The boy with the ponytail who kicked the hornets’ nest

In The boy with the ponytail who played with fire, we saw Jan Akerblom struggle up the side of a mountain in his attempt to drop the Ring of Power into Mount Doom. Where others, especially doctors, are seduced by the Precious he isn’t.

Why do it – because he saw lives destroyed and wonders if we are at risk of destroying society itself. Are any contracts anyone enters into while on an SSRI valid. Far-fetched?

Who Cares in Sweden

 

 My Wife has Left Me

Imagine you are approached by someone who says his wife has been on an SSRI for several years and during this time she has changed personality. Where once she was very sensitive and caring she has become more callous and unfeeling. Where once she would be in floods of tears at a weepy movie, at the funeral of a beloved twin-brother who died in tragic circumstances she didn’t cry at all.

He contacts you because now she has left him. He concedes that maybe the marriage was heading for the rocks anyway but he is still concerned that this is not her. That if she ever stops the medication and starts feeling more like herself again she will regret what she has done – if not to him at least to her children.

What do you do?

There is abundant evidence SSRIs can cause exactly this kind of emotional blunting or disinhibition. The comments by Neil Gorman and Allostrata on The boy with the ponytail give detailed accounts and references. One of the first articles on the topic had a Baltimore society hostess while on fluvoxamine serving her guests wine while naked from the waist up.

Its worth thinking for a moment before reading on – if you were the doctor, what do you do?

It’s almost impossible to know. Little details can change the picture dramatically. Perhaps he is much older than her and now that she has grown up she has found herself and resents his control and the SSRI disinhibits her just enough to make it possible to do what she might in many respects be better off doing – leaving him. Would it really be better to live a safer life or a life of quiet desperation?

If you’re her doctor and he approaches you, what do you do? If you suggest reducing the dose and she insists that no this is the real her and perhaps brings friends along who vouch for the fact she is now doing what they’ve implored her to do for years, what do you do? Perhaps she tells you she will get the drug through the internet if you don’t prescribe.

Who are you to decide these important issues for someone else? You’ve had no training in matters like this. Better surely to play Pontius Pilate, continue prescribing, and let events take whatever course they will.

Who Cares – about Side Effects?

Except as Who Cares in Sweden makes clear you cannot wash your hands of this responsibility.

This is not Side-Effects, the movie. You’re not in the position of Jonathon Banks (Jude Law) treating Emily Hawkins (Rooney Mara), whom you’re having an affair with and whom you’ve put on a new prescription drug, who has then perhaps gone on to kill her husband – we have to wait till February to see what actually does happen.

Unbelievable though it doubtless sounds, its worse. You are as much a police or probation officer as the doctor with whom every patient you prescribe for might want to have an affair with. This is whether it be an infant or a 96 year old. Prescription-only was a system introduced to control opiate and cocaine addicts. Anyone who gets their drugs through you is trapped in a set of Stockholm syndrome dynamics neither you nor they asked for.

But whether you asked for it or not you make your living out of it and the buck stops with you. Every inappropriate divorce, birth defect, school shooting, suicide, or case where a woman schoolteacher molests a juvenile male pupil that comes from your practice is your responsibility.  Every heart attack on Chantix, cognitive dysfunction or muscle weakening on statins or premature death on the next Avandia or Vioxx is down to you. Every love affair that might happen on a clinical trial you are running is down to you. But you can’t find out what dramatists think the implications are because The Effect is booked out.

If it were your son?

If you have a son who is a fireman and his life depends on others in the fire crew “caring” normally, what do you do if a fireman’s wife comes in to you and says that her husband has been showing no emotions lately? Or her husband is a pilot with the airline that your family are due to fly with in a week’s time?

A Cutthroat 

If you appeal to the fact that you can’t be blamed for companies withholding data, you end up in a cutthroat. Either you say that whatever the data now reveals you would have used the drug anyway in which case the company walks away with no legal liability.

Or else you say you wouldn’t have used the drug but how can you be blamed if companies withhold data. Sounds good, except we’re not talking breaking news here. The information about SSRI induced disinhibition, violence and suicide has been in the public domain for nearly 25 years.  The information about significant hazards on prescription drugs in general is out there for up to 20 years on average before you and your colleagues pay heed to it.

These drugs are available on prescription only because it was once thought you were the kind of person that might be able to quarry information out of companies or would steer people away from drugs if you were worried that we weren’t being told the full truth – it’s called professionalism.

They’ve started prosecuting doctors

Just recently a French psychiatrist Daniele Canarelli, 58, was found guilty after a patient of hers hacked a man to death.  The court decided she should have recognized the risks he posed. This was the first case of its kind and it led to extensive media coverage worldwide because of the implications for doctors in general.  It followed hard on the heels of a conviction of Italian seismologists for failures to warn sufficiently of earthquake risks.

Somewhere around 90% of the school or other mass shootings that have happened in recent years in America or Europe have involved shooters on psychotropic drugs usually antidepressants. The public sympathy for the victims typically also extends to the doctor who is seen as one more victim.  But the so called perpetrator is much more likely to be a victim than the doctor.  He may have been turned into a guided missile by his doctor.  These are people in treatment whose doctors clearly failed to recognize the risks they posed.

Does anyone care in Sweden?


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You and your meds. Give the real story. Get the real story.

Pharmageddon

Pharmaceutical companies have hijacked healthcare in America, and the results are life-threatening.

 

Dr. David Healy documents a riveting and terrifying story that affects us all.

 

University of California Press (2012)

 

Available on Amazon.com

 

Comments

  1. Brilliant documentary. RE – rate of Care Less Syndrome in SSRI’S.

    Who Cares In Sweden is the most thorough and solid filmed documentation of a significant public health problem yet produced. At 48 minutes in film 1, Robert Hare, the world’s foremost psychopath researcher noted “So what we need is solid and empirical evidence to show us to what extent antidepressant and other medications actually impact upon our ability to function as caring, loving, social individuals.” He bemoaned that Pharma was unlikely to fund studies… and sadly most psychiatric research is entirely commercially driven entirely BUT thanks to one recent NON-SSRI “antidepressant” (actually failed in clinical trials) i.e. agomelatine, its maker Servier has studied (financed the study of…) “Emotional Side-effects of Antidepressants” which provides this quantification of emotional side-effects.
    Jonathan Price, Victoria Cole, Helen Doll, Guy M. Goodwin. The Oxford Questionnaire on the Emotional Side-effects of Antidepressants (OQuESA): Development, validity, reliability and sensitivity to change. Journal of Affective Disorders 140 (2012) 66–74
    These items stand out in relation to this issue:
    Because I don’t care so much, I’m having problems at home
    I don’t have the same passion and enthusiasm for life
    Other people being upset doesn’t affect me
    Because I don’t care so much, I’m having problems at work or college
    Day to day life doesn’t have the same emotional impact
    I don’t react to other people’s emotions as much
    I don’t care as much about my day to day responsibilities
    I just don’t care about things as much as I did

    There’s many more – check the Oxford questionnaire.

    And what percentage of patients experienced these?
    207 participants
    26% no emotional side-effects
    16% insignificant emotional s/e
    30% mild
    23% moderate
    6% severe emotional s/e’s
     i.e. 60% at least mild, 30% moderate or more.

    They are common “side-effects” perhaps largely accounting for clinical effects, and the long term effects on individuals and society, as documented in Who Cares is indeed frightening.

    Thanks to Altrostrate for previous great reference list, and useful withdrawal links.

    Rob Purssey, psychiatrist and ACT therapist, Brisbane Australia

  2. Funny that. I was just thinking today that I was turned into a ‘loaded gun’ a ‘freaked out, out of control banshee’ a ‘wild woman of the west’, annie, get yur gun………..I might have got my gun, if I lived in the US……
    But ‘guided missile’ is exactly the right expression.
    Guided, from the minute you enter the psychiatric world of lethal pills, back a step to the gp, and then dynamite……………………………..whoosh, explosion, bang bang..
    If, I had had a loaded gun in my house, I know I would not have killed anyone but myself..
    I know that because, I was ‘drug disturbed’, and the only person I loathed was myself, because of Seroxat, and it’s ‘suicidal properties.’
    But, others are not so lucky…
    Their, reaction was to fight everyone and try and kill them all.
    That is a very bad reaction………but it happens, chillingly often, in the US, where guns are commonplace in the pantry..
    I did think ‘fleetingly’, during the terrible morning of ‘nearly being taken out by Seroxat’, that I could take my daughter, with me, but it passed in a millisecond and my sleeping boyfriend and daughter, had no idea what happened to me, in the garage, because I never told them.
    I only stayed sane, because I thought, let sleeping dogs lie, keep calm, carry on; just do the business of potential litigation against both GSK and GP and Psychiatrist.
    Keep calm, carry on…ten years on..

  3. I’m confused, by the question!
    What do you do?!!!! You be *her* doctor, that’s what you do – not anyone else’s doctor!
    It seems the question here illustrates the responsibility-shifting that goes on in Mental Health, and in medicine. Would you be asking similar questions in relation to physical health? For example, “if I help her to walk again, she’ll be able to leave him, so what should I do?”
    If you believe she needs these meds in the first place (and afaik they are pretty bad for outcomes), then why would societal matters come into play at all?
    If you believe she is better off without the meds, then you should be telling her that. The life consequences that stem from either choice are surely not your concern.
    Furthermore, if doctors are being prosecuted, it’s because they claim to be able to assess the level of risk – they can’t – they can only guess at it.

  4. The Obama initiative to control gun violence is well intentioned and probably as far as he can go given the political and public opposition these changes will face. Most of them are perfectly reasonable but there is one that should give us pause
    “…..the president recommended ….. providing mental health services in schools.” Will this be more treatment by prescription pad? He intends also to “….Issue a Presidential Memorandum directing the Centers for Disease Control to research the causes and prevention of gun violence.” Hmmmm…. and “Release a letter to state health officials clarifying the scope of mental health services that Medicaid plans must cover……
    Launch a national dialogue led by Secretaries Sebelius and Duncan on mental health.” As Secretaries of Health and Education respectively, who is going to supply them with the appropriate information?

  5. Responsibility is never taken by GPs for the side effects of SSRIs. They have been prescribed as wonder drugs. The only information given is that it would be at least two weeks before any effect is noticed. There may even be a worsening of depression to begin with. In the meantime the adverse effects kick in and the 17 year old begins to think she is going mad but is too afraid to say anything. She believes it’s the depression getting worse. This is a new scarey experience. She believes it’s herself not the drug prescribed by the lovely caring GP who assured her of its safety. Besides, she was told if she didn’t have depression there would be no effect. There was no list of side effects to check or any reference to medication related worsening. She was asked to come back in two weeks- not two, three, seven days or any time if she felt there was a problem. At the two week visit she was deemed to have depression and the prescription continued. Three years later she took her own life following a second badly monitored withdrawal. Legal advice was that negligence could not be proved as all GPs in the area would prescribe similarly. So could that mean all are equally not responsible?

  6. The Journal of the American Medical Association in August 2003, published an article entitled Taking Aim at Gun Violence. A few days ago, the newspapers were filled with headlines reading (Obama) Taking Aim at Gun Violence. Perhaps there ought to be a resurrection of the FDA’s Office of Counter-Terrorism and Pediatric Drug Development (seriously, that’s what it was called) that in 2003 tried to force drug companies to undertake clinical trials of medications in pediatric populations and submit data on safety and efficacy. Of course, it was struck down by Congress but perhaps its time has come round again.

  7. I’m glad this subject came up. If we don’t want doctors medicating us simply to squelch behavior they don’t approve of (and lord knows that’s been done time and again), do we really want them pulling us off medication based on their own prejudices about how our lives “should” be lived? Unless my plans include murder, or some other illegal action, those decisions ought to be mine.

    But without information, I have no freedom to decide. The hardest thing for anyone to see is that their feelings and actions are being controlled by an outside agent. (Just try talking sense to a drunk who has discovered at 1:00 am that he’s a genius.) It’s a rare person who will identify these changes on their own, and know that they are due to the drug. But at least if I’ve been warned of the possibility that my thoughts or my personality may change, I have a chance of recognizing negative changes when they appear. When something like suicidal thoughts or violent impulses are involved, this knowledge can literally save my life. When it involves more subtle changes, like blunted emotions, it can give me the chance to at least listen to family and friends who tell me I seem “like a different person.” A doctor who gives me these drugs without warnings and followup deprives me of my freedom as surely as his colleague fifty years ago who might have tried to sedate me into acceptance of the joys of housewifery.

    What scares me about “Who Cares in Sweden” is that it describes a state of mind that could be seen as very useful for putting up with an insane society based on inequality, greed and violence: “I try not to think about it. As long as I’m doing OK, it’s no skin off my nose.” Not only “useful” to the person who thinks that way, in terms of warding off distress, but useful to those in power who want to keep her quiet and “productive.” SSRI’s are not the only drug that has this potential; users of Adderall and other stimulants often describe finding themselves fascinated with the most tedious details of their work, while losing interest in and tolerance for people. That doesn’t mean the drugs are a conscious conspiracy by our bosses. It does mean that profits for pharma and advantages for “society” come together in a situation where those in power have absolutely no incentive to question what is happening to us under their influence.

  8. Neil Gorman says:

    Gordon Lucas, I disagree strongly with almost everything you said in your post.

    You said: “I’m confused, by the question! What do you do?!!!! You be *her* doctor, that’s what you do – not anyone else’s doctor!”

    But surely part of being her doctor would be listening to information that might be very relevant to her health? Consider the text of the Black Box Warning on Antidepressants, were it states…

    Patients of all ages who are started on antidepressant therapy should be monitored appropriately and observed closely for clinical worsening, suicidality, or unusual changes in behaviour. Families and caregivers should be advised of the need for Close observation and communication with the prescriber.

    You can view it here, as seen on Effexor XR prescribing information. http://labeling.pfizer.com/showlabeling.aspx?id=100

    What use is this if prescribers don’t take any notice of what family members or caregivers are saying? Don’t you agree that the husband could be attempting to alert the doctor of an unusual change in behaviour, in line with the warning?

    You then said, “Would you be asking similar questions in relation to physical health? For example, “if I help her to walk again, she’ll be able to leave him, so what should I do?”

    I don’t quite understand what you mean here. Why would learning to walk make someone want to leave their husband? I ask because the only way your analogy can make sense is if learning to walk can somehow alter your brain chemistry, and do so in such a way that it may affect your feelings of love and attachment to persons close to you. Unless of course you are assuming that the relationship problems were apparent before the medication was started, in which case that isn’t what is being discussed here.

    In the case of my wife, she went to her doctor and told him she had lost her long term job while 7 months pregnant with her second PLANNED child, her mother in law with whom she was very close, died of cancer a few weeks later, her baby was born premature by emergency c-section a week after that, her baby spent a week in SCBU, he wouldn’t breast feed due to being under developed which made her feel like a failure, her husband who was grieving for the loss of his mother while working 2 jobs to cover the bills wasn’t home often enough and her own mother lived too far away to give practical support. Long story short she ends up on Effexor for PND (it’s a chemical thing they said), and a while later it turns out that her husband had been the problem all along, and the Effexor only made her realise this and it gave her the strength to do something about it…..

    At this point I think it is reasonable to say that the prescriber should at least inform the women that the medication she is taking has been shown to have an effect on emotions, love and attachment etc. And perhaps, given that she has young children, it isn’t recommended she make any life changing decisions of that sort, while on, or withdrawing from this medication. I think it is also reasonable to say that the prescriber should take seriously the word of the person who spends more time with the patient than any other, knows her more intimately than any other and is following the information that is supplied by the manufacturer of the drug.

    So my question is, what would you have done?

  9. Oh dear.
    I totally understand your frustration, Neil.
    I was off Seroxat, I was overwhelmed with withdrawal, she did not give me the recommended Fluoxetine.
    The gp intimated that my relationship was probably the cause, she said, I would not have put you on an ssri, I would have told you to leave your boyfriend.
    mmmh
    Confusing information, this.
    I was a devoted mother and I was getting on with my, and our lives.
    I could not get on with my life when, I was, as I said before, ‘away with the fairies’ off Seroxat.
    So, suddenly this gp was an expert on relationships, as well as drugs……..
    She said to me, I really shouldn’t do this, but here is the address of a lawyer and why don’t you contact the lawyer and see if you can get ……..oh, all sorts of financial inducements to leave, the family home.
    I did not want all this interference. I wanted to get over acute akathsia and manic pyschosis, from six weeks off Seroxat.
    Every time I saw her I was led further away from Seroxat withdrawal, and into a world of destruction of my family life and home.
    In the end, she won……this was my entire life, she was playing with.
    Why did I listen to her?
    I trusted her to look after me with the medication.
    She failed spectactularly with that, and, oh dear, we lost it all.

  10. Hi Mr Healy,

    I just realized that all the articles about suicide claim that those who commit suicide are mentally ill following the APA definition.
    I also searched in French and Portuguese and the articles are the same.
    It happens often when Big Pharma is working.

    I’m appalled. If you could say something about it it would help.
    Thank you.

  11. The past few days have brought home to me the ability of SSRIs and polypharmacy to strip away emotions, even in the saddest of circumstances.
    My former partner’s mother is dying. The diagnosis came suddenly: a collapsed lung thought to be the result of a bout of pneumonia evolved into bilateral lung cancer with secondary tumours in the sac around her heart.
    When I learned that it was not possible for Ann to live out her final weeks at home, that I could not care for her, I was overwhelmed and wept four hours. Her son, who is on a mind-numbing cocktail of Amitrip, Effexor-XR and Buspirone, could not shed a tear. It worried him, still worries him, that the mother he loves and admires so deeply is fading before his eyes, struggling for each and every breath and yet he feels nothing.
    “I feel as though I should feel something,” he told me as we sat in his mother’s back porch, looking down the garden to the harbour. “But I can’t, I don’t feel anything. I think there’s something wrong with me.”
    This is not a cold-hearted individual. This is a man who once was “overly sensitive” to everything, generous to a fault.
    When he was introduced to Anafranil in the early 90s, he became violent. On Aropax he couldn’t sleep and when he mixed it with alcohol, became even more angry and more violent. He stayed awake for days on end, throwing a tennis ball on the roof for the dog to retrieve.
    I have no doubt his emotions are missing in action. At this time in his life, is that a blessing or a curse?
    When I withdrew from SSRI/SNRI therapy, the resurgence of emotions was completely overwhelming. The mania came first; bouts of frantic, round-the-clock activity. Then came the realisation that I was an emotional toddler. I was totally unprepared for the way the slightest thing would prompt outbursts of rage, high anxiety or floods of tears. It took me two years to relearn appropriate emotional behaviour.
    My brother, who took Cipramil for a after a serious accident that almost claimed his life, weaned himself off it within three months. I asked why. He said: “Because things became more important than people. I was losing contact with my wife and daughter.”
    Very early on, he identified the SSRI “who cares?” syndrome, the wall that distances many consumers from their families and friends.

  12. It seems perfectly clear that physicians who do not fully inform the patient about just the warnings issued by the drug manufacturer far less the reams of additional information available, is not obtaining informed consent to treatment. To proceed and even insist that the drug be consumed is medical battery. Why are more families – the patient usually not being in a position to take action- bringing charges?

  13. Wow, lots of hatred towards doctors here. Most posters seem to miss the point.

    Psychiatrists have NO CHOICE. I’ve tried numerous times to take people off ridiculous and harmful polypharmacy, by working together with them, trying to remove medications that ‘don’t work’ as THEY STATE. I do this very diplomatically and carefully and cooperatively.

    What did I get for my troubles? I got complained about and called in to the principal.

    Yup, patients complain if you try to help them. Imagine that.

    Also, I’ve tried countless times to suggest other methods before leaping to antidepressants. But everyone in the US insists that getting an antidepressant is their God given right. Eventually, you have no choice but to give in.

    You get flack from all directions if you try to go against the bio-reductionist grain. You get complained about and your so called career turns into something resembling a train wreck. For trying to do the right thing.

    Eventually you realize that you have to earn a living somehow so you learn to nod and smile and give patients what they want.

    You think physicians have power? We have none! What world are you living in? This is the real world! You can’t practice medicine like you think it should be practiced. You have bosses. Usually MBAs who want patients to be satisfied. Sometimes doctor who’ve joined in the ranks of the abusers. If you give the appearance of rocking the boat in any way, if you don’t write that prescription automatically and without hesitation, you’re putting yourself in harms way. They WILL take steps against you. And that means could mean losing your license and no work anywhere.

    You have patients who WANT A PILL. Period. And since these are Americans and entitled they will complain about you at every possible opportunity.

    It’s very nice to sit here and attack those who are already under attack, and that’s us doctors.

    Don’t be holier than thou!

    • David_Healy says:

      I think this post by whoever it is needs to be taken seriously. I don’t know whether its companies through patients who are putting the pressure on doctors or companies through guidelines and standards of care or just patients, but doctors in the US for the most part feel like they are living through a McCarthyism.

      Of course in the case of McCarthyism, it does take someone to break the cycle of fear.

      • Psychiatrists in the US need to organize, or to pressure their existing professional organizations such as the APA to speak up for the interests of clinicians. They don’t have a voice because they’re too meek to oppose the status quo of their own leadership.

        These questions of authority over clinical decision-making should be brought up at national meetings.

  14. Irene
    I tried to do this in the UK.
    I am well aware that the psychiatrist who introduced me to Seroxat, did not give me any warnings at all. But, he warned the surgery with a letter, of explicit advice.
    MY gp, missed this letter,or ignored it, tucked up, in my medical records for two years, and instead embarked on some sort of character assassination, because 1) the vital letter was not flagged up and 2) anti-depressant withdrawal is almost impossible to prove
    Informed consent is right, but, when persuasion creeps in, which it does daily with anti-biotics, flu-jabs, statins, benzos, the doctor is always right………
    We are not medical people.
    We trust our doctors…….
    The National Health Guidelines are now spelt out to doctors, but these guidelines are very different to the wording in the pil leaflets and this is where, it goes bottom up. If our government has enforced advice with their guidelines, how come the likes of GSK, can sit on their accompanying leaflet, at total odds, is clearly a matter of crucial illegality.
    I was told by a lawyer that there was no evidence that ssris can cause suicide, so despite every effort on my part, I was stuck in the muck………..
    These extremely serious matters of ‘consent to treatment’ and ‘medical battery’ which you describe has to come out in stages.
    First, you have to prove that ssris can cause unwarranted distress on cessation.
    Second, you may then get a chance to address the ‘circumnavigation’ of the practitioners who have been duped.
    It is an unwholly mess, but we have to start at the beginning, have a lot of patience, and then maybe seek redress, from the ones who were cuckolded and then cuckolded us…….

  15. Neil Gorman says:

    Annie says: “She failed spectacularly with that, and, oh dear, we lost it all.”

    That pretty much sums up exactly how I feel about all three medical professionals involved in my wife’s care. The Psychiatrist, the General Practitioner and the Community Psychiatric Nurse all failed spectacularly at every stage of my wife’s care.

    My wife ticked the neat boxes of having recently given birth, feeling depressed and having a grandmother who suffered from a depressive episode in later life.

    For the three professionals mentioned above, it seems this was more than enough evidence for them to ignore all the horrible life changing events and pressure she had experienced recently, and instead inform her that she had a defective brain. A chemical imbalance brought on by child birth and most likely a hereditary genetic defect, but one that could be helped with medication. With a start like that, there was never going to be a good outcome.

    Later, as a way to explain the apparent failure of the drugs to fix her defect, she was called treatment resistant (blame patient).

    After their ‘most powerful weapon’ (effexor), failed to return her to her normal self, they jumped over to a psychological cause (blame husband).

    Later, when my wife started to recover (6 months post withdrawal), and she started to confirm everything I had been saying was true, the CPN made a few references to her possibly having bipolar disorder (blame patient).

    Later still, when the CPN signed my wife out of her care (no doubt recorded in some way as a success), she suggested that we had needed the time we spent apart to evaluate and appreciate our true feelings for each other, and that she was glad we had worked out our problems. (blame patient and husband and pretty much ignore everything they have told you).

    I try to put myself in their shoes, but when I go back over the decisions they made, all I can see is illogical thinking, a host of disastrous errors, near complete ignorance of the available data and a blame-everything-but-the-drug attitude.

  16. Yes, Neil, absolutely spot on.
    But, let’s listen to *person* above and his/her comments and the obvious anger; he is upset.
    This ‘person’ is caught between the devil and the deep blue sea and I understand his dilemma.
    However, I know plenty of people who have arrived at their local surgery with the express wish of getting an anti-depressant. They have read, through many years of media hype, that these types of drugs could help them get over a crisis, big or small.
    I have even seen them slink out of the surgery, upset, because they did not get what they went in for.
    The gp said NO. Go away and come back in a few weeks and we will talk about it then……..
    Amazing what happens in a few weeks…….certainly and probably a lot of emotional activity in the life of the ‘potential customer.’
    Not resolved, of course, but, equally, the ‘heat is off”, they have calmed down and forget all about the visit to the surgery.
    ‘Psychiatrists have no choice’………..oh yes they do….but psychiatrists today only come with a prescription pad, and that is wrong……
    You are a doctor, and poignantly, in the US…
    Poor you…………a no win situation………..
    We are doing a little doctor bashing, currently, because WE DID NOT ASK FOR THE PILLS, they were a given, often not by them, either, and we were the ones picking up the pieces of our shattered lives when it all went deathly quiet*……..and badly wrong.
    Seems a bit *noisy* on the $$ other side of the pond $$

    Watch the movie “True Grit”. John Wayne said, ‘get off your horse and drink your milk’. Quite so.

  17. I take persons comments very seriously and I do have a certain amount of sympathy for what he says. The bulk of my anger goes toward the Pharma corporations and the toothless regulators, but I have to reserve a little for the Doctors.

    As far as I am concerned, person has just talked himself out of a job.

    If you have no choice, no power, no freedom to practice medicine properly, you are unable to deal with your patients, you are not prepared to speak up when things go wrong and in the end you admit that your job has been reduced to a nod, a smile, and giving patients what they want without hesitation… then what use are you to me? What use are you to anybody?

    We might as well start installing the vending machines to at least get a little better value for our money.

    If things are that far gone and physicians are just content to take their wages while letting this continue as it is, then they are surely a massive waste of money/taxes/insurance/resources…. a medical lemon if you like?

    I think this highlights a problem for Rxisk as well, at least in the US. Support from physicians will be hard to come by if using the service could be seen as subversion or treason. In the world that person describes it looks like acting on currently published data is bad enough to threaten your career, never mind being caught using data generated from anecdotes on Rxisk.

    • I know for a fact that psychiatrists in the US can practice ethically and provide good care for their patients by tapering or minimizing medication. They may have to practice independently and not take insurance. This may limit the pool of potential customers and make income somewhat less predictable.

      But I do know psychiatrists who are practicing outside the insurance system to follow their consciences, and doing quite well.

      It’s fear of not enough money and a sense of privilege — “I went through med school and deserve the compensation” — that keeps US psychiatrists under the thumbs of the insurance system. It’s not impossible.

      And, I say again, if you pay dues to the APA, you’re not getting your money’s worth from your own professional organization, and you need to speak up about being forced to violate your own ethics.

      So there’s a certain lack of courage here, too.

      • I can verify from Chicago that psychiatrists are coming to know and love the cash-only practice model. They aren’t suffering — but the patients are. A relative is currently paying $175 out of pocket for each 25-minutes session — and this is a “compassionate” discount from the usual $250. She struggles to come up with the money — and while she’s an ordinary working stiff she is not poor; she makes a little over double the minimum wage, with no dependent children. And, thank god, her insurance co has not yet questioned the scripts from the off-the-books doc, which she could not possibly pay cash for. For people who are truly hard up this is not an option.

        With all due respect, this is no solution at all. “Quality” medicine for those who can afford it (and have learned the hard way that it’s “worth the price”) — toxic medicine for those who can’t, or aren’t hip yet? Something below toxic medicine for the kids in foster care and the disabled on Medicaid? And, of course, there’s no guarantee that your hard-earned money will not just buy more expensive toxic care.

        A doctor who decides not to treat the majority of the population is no doctor at all. This will be a tough fight but we must take it on. It took a long time for patients to be indoctrinated into the “brain disease” theory of their distress, longer still to create the scaffolding that now has employers, judges, primary care docs, insurance munchkins, social-security bureaucrats and your Aunt Martha all pressuring the patient to take the pills. (To clarify — when it comes to employers and insurance cos., they often refuse to accept that you are in any sense “ill” or deserving of time off, benefits if you are not on medication.)

        There are plenty of patients who want to challenge it — and plenty of doctors. Person, you are not the only one who’s miserable. Best of luck to all of us in remaining Persons, because it sounds more and more like that’s what’s at stake.

        • US prescription drug insurance will cover prescriptions written by any MD etc.

          Going cash-only to get out from under insurance company requirements is certainly not ideal for patients. It does resolve the question of whether psychiatrists are helpless to avoid unethical practice.

          However, if insurance companies have difficulty filling their psychiatry panels, and understand why, this may cause them to change their guidelines.

  18. Lack of courage??? What sheer nonsense. I could tell you all about my 15 years of struggle against the system and how it left me all alone and broke…but I’ll think about that cartoon from XKCD and back off before I get a heart attack, which I’m near enough anyway.

    http://xkcd.com/386/

  19. Neil Gorman says:

    Person, if you struggled against the system for 15 years and it cost you so much personally, then I applaud you for trying so hard.

    To me it seems that you are not the type of doctor that the contributors here are frustrated with. Just as I and others on here not the type of patients who demand the latest blockbuster drug as our God given right…. and neither was my wife.

    Perhaps if you had been my wife’s psychiatrist during the 15 years you were struggling against the system, things might have turned out better for her.

  20. person, if you are knowledgeable about tapering people off psychiatric drugs, I am referring people to such doctors, see this list http://tinyurl.com/7cp8l8v If you wish to be included, write me at survivingads at comcast dotnet

  21. When I was in training, back when the earth still cooling and we in Scotland were painting ourselves blue, we had no fancy machines or medications. We had to use our senses and our common sense to diagnose and treat. The most important thing I was taught was that sometimes the best medicine is no medicine. As a woman in medicine I have to say that the row is even harder to hoe. Refusal to use the “flavour of the month” or to try something unorthodox is met with jeers, finger pointing and absolutely no career advancement – even when your approach works and your patients do well. Come to think of it, things are even worse when your patients do well. Hmmm…..Sir William Osler, back before even my time, said many wise things, among them:
    “The first duties of the physician is to educate the masses not to take medicine.”

  22. To shift the topic a bit and at the risk of begging the question, it appears that SSRIs and other psychotropic drugs may cause or exacerbate anxiety. If we consider that there seems to be, albeit grudging, admission that antidepressants increase the risk of suicide, we must, at the same time admit that one of the common conditions leading to suicide is anxiety. To give only one of many examples, Weitoft in the Journal of Epidemiology and Community Health noted that individuals who reported severe problems of nervousness, anxiety, and uneasiness had about double to triple the risk of death during the study period. Men who had reported severe problems with anxiety, nervousness, or unease were nine times more likely to attempt suicide over the next five years than men who didn’t report such problems. What evidence is there then, that antidepressants, particularly SSRIs do not cause the anxiety that leads to suicide? It has been admitted that “anxiety may worsen during the early stage of treatment” but there is no evidence of longer term effects. This is a question that urgently requires investigation.

  23. I have suffered from anxiety for many years and never ever did I feel suicidal.I was prescribed seroxat ( Paxil) in 1997 and my doc told me I had a chemical imbalance that was causing my problem and needed these drugs like a diabetic needed insulin. I took this drug for 8 years and in that time I went from an individual who maybe cared too much to someone who didn’t give a damm. that was not the person I was but was how I became on these drugs. however when I stopped taking it i then became suicidal as the anxiety and horrible withdrawl effects I experienced on stopping made me feel suicidal.I have endured 8 years of these horrible symptoms of withdrawl and I am grateful that I am still here to tell the tale.

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