HEALTH

A Tragic Lesson

Could Heath Ledger's overdose have been prevented?

By Jennifer Barrett | Newsweek Web Exclusive

Feb 6, 2008 | Updated: 5:35 p.m. ET Feb 6, 2008

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Posted By: docktorb@aol.com @ 04/21/2008 12:23:59 PM

Comment: Heath Ledger was both over and undermedicated. His last interview was almost certain evidence of a cyclothymic/bipolar problem. It's strange to me that the psychiatry professor didn't say anything about that.
That would go against his antimedicine theory. Yes,too many medicines are being given, but in Heath Ledger's case the right medicine, a mood stabilizer, was not prscribed. A primary care doctor should know to screen for that, but with the government and insurance companies push for assembly line medicine, it's not surprising that it was missed. As a primary care physician, I frequuently am reluctant to send a patient to a psychiatrist as the commentator suggests. In our area they tend to add a medicine at every visit instead of changing to an effective one. Children are often on five or six medicines when the do better when changed to one mood stabilizer and perhaps an anti depressant.

It is possible that Ledger refused a mood stabilizer, opting for the bandaid treatment with valium like drugs. These give immediate relief but don't treat the underlying condition. Things usually get worse over the long haul as in Ledger's case. It's easy to see a desperate in amanic insomnia taking more and more drugs to get to sleep. Finally it's enough to puy you in a permanent sleep. As many as one in thirty people has bipolar or it's milder cousin, cyclothymic disorder. This is extremely common in actors and other creative people. They tend to be the movers and shakers of the world. Think Alexander the Great, Teddy Roosevelt,Ted Turner, Van Gogh, Jim Bakker. They get things done but are at risk of getting carried away. It's only a little exageration to say these people either become millionaires, go to prison, or both. It must be controled to get the maximum benefit without the harmful results. This does involve counseling, education, and yes, mood stabilizers at the lowest effective dose. A knowledgible primary care physician is essential to manageing this condition through it's fluctuating stages.
Posted By: docktorb@aol.com @ 04/21/2008 12:22:55 PM

Comment: Heath Ledger was both over and undermedicated. His last interview was almost certain evidence of a cyclothymic/bipolar problem. It's strange to me that the psychiatry professor didn't say anything about that.
That would go against his antimedicine theory. Yes,too many medicines are being given, but in Heath Ledger's case the right medicine, a mood stabilizer, was not prscribed. A primary care doctor should know to screen for that, but with the government and insurance companies push for assembly line medicine, it's not surprising that it was missed. As a primary care physician, I frequuently am reluctant to send a patient to a psychiatrist as the commentator suggests. In our area they tend to add a medicine at every visit instead of changing to an effective one. Children are often on five or six medicines when the do better when changed to one mood stabilizer and perhaps an anti depressant.

It is possible that Ledger refused a mood stabilizer, opting for the bandaid treatment with valium like drugs. These give immediate relief but don't treat the underlying condition. Things usually get worse over the long haul as in Ledger's case. It's easy to see a desperate in amanic insomnia taking more and more drugs to get to sleep. Finally it's enough to puy you in a permanent sleep. As many as one in thirty people has bipolar or it's milder cousin, cyclothymic disorder. This is extremely common in actors and other creative people. They tend to be the movers and shakers of the world. Think Alexander the Great, Teddy Roosevelt,Ted Turner, Van Gogh, Jim Bakker. They get things done but are at risk of getting carried away. It's only a little exageration to say these people either become millionaires, go to prison, or both. It must be controled to get the maximum benefit without the harmful results. This does involve counseling, education, and yes, mood stabilizers at the lowest effective dose. A knowledgible primary care physician is essential to manageing this condition through it's fluctuating stages.
Posted By: the.cheshire @ 02/22/2008 3:42:09 AM

Comment: I doubt very much if poverty was 'the biggest cause' or even a factor in Heath Ledger's death. The use of the word "then" for "than" makes me doubt your professionalism, but I do agree that drugs make people "do strange and terrible things they would regret forever"--if they ever get off of them and get back to a mental state where they can regret them. I agree with this because that's exactly what happened to me.
I was prescribed Paxil and Xanax and Trazodone all at the same time. When I complained to my Dr. that I was getting worse instead of better, he increased the dosage. How was that supposed to help?
TV commercials for drugs clearly tell of side-effects and negative results, which the doctors should, but usually don't. When you fill a prescription, the drug store staples a sheet of paper with the side effects written on it, so that is no excuse for patients wanting the drugs anyway, unless they can't read (closed captioning) or hear--yet there were other side effects from the drugs I took that I experienced, that weren't anywhere on the papers or in the doctor's mouth, that I actually had to search the internet to find.
People already on drugs don't mind being put on more drugs. It's like using peroxide to pre-soften resistant hair so that it will "take" more peroxide hair color-- one drug conditions the patient to accept more with no concern for the side effects or damage they can cause.
Aren't doctors to drug companies what mechanics are to parts companies? It's sad the way things are and it's sad that Heath is dead. I think it boils down to one thing. When it comes to what happens to the people taking their prescriptions, the doctors and the drug companies simply do-- not-- care--.
Posted By: cookiecndy @ 02/15/2008 2:30:56 PM

Comment: Very good list. I think psychiatry has failed 1-6 so far
Posted By: news_editor @ 02/12/2008 11:57:28 AM

Comment: It is in denying that these very questions have not and can not and will not be answered that the APA, NAMI, and organized psychiatry has a right by court order to "treat" anyone that they want to with these drugs. Once hooked because of careless over prescribing, advertising, and street use some people may do some strange and even terrible things they may regret forever. Poverty is the biggest cause of all of this. It then beoomes a cycle between poverty and this psycho-social-court system that we have. No one wants to go to jail and we have so many laws on the book now that anyone and everyone is ending up in jail for almost anything and it is easier to take a plea to use then go to jail, some laws need to be repealed and some need to be changed. The doctors oath of irst do no harm is not being followed. Prevention isn't being done, people feel they are obligated to go after shooting stars and catch them in our society and the only way that this is possible is to "feel good by pill", this is a societal problem and needs to be stopped. Again I will ask you to answer these questions:

Give your readers clear, convincing conclusive: 1. Evidence That Clearly Establishes the validity of "schizophrenia" "depression" or other "major mental Illnesses" as biologically-based brain diseases. 2. Evidence For A Physical Diagnostic Exam such as a scan or test of the brain, blood, urine, genes, etc that can reliably distinguish individuals with these diagnoses (prior to treatment with psychiatric drugs), from individuals without these diagnoses. 3. Evidence For a Base-line Standard of a neurochemically balanced "normal" personality, against which a neurochemical "imbalance" can be measured and corrected by pharmaceutical means. 4. Evidence That Any Psychotropic Drug can correct a "chemical imbalance" attributed to a psychiatric diagnoses, and is any thing more than a non-specific alterer of physiology. 5. Evidence That Any Psychotropic Drug can reliably decrease the likelihood of violence or suicide. 6. Evidence That Psychotropic Drugs do not in fact increase the overall likelihood of violence and suicide.
Posted By: Calabria @ 02/10/2008 1:18:58 AM

Comment: I believe Heath would still be alive if the masseuse would have called 911 immediately.
Posted By: fireagate @ 02/09/2008 11:19:55 PM

Comment: Cumulative effects of two anti-anxiety drugs plus the use of oxycodone would certainly lead to a potential life threatening toxicity even in a patient used to such drugs. Was he using alcohol at the same time thus intensifying the effects of all the drugs? Was he also seeing more than one doctor for the prescriptions thus resulting in multiple rx's and leading to confusion on his part. Yes it is a shame that we have lost such a wonderful person but let that be a lesson to all of us: be careful with the use of any prescription drug wether it be a narcotic, sedative, laxative or antihypertensive. All drugs have the potential for lethal side effects if not taken correctly and safely.
Posted By: casper75 @ 02/09/2008 5:05:36 PM

Comment: To say the man is a drug addict is like saying you know a total stranger in a store is a shopaholic?
I do not think there is a person in this country who is not on some form of medication, and or have a vice.
Whether it be drugs, alcohol, or chocolate...
I do not know why he would be taking 2 painkillers, as well as 2 anti-anxiety medications?
But I do know that Temazepam has claimed many victims when taken with combination of sleep aids even at a low dose.
They said he was having trouble sleeping and even when taking the medications for sleep, he could not stay asleep for more than 2 to 4 hours.
He must have been having some mental issues at the time, and sometimes people actually do listen to their doctors, and take the medications provided by them, to get well, because it is a doctor, that is who you go to, listen to when health issues arise.
I think if he had multiple doctors like 12, or 13 there was a underlying problem, but if he had gone to 2 different doctors, and didn't think of telling them the combination of drugs, how would they know?
Most doctors do not talk to one another unless some sort of communication is needed.
It is a tragic loss of such talent, and it seems a really good, human being has left this world as well...
Posted By: Kedwyn @ 02/09/2008 5:35:16 AM

Comment: Of course it coulbe prevented. Who in their right mind would prescribe or take two different massive painkillers? I have trouble getting my monthly 30 count hydrocodone refill and I am a 60% service connected veteran with serious spinal injuries. And again who would prescribe and who would take two different anti-anxiety meds? Having worked with seriously disturbed patients in inpatient units I have never seen one on two anti anxiety meds at the same time.
Posted By: Kedwyn @ 02/09/2008 5:34:01 AM

Comment: Of course it coulbe prevented. Who in their right mind would prescribe or take two different massive painkillers? I have trouble getting my monthly 30 count hydrocodone refill and I am a 60% service connected veteran with serious spinal injuries. And again who would prescribe and who would take two different anti-anxiety meds? Having worked with seriously disturbed patients in inpatient units I have never seen one on two anti anxiety meds at the same time.
Posted By: GreatDane @ 02/08/2008 9:05:52 AM

Comment: oh, good grief. The headline just screams for comment: "Could Heath Ledger's overdose have been prevented?" Of course, it could. By any of the following:

1. someone to monitor his meds if he was incapable of reading
2. him reading the labels and paying attention to the inserts that are given out with every prescription

Either of these steps would have prevented. The rush to absolve him of responsibility for his own foolishness is so predictable and so infuriating. I wonder who will be found to serve as defendant in the lawsuits that are sure to be filed against SOMEBODY because he took too many pills.
Posted By: famulla @ 02/08/2008 1:09:51 AM

Comment: HEALTH
A Tragic Lesson
Could Heath Ledger's overdose have been prevented?
By Jennifer Barrett | Newsweek Web Exclusive
Feb 6, 2008 | Updated: 5:35 p.m. ET Feb 6, 2008

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Back to your depressing agents. The more of the cocktail you take the brain misrecognise what to absorb primarily and goes in a cobweb like situation. The dead brain tells no tale and ends there. The dead brain, the medications are sold on the counter hidden as fat burners, or the belt to reduce the waist. Try this and you go up fast. This is silly. The adult ought to know how much is too much. Remember we use the phrase, ???If you drink do not drive???, who listens. The drunk drivers knock many. This is the same here
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Firozali A Mulla MBA PhD
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Posted By: Survivor-mi50 @ 02/07/2008 7:02:55 PM

Comment: The medical profession prescribes according to what the Pharmas Bachelor degreed detail salespeople market to them; most haven't a clue about pharmacology, or what they're prescribing, yet many receive "incentive rewards" for writing the scrips. It must stop. We need more basic science education in medicine.
Posted By: gronamox @ 02/07/2008 9:39:42 AM

Comment: It is people like mfenwick who restore my faith in the truth of religion. Yes, Mr. Ledger killed himself so his beneficiaries would get a big payday. Astute. Wasn't it Christ who said,"I don't feel one damn bit sorry for him?"
Posted By: gronamox @ 02/07/2008 9:35:23 AM

Comment: This lecturer so-called needs to take a step into the real world. Psychotherapy, aka a grand waste of time and the pastime for the IDLE RICH and NEUROTIC, is not covered by insurance. Or if it is, the payout is ridiculously low. Heath Ledger wasn't a moron, as far as I know. He knew what drugs he was taking. He knew he was abusing them and self-medicating. Any combination of those drugs with the flu could have suppressed his respiratory system. How does this Therapist know he wasn't seeing a psychiatrist? He doesn't. This is one movie star under tremendous career pressure who was overdoing the drugs so he could get to sleep. How do you extrapolate to the entire country based on this? Yes, television is evil, praise the lord. I'm sure Heath watched a lot of TV and went into his Dr.'s office for oxycontin. They have an hilarious ad for oxycontin out now. All the addictive drugs have great ads. I don't think so.
This Doctor is as misinformed as are most experts Newsweeks interviews. And don't drop Yale's name so easily. It is my alma mater. Has this clown ever done anything but talk about his book on a college tour? Is that where he gets Yale on his resume. Perhaps he rushed into the hospital to use the men's room and starting ranting in the waiting room. Marketing books for quacks is as bad as a Crestor ad with Mandy Patinkin.
Posted By: EE7011 @ 02/07/2008 9:29:49 AM

Comment: As someone looking at Hollywood and the entertainment industry from the outside in I can't imagine how people remain level headed in that field of work. Hollywood wants to create super humans who are perfect. I tuned in to TMZ once and never watched again. I can't believe people get paid to do that type of work! I think you could easily lose your sense of self in the entertainment industry and so you find "help" to get you through it. Medication, in my opinion, should be a last resort when you have exhausted all other options. Maybe some celebrities trust drugs more than they trust people in the business?
Posted By: popslashgirl @ 02/07/2008 8:58:09 AM

Comment: mfenwick, I would dispute your conclusions. Considering that he was taking multiple medications, even taking the exact prescribed dosage of each drug could have been enough to cause an overdose, if they were all taken together. If he had taken staggered doses of his various prescriptions, so that the drugs weren't clearing his system before the next dose of medication arrived, that could have been enough to cause the kind of fatal overdose that he suffered.

To the best of my knowledge, Heath Ledger had no medical degree, and might not have known that just because the dosage prescribed is safe on it's own, it may not be safe when combined with another drug (or two, or five). For example, Valium is a drug that, even when taken at the exact prescribed dosage, can cause an overdose when mixed with alcohol. It doesn't surprise me at all that it could cause a serious overdose situation when combined with oxycodone, hydrocodone, or his sleeping aid medications.

No one's asking you to feel sorry for him. But please show some respect. A man died. As John Donne said, "each man's death diminishes me."
Posted By: mfenwick @ 02/07/2008 8:27:02 AM

Comment: You cannot overdose "accidentally" on the medication he was taking. He either committed suicide or took more than he was supposed to due to drug addiction. His death was ruled accidental so that his life insurance would pay the benificiaries. Insurance companies won't pay because of suicide or drug addiction. I don't feel a damn bit sorry for him or any of those Hollywood fools.
Posted By: mfenwick @ 02/07/2008 8:26:13 AM

Comment: You cannot overdose "accidentally" on the medication he was taking. He either committed suicide or took more than he was supposed to due to drug addiction. His death was ruled accidental so that his life insurance would pay the benificiaries. Insurance companies won't pay because of suicide or drug addiction. I don't feel a damn bit sorry for him or any of those Hollywood fools.
Posted By: dmc24 @ 02/07/2008 8:02:55 AM

Comment: CourtCPW - I agree with you to a certain extent, but most people don't even think to disclose the medication they are taking unless asked. If you're seeing a number of different medical professionals in a number of different cities or countries, the possibility of things falling through the cracks is increased exponentially.

I think Dr. Barber hit the nail on the head when he said that the advertisement of perscription medication on prime-time television was the beginning of these types of issues. The average person doesn't have the medical expertise to know whether Pill A will cure their problem, but they see these people in the commercial being cured and they're told to "talk to their doctor" and they do. We are definitely a society who prefers the quick-fix to actually working hard at something! It's a sad commentary on what America has become.
- Posted By: Survivor-mi50 @ 02/07/2008 19:09:45
  
  Comment: Let's face it, the Pharmas haven't a modicum of ethics, much less morality. Money's the bottom line, and as long as they are for-profits, this will continue.
  
  The US won't put money into neuro/brain research, and there are physicians that prescribe willey-nilly, ask any addict! It's all foreign to me, but human behavior isn't. Once someone is taking more than 3 very necessary RXs, there's going to be problems affecting the central system. Its a sad case, but so are thousands of others...notice we don't hear about the rest, indicating our nation's values.
Posted By: mike1964 @ 02/07/2008 6:46:08 AM

Comment: Ignorance is bliss.
Posted By: CourtCPW @ 02/07/2008 3:13:32 AM

Comment: No competent health professional would have allowed one patient to take all of those prescription at once. Alprazolam, diazepam, and temazepam are all in the same class of drugs. As for the pain medications, Oxycodone and hydrocodone should not be used together not only because of interactions, but both shouldn't be needed (oxycodone is a stronger pain medication). I feel that Mr. Ledger was very irresponsible because he should have disclosed all medications to each of the prescribing physicians and pharmacists. This was very preventable if indeed it was an accident. Hopefully other irresponsible patients who neglect to disclose all pertinent information will learn from this tragic accident
Posted By: Gabby @ 02/07/2008 2:54:56 AM

Comment: I just thought that it was sad the way he died. I never watched any of his movies, but I know that Heath Ledger was an acclaimed actor already and on his way to the top. Again, so unfortunate on what happened. It was a tragic loss and clearly a lesson to everybody.
Posted By: Gabby @ 02/07/2008 2:34:58 AM

Comment: I jus think it was pretty sad the way he died. I never watched any of his movies, but I know that Heath Ledger was an acclaimed actor already and he was on his way to the top. Again, very unfortunate on the way he died. It was truly a great loss and clearly a lesson for everybody.
Posted By: Aliza R. @ 02/06/2008 11:38:22 PM

Comment: I'm surprised the article didn't say anything about the role a good pharmacist plays. If you fill all your prescriptions in one place, you have someone trained in drug interactions and dosage double-checking everything. Sometimes even a good doctor makes a mistake and prescribes something that interacts badly with something he/she prescribed before. Or, one drug is a stimulant, and so shouldn't be taken at night. And, in the case of someone who seems to take the view that if one anti-depressent can help, two are better, a pharmacist can intervene and say drugs don't work that way. Or if a person seems to be going through the pills to fast (ie takes multiple sleeping pills if one "doesn't work"). They're not a panacea, but they help.
(and no, I'm not a pharmacist, nor related or friends of any).
Posted By: relic720 @ 02/06/2008 9:20:08 PM

Comment: He had problems sleeping because he was addicted to cocaine, which is a stimulant. It shocks me that they are more concerned with covering up his drug abuse so as not to impair his legacy than they are with being forthcoming and honest to the perils of drugs as a whole. The reason that the woman who was there to give him a massage called the Olson twin more times than she called the ambulance is simple: She was aware of his drug problem, she witnessed drugs at the scene, and called Olson. Olson then had her "personal security" clean up the scene, as Ledger had already been dead for some time. You may ask yourself "what is the connection between Heath Ledger and Mary Olson? Have you seen Mary Olson lately? People should stop covering up for these so-called stars, and be honest and real about the plague of drugs in the entertainment industry. It's hard to be politically correct when the entire system is so flawed as its jaws clamp closed, snuffing out the life of it's talent. After chewing it up an spitting it out, it looks for new blood to roll the dice and gamble with meeting the same fate as Heath Ledger, River Phoenix, and John Belushi. It's time to wake up. Address the system that at times creates, harbors, and sheilds the epidemic of substance abuse. It is fair time that we look at the entire culture of our entertainment industry, and look for solutions. If we do not, "Gone Too Soon" will become a permanent fixture in our news headlines.
- Posted By: noluckystar @ 02/09/2008 08:56:26
  
  Comment: I totally agree,from what we're seeing and hearing Heath was a drug addict,no different than the thousands of others in all walks of like. He had to keep taking more and more to get the effects he was used to and addicts don't care about the danger they need the drugs.Why are they hiding this,people close to him know this.
Posted By: barfooz @ 02/06/2008 7:00:13 PM

Comment: Drugs aren't the answer to every problem. Go seek a therapist. Start eating and sleeping right, and exercise. Drugs should not be the first resort for mental health issues.
- Posted By: gaylep @ 02/06/2008 20:40:17
  
  Comment: I really hope that there's not going to be any finger-pointing in this case at the doctors who prescribed the medications. In the end, Heath Ledger was stupid for not having had the cognizance to not mix all of those drugs simultaneously and to not get psychiatric treatment for his sleep and anxiety problems. If anyone should be held accountable it should be Mr. Ledger. C'mon people: Take responsibility for your actions and act responsibly!!!
  - Posted By: sooner19 @ 02/06/2008 23:54:05
    
    Comment: I have to agree!! Common sense had to play some role here as well!
    - Posted By: redrick_1231 @ 02/07/2008 00:15:26
      
      Comment: Obviously you all are ignorant. Addiction isn???t pretty in any case, and you call him stupid? Have you ever had anxiety attacks or depression? It???s a bit more complicated than eating and sleeping right. Leave him alone, he was brilliant!
    - Posted By: redrick_1231 @ 02/07/2008 00:14:56
      
      Comment: Obviously you all are ignorant. Addiction isn???t pretty in any case, and you call him stupid? Have you ever had anxiety attacks or depression? It???s a bit more complicated than eating and sleeping right. Leave him alone, he was brilliant!

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A Tragic Lesson

Discuss

Posted By: docktorb@aol.com @ 04/21/2008 12:23:59 PM

Posted By: docktorb@aol.com @ 04/21/2008 12:22:55 PM

Posted By: the.cheshire @ 02/22/2008 3:42:09 AM

Posted By: cookiecndy @ 02/15/2008 2:30:56 PM

Posted By: news_editor @ 02/12/2008 11:57:28 AM

Posted By: Calabria @ 02/10/2008 1:18:58 AM

Posted By: fireagate @ 02/09/2008 11:19:55 PM

Posted By: casper75 @ 02/09/2008 5:05:36 PM

Posted By: Kedwyn @ 02/09/2008 5:35:16 AM

Posted By: Kedwyn @ 02/09/2008 5:34:01 AM

Posted By: GreatDane @ 02/08/2008 9:05:52 AM

Posted By: famulla @ 02/08/2008 1:09:51 AM

Posted By: Survivor-mi50 @ 02/07/2008 7:02:55 PM

Posted By: gronamox @ 02/07/2008 9:39:42 AM

Posted By: gronamox @ 02/07/2008 9:35:23 AM

Posted By: EE7011 @ 02/07/2008 9:29:49 AM

Posted By: popslashgirl @ 02/07/2008 8:58:09 AM

Posted By: mfenwick @ 02/07/2008 8:27:02 AM

Posted By: mfenwick @ 02/07/2008 8:26:13 AM

Posted By: dmc24 @ 02/07/2008 8:02:55 AM

Posted By: Survivor-mi50 @ 02/07/2008 19:09:45

Posted By: mike1964 @ 02/07/2008 6:46:08 AM

Posted By: CourtCPW @ 02/07/2008 3:13:32 AM

Posted By: Gabby @ 02/07/2008 2:54:56 AM

Posted By: Gabby @ 02/07/2008 2:34:58 AM

Posted By: Aliza R. @ 02/06/2008 11:38:22 PM

Posted By: relic720 @ 02/06/2008 9:20:08 PM

Posted By: noluckystar @ 02/09/2008 08:56:26

Posted By: barfooz @ 02/06/2008 7:00:13 PM

Posted By: gaylep @ 02/06/2008 20:40:17

Posted By: sooner19 @ 02/06/2008 23:54:05

Posted By: redrick_1231 @ 02/07/2008 00:15:26

Posted By: redrick_1231 @ 02/07/2008 00:14:56

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