By Moryt Milo
Stanford psychiatrist Dr. Rona Hu is a fighter when it comes to patients with serious mental illnesses. She has been at Stanford Hospital for almost three decades and is the Medical Director of the hospital’s acute psychiatric inpatient unit, where she specializes in the care of those with schizophrenia, bipolar disorder, and depression.
“I don’t give up easily. It’s important to me what I am doing. What you are doing. We are all in this together,” she said at the April 8 NAMI-Santa Clara County general meeting.
Dr. Hu offered insight into why this field of medicine has touched her so deeply. She brought up a high school friend who attended an Ivy League college and went on to medical school at Johns Hopkins University. The friend developed schizophrenia and died by suicide. She talked about a medical student she dated, while both were in med school, who struggled with bipolar disorder and had to drop out. This world is personal to Hu on multiple fronts.
The dozens of people who listened to Hu’s talk heard her passion and sharp understanding of struggles family members experience with loved ones and adult children during the “Ask the Doctor” event. She covered a number of topics ranging from Keto diet as a replacement for medications, to best and newest medicines, to side effects, diagnoses, and the most pressing topic of the evening—weight gain.
Although Stanford conducted research on Keto, Hu said no particular diet should be a replacement for medication. Her opinion was clear.
“Absolutely not. I don’t recommend it. Keto diet in addition to medication is a possibility,” she said, pointing out it’s difficult to maintain and not easy to incorporate into one’s daily life. She noted diets are temporary, whereas developing healthy eating habits is the better approach.
Interest was high on the topic of medications, especially the newest antipsychotic on the market, Cobenfy. Hu said some medicines that have been available for years are still considered the gold standard like Clozapine for schizophrenia and lithium for mood disorders.
“Research has shown that lithium is very helpful for preventing suicide and very helpful with bipolar disorder,” Hu said.
But she didn’t brush off the side effects, depending on the dosage or how long a person is on the medication. She also mentioned Depakote, a seizure medication, also used for bipolar disorder. Still, these medications provide mental health stabilization.
She brought up a study in Europe showing positive outcomes for long-acting injectables. The study followed 20,000 people and found that those individuals have the best outcomes when it came to relapse prevention and functionality.
Dr. Hu discussed this in relation to newer atypical antipsychotic and antidepressant medications that don’t require as much monitoring, but they have other side effects such as weight gain and involuntary body movement known as tardive dyskinesia.
Concern Over Weight Gain
This is when the conversation steered into a multitude of weight gain questions and concerns, including whether people with serious mental illnesses should consider switching to Cobenfy.
Stanford was a testing site for Cobenfy, which came to market last fall. It tackles the problems of schizophrenia differently than other antipsychotics. Second-generation antipsychotics block both dopamine and serotonin receptors. Cobenfy doesn’t do this. The medication targets muscarinic receptors and doesn’t appear to cause weight gain or metabolic issues like other antipsychotics. It also appears to improve cognition.
Dr. Hu wants to prescribe Cobenfy, but insurance companies are not making it easy, and she is “jumping through hoops” to get authorization. Currently, it’s approved for schizophrenia, but not bipolar disorder. She said insurance companies have been finicky, and patients shouldn’t go off their medication while waiting for approval, since it’s not guaranteed. Even then, an individual should taper down on their existing medication when another medication is introduced.
A number of parents said their adult children had gained anywhere from 80 to 100 pounds on existing medications and were becoming withdrawn and embarrassed. Some family members asked about new weight loss drugs as a solution. Hu was supportive of the drugs and said patients should be allowed these medications if obesity or being overweight was problematic. The families have to provide insurance companies with detailed information and fight for the medication, Hu said.
She showed compassion about the effects of weight gain.
“It’s important to understand this is a common problem. We need to take the morality out of it. That’s already a help,” she noted. “You and your loved one or you, your loved one, and your doctor are all on the same side. It’s not like someone is gaining weight to spite you or their own body.”
Throughout the evening, Hu gently addressed the question. Whether it was about weight gain, hearing voices, or not accepting the illness, the constant was working together as a supportive family, finding adequate treatment, therapy, and stable housing. These were the keys to stability.
To watch Dr. Rona Hu’s full discussion on YouTube, click here.
