.

Translated by the Russian Reader

Mikhail Kosenko: Closing Statement in Court

On Tuesday, the Zamoskvoretsky District Court in Moscow convicted Mikhail Kosenko, recently declared a prisoner of conscience by Amnesty International, of involvement in “mass riots” and use of force against police officers during clashes between police and protesters after a sanctioned opposition march was prevented by police from reaching its end point, on Bolotnaya Square, in Moscow on May 6, 2012, the day before President Putin’s inauguration for his third presidential term. At the request of prosecutors, Kosenko, who suffers from a post-traumatic mental illness that previously required no hospitalization, had been declared mentally incompetent by the court, which has now sentenced him to compulsory psychiatric treatment, thus apparently reviving the state’s punitive use of “psychiatry” against dissidents during the late Soviet period.

During Tuesday’s court hearing, Mr. Kosenko made the following statement, which was recorded by Novaya Gazeta reporter Yulia Polukhina and published in the original Russian on the newspaper’s web site. My translation is illustrated with sketches by artist Victoria Lomasko, who was also present at the hearing. I thank her for permission to reproduce them here.

__________

The most valuable thing in the country is freedom. This is what the majority of our population is deprived of to one degree or another. This applies in particular to prisoners. A huge number of people are in prisons and camps for no reason, and no one will help them. And those who are there for crimes they have committed do not deserve the conditions [in which they are imprisoned]. As the prisoners themselves say, no one [is] able to recover after imprisonment. The plight of the mentally ill in incarceration is hard; the most difficult thing for them is haloperidol, a banned substance. There are side effects from it and many fatalities. It causes muscle cramps, rigidity, and pain.

galoperidol

Mikhail Kosenko: “The hardest thing is halperidol. It causes muscle spasms and pain.”

Our people are used to suffering. An eastern model of society is being built in Russia—lack of freedom in exchange for a sated life. The authorities base their propaganda on material measures—money spent and its results. That happiness doesn’t lie in money is an ancient idea, although one now challenged. Happiness lies in people’s freedom. There are many countries where the material standards are lower than in Russia but the level of satisfaction with life is much greater. Our people are used to living in poverty, and they imagine that a little prosperity is a big achievement.

opasen

Prosecutor: “Kosenko is a danger to himself and others.”  (Judge Ludmila Moskalenko, who found Kosenko guilty, is seated on the right.)

Freedom is freedom from evil. Real opportunities… Our country has great potential, and different kinds of freedom are needed to realize it, but they either do not exist or are restricted. Freedom of the media… The most important medium is television, but there is censorship on [Russian television], which is prohibited [by law].

The authorities impose their strategy on television reporters. That is why pickets, rallies and marches are so important for the opposition. It was on this ground that the authorities decided to tussle with the opposition. Rallies and marches organized by the authorities are underwhelming, so they took the routе of creating all kinds of obstacles [for the opposition]. The authorities decided it was they who determined the location of rallies, even though the law says otherwise. The opposition wants to hold a rally on one square, and the authorities force a different square on them. Our society, accustomed to laws being violated, was not much bothered by this. Then the authorities have used obstacles, nuisances and coercion to make rallies ineffective and to limit the area where they are held, as happened on May 6, 2012.

sostoyanie

Defense lawyer Dmitry Aivazyan: “Kosenko will be in the same condition ten years from now. There is nothing to treat.”

While drastically limiting the area of the rally, as opposed to what had been agreed, the authorities considered its illegal demands the law. Because the authorities think they are the law. When, amidst the crush [on May 6, 2012, on Bolotnaya Square], dozens of people broke through police lines, the authorities decided they now had the right to disperse the tens of thousands of people who had come to the rally. With their tactics and politically motivated actions, the authorities constantly irritated people, who stood up to these illegal actions. The authorities break the law, but when they are rebuffed, they pretend to be legalists themselves, what with their Article 318 [use of violence against authorities – Editor] Riot policemen perceived the demonstrators as their enemies, meaning that they had been coached ahead of time to act so harshly, to react so harshly. The riot police on Bolotnaya Square obviously were not the law. Their superiors had politically encouraged the actions of the riot police on Bolotnaya Square. It was a political confrontation. The demonstrators were protesting against unfair elections. The demand for fair elections is the most just demand. The authorities oppose fair elections, because [if fair elections are held], they will have to resign. The regime consists largely of incompetent people, of the people who break the law. What we need is rotating governments, not the everlasting tenure of a single regime. With the current regime, Russian will be unable to deal the major challenges that will be inevitable in the future.

dvazdi

Defense lawyer Alexei Miroshnichenko: “No one can be held liable for the same crime twice.” Seated to his right is Kosenko’s sister Ksenia.

Combined with low efficiency, the huge exertions the authorities sometimes display lead to significantly poorer results than could be otherwise. In our country’s history, power has never passed to the opposition legally. The current regime has set many anti-records: the highest consumption of heroin in the world, and it is the same thing with alcohol. And such a regime is competent? And should remain in power forever? The people protesting against it are wrong?

Supporters of the government say there is no one else to run the country. This is doubtful. Russia has huge numbers of talented and strong-willed people, and they can get into power only through honest and fair elections. I want to thank everyone who has supported me—my lawyers, my sister, and everyone who has come to these hearings. As for my sanity, I ask the court to consider me sane.