The Antidepressant Era was written in 1995, and first published in 1997. A paperback came out in 1999. It was close to universally welcomed – see reviews 1, 2, 3, 4, 5, 6, 7, 8, 9, 10. It was favorably received by reviewers from the pharmaceutical industry, perhaps because it made clear that this branch of medical history had not been shaped by great men or great institutions but that other players, company people, had been at least as important.
Nobody objected to it, perhaps because at this point I had not agreed to be an expert witness in a pharmaceutical induced injury case. There were likely no PR companies who had a brief to manage Healy. I knew before The Creation of Psychopharmacology came out in 2002 that the response to it would be very different.
Disease mongering & the myth of lowered serotonin
Many of the ideas in The Antidepressant Era had appeared earlier. The idea that a lowering of serotonin (chapter 5) was a marketing myth and had nothing to do with science, first appeared in my doctoral thesis in 1985, and later in Psychopharmacological Revolutions in 1987. The idea that companies market diseases as a way of marketing medicines (chapter 6) first appeared in 1990 in Notes toward a History and The Marketing of 5HT.
The Antidepressant Era in turn contained many of the elements of Pharmageddon – the key role of the 1962 amendments to the Food and Drugs Act which, through product patents, prescription-only status for new drugs and the role of clinical trials, have created modern healthcare.
Is Valium a better drug than Prozac?
In 2000 I was approached by Duncan Dallas, an independent television producer from Leeds who wanted to do something critical on the antidepressants. Prozac was still at this point widely seen as a miracle of modern medicine, rather than an inferior drug to older antidepressants. Bioethicists and social scientists were still lining up to herald the creation of the New Man through modern genetics and modern psychotropic drugs.
Saying that what we were witnessing was a triumph of modern marketing rather than modern science caused a frisson in most circles. There were no natural allies – not in psychopharmacology or biological psychiatry but not in social science circles either.
But this is what Duncan wanted. The Antidepressant Era, the movie, opens with some of the hype around SSRIs, has astonishing footage of Roland Kuhn and Alan Broadhurst, two of the key people behind the discovery of imipramine, and outlines the overthrow of the benzodiazepines and their replacement by antidepressants.
It shows how rating scales and screening are used in psychiatry to create problems for which a drug becomes the answer. It was the first program to wheel on stage the marketing men who created the social anxiety campaigns that sold Paxil, and it outlined the role of DSM III in the creation of depression.
Duncan’s version has a wonderful artistry. The book opens with a quote from George Oppen’s The Skyscraper. The “movie” closes with the same quote.
The building of the skyscraper
The steelworker on the girder
Learned not to look down, and does his work
And there are words we have learned
Not to look at,
Not to look for substance
Below them. But we are on the verge
Of Vertigo.There are words that mean nothing
But there is something to mean.
Not a declaration which is truth
But a thing
Which is…Oh, the tree, growing from the sidewalk –
It has a little life, sprouting
Little green buds
Into the culture of the streets.
We look back
Three hundred years and see bare land.
And suffer vertigo.
Downfall – Adolf who?
Its central moment is an astonishing sequence featuring the then President of Hoffman-la-Roche, Adolf Jann, embarking on a rant that looks now like an uncanny forerunner of the famous Adolf Hitler rant in the movie Downfall. The rant that launched a thousand You-Tubes. Adolf Jahn thumps his fist on the table, voice rising, as he angrily tells an interviewer in effect “You – none of you – can do without us – just try”. See section at 20 minutes 50 seconds to 22 minutes.
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There is nothing specific to Jann or Roche here. This was and is the common credo of the pharmaceutical industry. This is what the CEOs of GSK, Pfizer, Merck and Lilly are saying to governments today. Healthcare is not sustainable unless we develop drugs that get people well so they aren’t a burden on the State, and if healthcare is not sustainable democracy may not be either. Facilitate us or society as you know it goes down the drain.
It would be a mistake to see this as a horrible modern manifestation of rapacious capitalism. Socialists from George Bernard Shaw in the early twentieth century onwards have turned to biology as an answer to social problems. If we cannot get mankind to agree to change for the better, perhaps we can improve on mankind. This belief powered the efforts of governments to eliminate the unfit from the late nineteenth century through to the eugenics movement and underpins some of our hopes for the New Genetics.
Eugenics looks terrible in retrospect while modern genetics looks like our only hope – but the same impulse underpins both. There is no better example of what good history is about than this. Anyone writing the history of eugenics should really portray its prime movers in the same light as we now portray the heroes of the the Human Genome Project.
We should always remember that the nominees for the 1937 Nobel Peace Prize included both Gandhi and Hitler. There was a time when one looked at least as likely as the other to contribute to modern civilization.
Revolution’s little helper
The same dynamic made Valium look like a very dark drug in 2000 – so that even its name was withdrawn. Prozac in contrast looked like the gateway to the hoped for shiny uplands of the future, when by the mid-1990s Prozac should have been seen as a far darker drug than Valium.
Valium entered a world in which psychiatry in many ways led medicine as it had done for almost a hundred years. Psychiatry was the first branch of medicine to have specialist hospitals and specialist journals. And Valium really did work remarkably well. Far from being simply a superficial treatment it likely led to the disappearance of catatonia and saved a lot of lives.
Valium probably did a lot to stimulate the Revolution of 1968. The conventional wisdom now is that Valium was Mother’s Little Helper and in this role that it played a part in the imprisonment of women in suburbia. In fact, Valium and other benzodiazepines undo conditioned avoidance. They were advertised initially as being among other things useful for salesmen – to overcome their inhibitions. They almost certainly disinhibited many women to speak out against patriarchy. They helped students breach the double-binds that Ronnie Laing and others in the 1960s were preaching were holding back society.
Prozac and the SSRIs in contrast far more often produce an apathy that is destructive to engagement in society as Who Cares in Sweden shows. Prozac, Paxil, Zoloft, Efexor, Pristiq, and Cymbalta are far more likely to lead to suicide and murderous violence including school shootings than Valium ever did. And the SSRIs lead to just as many cases of dependence as the benzos ever did.
Tamiflu – PharMessiah?
Are we incapable of learning? Will we always be seduced by the latest PharMessiah?
The Antidepressant Era, the movie, contains an extraordinary comment on just this that no one could have foreseen when it was finished in 2001. It almost looks like the Scriptwriter in the Sky must have inserted the clip of Adolf Jahn telling us that if we don’t facilitate him and Roche society will collapse. We can only afford to keep our economy and society going if he and his company are let develop new drugs.
Well Roche got to develop Tamiflu. Where Valium was the headline drug in the 1980s for the problems a rampant pharmaceutical industry might pose, Tamiflu is now. Governments throughout the Western world stockpiled billions of dollars worth of Tamiflu on the promise that it would prevent the transmission of influenza and other viruses, and would either keep people in work or get them back to work faster, thus saving our economies huge amounts of money.
Except the drug now appears to be close to worthless and to have always been so. It seems that the impression that Tamiflu might help could only have been created because companies can hide the existence of many and in some cases most of their clinical trials and hide the data from all of them, ghostwriting the ones that are published in a manner that keeps all data out of the public domain.
Facilitate us too much and we will lead to your Downfall.
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No reasonable person could disagree with the appalling state that “mental health” has fallen into but, on a personal level, I remain intrigued by some phenomena that have and still manage to get individuals medicated and incarcerated in various institutions. I have found that my own ability to listen to and understand patients has been enhanced by experiencing, myself, two phenomena that, had I not, would have remained mysterious to me i.e. visual hallucination and suicidal ideation. I am one of the 30% or so who hallucinate on Demerol. I wear a MedicAlert bracelet to warn against my being given it. During the birth of my first child, I was given Demerol (without my knowledge – being preoccupied with some difficult sensations at the time) and I hallucinated a nurse coming in with a newborn who was sitting up and talking to me. Fortunately, I recognized the experience for what it was so that when I see homeless people having “conversations” with no-one on the streetcar, I can understand or when a patient tells me she hears or sees things that aren’t there I don’t head straight for the antipsychotic. Hallucinations are absolutely real to those experiencing them, for whatever reason. They are not “dreamlike” or hazy or have any aspect of the imaginary. That’s what makes them hallucinations as opposed to the imaginary friends many children have and talk to.
The second learning experience occurred when I allowed a colleague to give me some Wellbutrin when I was going through one of life’s nasty experiences that we all suffer from time to time. I really knew better but thought that for a few days it might help. On the third day, I was suddenly – and I do mean suddenly- hit with the conviction that I had to kill myself because life was utterly meaningless, hopeless and black. I was so frightened that I stopped a taxi rather than take the subway as I would have normally, called my colleague and told her what was happening and that she had to call me every hour until it passed. If such things can happen to someone like me, fully functional, not “depressed”, so quickly and emphatically, then anyone more psychologically vulnerable and less medication savvy is in grave danger.
Had I not had these brief experiences, able to understand the reasons for them, I can’t say for certain that I would be as passionate about appropriate diagnosis and treatment as I am. I certainly hope so. But here’s the catch. Until fairly recently, I have refrained from relating these experiences to my colleagues in psychiatry. The one time I did, trying to persuade him of the dangers of current treatment paradigms, I found myself on the receiving end of a look that clearly indicated a combination of disbelief and wariness. All I could do was throw up my hands in frustration and keep my mouth shut. So, to a minimal degree, I do know what it feels like to be regarded as somewhat off kilter, not nearly to the degree that happens to those who become ensnared in the system but enough to make me more sensitive to the patient’s perspective.
For anyone who believes the FDA is looking out for us, this Christmastime bulletin from Medscape Medical News should act as a wake-up call:
December 21, 2012 – The US Food and Drug Administration (FDA) today expanded the approved use of oseltamivir (Tamiflu, Genentech) to treat children as young as 2 weeks old who have shown symptoms of influenza for no longer than 2 days. The drug is not approved to prevent flu infection in this population. In addition, the safety and efficacy of oseltamivir to treat flu infection have not been established in children younger than 2 weeks old.
Although there is a fixed-dosing regimen for patients aged 1 year and older according to weight categories, the dosing for children younger than 1 year must be calculated for each patient according to the child’s exact weight, the FDA said in a press release. These children should receive 3 mg/kg twice daily for 5 days. These smaller doses will require a different dispenser than what is currently co-packaged with oseltamivir.
“Pharmacists must provide the proper dispenser when filling a prescription so parents can measure and administer the correct dose to their children,” Edward Cox, MD, MPH, director of the Office of Antimicrobial Products in the FDA’s Center for Drug Evaluation and Research, said in the press release. “Parents and pediatricians must make sure children receive only the amount of Tamiflu appropriate for their weight.”
The most common side effects of Tamiflu, so they say, are vomiting and diarrhea. That might not worry the average healthy adult – but they can be disastrous for a little seven-pound newborn with a fever. What scares me about these instructions is that they seem to be pegged not so much to preventing tragedies (shouldn’t Genentech be required to provide that infant dispenser? And hopefully a weight conversion chart for the stressed-out American parent who doesn’t know a kilogram from a kumquat) as fixing the blame on the pharmacist or the parents when something awful does happen.
The list of potential problems includes delirium with panic attacks, hallucinations or convulsions. It can also include suicidal behavior, according to the folks at the science blog Effect Measure (http://scienceblogs.com/effectmeasure/2009/07/01/tamiflu-and-adverse-effects/) who seem to know their stuff on this. As of 2006 the FDA knew of 103 such cases of “abnormal behavior”, virtually all among children.
Yet this stuff gets promoted by the CDC as the way to save lives among “vulnerable” elders and children during a flu outbreak. It must be Genentech’s world … we just live in it.
It looks as if the FDA has joined the swollen ranks on the non-pharmaceutical promoters of Tamiflu.
In a recent interview with Medscape (http://www.medscape.com/viewarticle/777966) the FDA commissioner, Dr Margaret Hamburg stated:
“We are confident in our review of the data and conclusion that Tamiflu is beneficial in decreasing the risk for flu infection in certain populations and in decreasing severity of the symptoms of the flu in infected patients”.
This is what Roche, the manufacturer of Tamiflu have to say on the ability of their drug to preventing or reducing the risk of infection:
“As a result of their design, neuraminidase inhibitors do not prevent infection per se; rather they prevent the establishment of viral replication sufficient to cause disease.”
James Smith, Regina Dutkowski, and Penelope Ward, “Antivirals for influenza in healthy adults,” Lancet 367, no. 9522 (May 13, 2006): 1571; author reply 1573.
And this is what around the 12th of October 1999 FDA had to say about Tamiflu’s ability to decrease severity of influenza symptoms:
“It is the division’s consensus that the applicant’s analyses of the severity of symptoms in terms of AUC of symptom scores can not be fully supported by the methodology employed for the two pivotal trials. Therefore, to present such data in the package insert could be misleading. The symptom scores were represented by arbitrarily chosen numbers, without giving considerations to the differing clinical significance (i.e. score weight) conferred by individual symptoms. Thus, these scores merely convey qualitatively that a subject who has a score of 10 is sicker than a subject with a score of 5. To quantify these scores as expressed by the AUCs is deemed not strictly appropriate”.
Tamiflu and Relenza/Tamiflu/Tamiflu – NDA 021087/19991027_000/21087_Tamiflu_medr_P2.pdf
(AUC or Area Under the Curve is a graphic plot reporting the scores).
Two points emerge from the Tamiflu story:
– Roche control every single scrap of information there is to know about their product. In this situation there can be no meaningful indendent scrutiny of a drug’s perfomance – until it’s too late.
– Public insitutions and governments are quite satisfied with the current situation. They accept the word of pharma & friends, make decisions on this basis and are resistent to any change – unless there is a catastrophe.
bmj.com/tamiflu documents all this.
The CDC has an extensive website on the effectiveness as opposed to efficacy of flu vaccination in general :
http://www.cdc.gov/flu/professionals/vaccination/effectivenessqa.htm
Not a very stellar record and one which becomes confused, as it does every year with viral infections such as Respiratory Sincytial Virus that can be very dangerous in young children but is usually described as mild in older children and adults. Last year during flu season it affected large numbers of adults and developed into pneumonia with severely negative effects. It was, unfortunately, included in the flu statistics and I suspect this happens more often than not. The question of the effectiveness and usefulness of flu vaccinations remains unproven.
The following is a powerful and pertinent quote from Vincent Felitti, MD (principal author of the Adverse Childhood Experiences (ACE) Study) in conversation with Ruth Buczynski, PhD:
`The resistance to understanding… is interesting because anybody my age or older should remember this. Almost everyone knows that the demonized street drug crystal meth is a big problem. It is interesting that no one seems to remember that the first prescription antidepressant medication introduced for sale in the United States in 1940 was methamphetamine. It was introduced by Burroughs Wellcome, and the brand name was Methedrine. If anyone has any doubt about this, they can go to any major university library and pull out a bound volume of the Journal of the American Medical Association from 1940 or ‘41. There they will see full-page ads for Methedrine. The question therefore becomes: does it mean anything that the first prescription antidepressant medication is exactly the same chemical as crystal meth? Is that just an irrelevant happenstance, or are people unwittingly buying antidepressants on the street? If so, isn’t it dangerous?’
(Teleseminar, The National Institute for the Clinical Application of Behavioral Medicine [nicab])
I have the feeling that we are in danger of throwing out the baby with the bathwater, under the growing conviction that all psychotropic medications are disastrously harmful. The methedrine story is accurate and has obvious application to the treatment of children with Ritalin but there are drugs such as Nardil that have been around for over 70 years and are extremely successful very quickly (within days) with certain types of depression, mainly the so-called “atypical” or “endogenous” depressions that seem to be inherited and have very typical manifestations. Today, it is almost impossible to get a psychiatrist even to consider using them in appropriate cases, mainly because they know nothing about them nor do they know how accurately to diagnose depression and identify its various forms. The manufacturer a few years ago was on the verge of ceasing production of Nardil until patients who relied on it to remain “normal” and functional raised a storm of protest. Of course BigPharma is more likely to respond to a demand for sales than for the opposite. In the interest of stopping the abuse by SSRIs let’s not lose sight of those medications that do work very well for the appropriately diagnosed patient.
I’ve read all your books and think they’re great.
Not to depress you or anything, but your work (as well as my personal efforts in other places) have had zero impact on anything. I’ve had countless conversations with educated people – laypeople, medical and other mental health workers, and it’s like talking to the wall. Everyone, including laypeople, is so sure of the propaganda that they always look at me like I’m crazy and don’t have a clue. They’re sure there’s such a thing as chemical imbalance, for example. Over a decade of fighting this has convinced me that arguing is pointless.
You can’t win. Aren’t you tired of tilting at windmills?
You are right that books have zero impact – even a negative impact in that lectures about the horrors of SSRIs just increase sales of SSRIs. That’s the reason .for RxISK. Doing something is different to saying things. If everyone co-operates to produce a very public dataset we can force change.
That’s kind of depressing. Well, I love all your writing, for whatever that’s worth. ‘Person’ loves your writing.
Don’t know what’s the right place for this question, but IIRC in The Antidepressant Era you were less hostile or even sympathetic towards tricyclics (it’s been a while so I don’t remember exactly). I always wonder: is there an antidepressant that really works? What would David Healy give?
So here I’m asking. Let’s say there was no pressure from anyone, not from patients, not from Admin (maybe that’s my world, not yours).
Let’s say it was for yourself. What would be your antidepressant/s of choice? I have no idea with all the B.S. and marketing and biases and patient self reports what actually works. If anything. And I’m a psychiatrist, if that wasn’t already clear. No idea. If I could really do the right thing, without pressure, without caving in to everyone’s demands and without fear of litigation or censorship by the medical board if I don’t prescribe an antidepressant. Because I have been severely attacked for not prescribing when I thought it not necessary. I no longer dare to do this. But never mind that.
What would I prescribe for depression?
Everyone these days wants person-centered care. Well a major point behind the argument from The Antidepressant Era through to Pharmageddon and Rxisk is that I unlike anyone I treat can avail of very person centered healthcare. If my skin flakes with eczema I can prescribe a steroid ointment. If I am nervous before a public lecture I can take a diazepam. If I have an infection I can get the antibiotic I have always responded to and don’t have to take the fluoroquinolone I’d be scared to death to take that is being forced on me by some doctor prescribing the latest thing. If I have erectile issues I can get Viagra – all without having to reveal my problems-weaknesses-vulnerabilities (more recently termed diseases) to some youngster who might decide that ethically they can’t go along with what I want.
No matter how sensitive I am to you, how willing to respond to your feedback re what is working or not, ultimately the relationship is at present demeaning. It is a system designed for addicts that its very difficult to humanize. It is not reasonable that you have to reveal so much more about yourself to me than I have to you. Having you come in the door to me carrying a Rxisk report about problems you may be having levels the playing field a bit – it restores some power to you. However nice you are to me, I have to take into account you have just put our relationship on a different legal basis.
So if you could get anything you wanted over the counter, and still thought some advice from a third party might be a good idea. What could I offer you that you couldn’t get from a nurse or pharmacist or clinical psychologist prescriber? Good question!
I’m certainly aware of the theme that runs through your books, which (very) roughly stated is that prescriptions should be OTC and not in the hands of someone else. I pretty much agree. Except for antibiotics and a few other things which are public health issues.
In the US, btw, self prescription of anything, not to mention controlled substances, is a big no no. In some states it’s considered iffy, in other forbidden. Prescribing to yourself a bit of valium will lead to loss of your license. You’d have to be a fool to do so in the US.
I don’t agree that we bring no added value. This added value has been decimated by outside forces, but the power of the relationship, the belief in another person’s dedication to your welfare and the preciousness of the physician patient relationship should not be underestimated. And it doesn’t have to be a bad thing. When you’re unwell, placing your trust in another can be very comforting.
Also, I wouldn’t toss away the importance of our years of medical training in developing a particular kind of knowledge and way of thinking. Where another person sees ‘crazy’, if we’re doing our job right, we might see ‘UTI’. Where an SW sees ‘chemical imbalance’, we see ‘deranged parenting, unable to handle emotions as a result’. The later is odd but true, non-physician mental health workers are more inclined to believe the junk message. I wouldn’t discount many aspects of our training even if we’ve filed them away years ago. Medical thinking is not supposed to mean ‘drone handing out script’, it can mean going through all the differential, physical and psychological and then proceeding to engage in psychotherapy.
And I still don’t know which antidepressants really works…given that we are the one with prescriptive authority (like it or not) and patients do come to us expecting to be given an antidepressant, what can I give with the wholehearted belief that I’m doing good? Currently I give whatever they ask for usually, whatever they’ve been on before, that’s basically the way I do it (and after trying to dissuade them a bit from the idea, since we’re not talking about severe depression in most cases). I don’t believe in any of it, though.
And I do believe there are S/Es such as an increase in suicidality. I’ve certainly seen patients who were not depressed given an SSRI for some reason, go on to attempt suicide. I think you’re right about the path being through akathisia. That’s part of my risks and benefits explanation.
Is there some antidepressant worth believing in?
Well I was asking you to consider what would happen if drugs were OTC rather than advocating that they should be. And in response to thought experiment of what added value do we bring, you’ve offered much what I hoped you would – we would offer what we used to offer when drugs were available from us on prescription but not on prescription only. Its unlikely that States will move back to non-prescription only status of drugs any time soon if ever, but most jurisdictions are now employing cheaper prescribers than doctors so we may be about to go out of business unless we can carve out a role for ourselves that has “Brand Value”.
The other option is to change the power-balance by empowering patients to speak out about adverse events in a manner that we are forced to take into account.
Yes the `critical mass’ of opposition aspect is crucial. The Australian Federal Parliament launched Guidelines for the Treatment of Complex Trauma (as distinct from single incident PTSD) late last year, and they have been widely endorsed internationally partly because they have come from an organisation with a diverse mix of stakeholders (clinicians, researhers, consumers etc) so that we can’t be accused of trying to advance a `narrow sectional interest’. Numbers are crucial, and diversity of composition critical in this. Currently trying to get basic trauma-screening into general practice, and there are many parallels in terms of the current discussion (medication potentially problematic in treatment of complex trauma; doctors disinclined to consider underlyng aspects, diverse presentations fragmented into different diagnoses, etc). Which is all `writ large’ at the social level, where `health’ is seen as a separate domain from `politics’, etc and the latter is where the action needs to be. But innovative approaches continue to gestate..
Pam – not sure I agree with this – but you’ll have to wait for some global mental health posts to see where not
I get the same reaction when I insist that MAOIs or tricyclics or benzodiazepines or, more than any of these ,with few exceptions, talk therapy is what’s indicated. I can’t express my rage when I hear that no-one has time for talk therapy these days. That’s when I’m tempted to seek a Valium myself.
Well I don’t know about zero (much less negative!) impact, but of course the intransigence of some predictable sectors remains high. In addition to David’s, I also think here of the major contributions of Vincent Felitti and Dan Siegel respectively, the former who initially couldn’t believe what his accumulated epidemiological data was telling him (`If this were the case, wouldn’t someone have told me? Wasn’t that what medical school was for?’) and the latter who was literally told by a supervisor that if he persisted with the questions he was pursuing he should be a social worker because `real’ doctors weren’t interested in such things. While continuing with the high level publications, Dan, like David, uses social media to `get the message out’, because it’s too important to be confined to those who remain impervious even as the evidence proliferates (and of course David and others have educated many of us about the problematics of `evidence-based’ research so-called, the ripple effects of which surely can’t be underestimated). A multipronged strategy is clearly needed. But`call me old fashioned’ (as a famous Australian expat says!) because I think the books remain a critical component of this, even if, by themselves, they are not necessarily enough..
Pam – A huge component of the problem has to be that the reaction from politicians through to healthcare managers is to assume there is nothing much wrong because there is no clamor at their doorstep. There is no clamor partly because doctors are ulta-absorbent soaker uppers of clamor. There is no other area of life where so many defects in a product go unlabelled, where product failure leads to no offers of your money back, or where successive generations of a product may be inferior to earlier versions. The system isn’t working. A few books, tweets or blog-posts aren’t going to fix this. The system in fact is getting worse – you could call it healthcare warming.
Taking action definitely beats just talking about a problem — but sometimes it’s only by talking about it (and taking the time to write a really compelling book) that you gather together the initial troops you’ll need to start taking action. I would not hesitate to say reading Let Them Eat Prozac changed my life in significant ways, or rather gave me the tools to start changing it myself. The changes continue, and are positive if not always easy, and to think it all started with some dumb old book!
And although I respect the guy for his years of speaking out, I would have to hold Peter Breggin’s books partly responsible for my continuing to swallow the next pill despite my misgivings. When you’re swimming totally against the stream you need to be twice as logical and factually accurate as the so-called mainstream spokesmen — and there were enough alarmist sound-bites, goofy generalizations and just plain Wrong Stuff in those books to allow me to tell myself that the pharma-skeptics were just a bunch of cranks after all.
It’s the book that eloquently expresses what you already believe that always seems so sadly powerless. But the really good book that falls into the hands of the person who is not yet on your team can make a big difference. So don’t knock’em, and thanks for writing’em.
But how many people actually read books, especially non-fiction? Perhaps the answer is a best seller novel with these problems as a main plot and characterization driver.
We might get a referendum, we might get to re-negotiate the persistent ‘interference in our lives’ from the European Directorate.
Do we want to re-negotiate with manufacturers of anti-depressants to change the wording in the leaflets?
Do we want to take the manufacturers to court for mis-information in their leaflets?
Do we want to bring the medical profession to it’s knees, with their mistaken interpretation of our ‘problems’ and wrongful use of medication?
Big questions.
And the answer is……..Yes, yes, yes….
The public perception, at present, because of the magnetic pulling power of over and over and over prescribing of these drugs, is simplistically revealed in recent media stories.
Peter Hitchins, writes, frequently damning indictments about ssris and aggression and suicide and killings regarding the nature of these anti-death pills and I read the comments section afterwards.
Without fail, the majority of the general public perceive that anyone on anti-depressants is a complete ‘nutter’ in the first place….
This is public perception.
How we ‘fell this tree’ the size of a Californian Redwood, is a warning that Healthcare Warming is hotting up and it is not on our side………
Climate control is called for. There is a lot at stake here, at Rxisk and risk and risk and risk……
Preaching to the choir has always been an issue with me. Like one of the commenters on here suggest, people look at you as if you are an alien or, worse still, crazy, when you talk about dangerous meds.
I have learned.
I’ve found that people only sit up and listen when it happens to them. There may be a family member struggling with addiction on one of these drugs or a loved one who, after taking one of these drugs, all of a sudden starts talking about death or ways to die.
We all write about this because we have some experience with it, there was no choice, it was forced upon us.
I’m a fan of rock music, when fiddling with the radio dial in the car I am searching for music that I like – I skip music I don’t like, I find it just doesn’t hit the right spot. Same goes when we, as advocates, talk to friends, family members or neighbours about what we know about this industry. Suppressed yawns ensue because they find our subject matter boring.
I have friends on Facebook who would sooner upload a photo of a fluffy bunny rather than a story of an SSRi inducing suicide in a teen.
Trick is to keep banging the drum. Line from the movie ‘Field of Dreams’ has never been more apt – “If you build it they will come’
Good tagline when promoting Rxisk.
Thank you Dr Healy for your many documentaries, lectures, books and papers on the subject of psychiatric drugs. Your work is invaluable.
I don’t agree that the books have zero impact. They have a very small impact on the situation overall, which is negated by the seemingly unstoppable healthcare warming deniers. But on individuals the impact and can be profound, even life saving/changing for some. So thanks from me anyway.
I have to agree with David when he says the system is getting worse. It is very depressing. (and no, I don’t want a drug for that). I think the whole Tamiflu situation highlights just how bad things are.
Recently I have read some stuff by Debora MacKenzie, the WHO, CDC, FDA, Orac the prominent skeptic/blogger/surgeon, and many more articles, blogs and opinion pieces on the subject.
For a little while I got excited that some real change may come, but no. And what do we have now? Scientists and policy makers shouting ‘Conspiracy theorists! anti-vaxxers! paranoid nut jobs! Propaganda! at anyone who dares speak up…. is this what scientific debate has been reduced to?
Some of the ad hominem attacks against researchers are disgraceful, and should have no part in science. Yet there they are, virtually unchallenged, plastered all over the web, sometimes in so called respected publications or from so called respected organisations.
There appears to be no attempt by the deniers to have any kind of sensible, scientific discussion on the matter. They just completely ignore what is at the heart of the issue, as if it doesn’t even exist. Instead they bang on about their weak and incomplete evidence as if it’s incontrovertible.
Bertrand Russel, once said,
“The whole problem with the world is that fools and fanatics are always so certain of themselves, and wise people so full of doubts.”
Seems to me there are more fools and fanatics invloved in medicine than there are wise men. The whole system from top to bottom is starting to look more like the ‘Ministry of Truth’ every day.
As Bob Fiddaman says, ‘people only sit up and listen when it happens to them,’ and for that reason I fear that Tom Jefferson is right… it will probably take a catastrophe.
But, if it wasn’t for the books, the people like Jefferson, Healy, Goldacre etc, and the attempts to do something meaningful like the Cochrane Collaboration, Rxisk, alltrials.net, and the BMJ’s open data campaign, I probably would have lost faith in medicine and science by now. And I am sure I am not alone in feeling this way.
You guys are the real defenders of science like or not…, and we need you more than ever.
I’ve been thinking about Doc Person’s dilemma: what can he prescribe that works? Just an idea…
Working with injured workers, I’ve watched rehab medicine follow the same sorry path as psychiatry. If surgery doesn’t relieve your pain, you’re sent to a sort of limbo called “Pain Management.” There you’re treated with a cascade of pharmaceuticals, and endless “procedures” – especially epidural steroid injections, of which you can have three to six per year till the end of your days. They’re very lucrative: so fast and easy to perform they could almost be an office procedure, but almost as expensive as surgery. The pain management docs are thriving. The patients? Not so much.
So what does this have to do with psychiatry? Hold on, I’m getting there … I talked with a retired orthopedist who recalled that when he started out, these injections were seen very differently. Their purpose was supposed to be to open a window of opportunity for physical therapy – that is, to provide enough temporary pain relief that the person could tolerate physical therapy, which was seen as the path to real long-term improvement.
What if we took the same attitude towards psychotropic drugs? Instead of pretending they were supplements engineered to correct some deficiency we pretend to understand, we’d just use them to reduce the worst of the pain and confusion so the person could be helped to rebuild their social supports, their physical health, their sense of meaning and value. With that kind of shoring up, maybe the next episode could be nipped in the bud – or at least made less severe. The drugs might be used for two weeks or twelve months, but the goal would be to open a window of opportunity to create as much recovery as possible. If a drug didn’t open that window – if it made people too groggy, or emotionally numb – we’d ditch it and look for something better.
With an approach like that, we might worry less about finding The Antidepressant That Works. There might be some role, in some cases, for most current drugs, many old ones and some new ones yet undiscovered. Meanwhile, we might begin to see the value of the person who prescribes the chemicals and the person who gets to know the patient being (gasp!) the same person. Meaning “shrinks” could actually interact with their patients for more than ten minutes a month. And the social workers and psychologists needn’t suffer, because many patients might be advised to pursue counseling (gasp!) without any chemicals.
We’d definitely threaten the profits of the drug companies, whose business plans depend on enforcing lifelong maintenance consumption of their drugs. Their friends in the AMA, APA etc. would have fits. The insurance companies, who are not nearly as interested in rational health care as they claim, would hate us too. But patients would have new hope, and in the process the mass of “shrinks” might be able to stop leading lives of quiet desperation. What do you think?
Johanna – this seems spot on. Thanks. David
Johanna
What you describe is exactly the intention of medications as I was taught. Diagnose correctly, then find a suitable drug that allows the patient reach a point at which he can collaborate in talk therapy until able to be weaned off. I look in at my local psychiatrist’s office and see at least ten people waiting, at three in the afternoon. Anyone can do the math here.
This is what i thought would happen not to be put on pills and just left for 8 years as in my case. i was told I had to take them for life as i needed the serotonin top up like a diabetic needed insulin!
Johanna and Irene
If only our GP used that approach to Cipramil my daughter would still be alive. The day before she took her own life aged 20 she was put back on medication. Her problem was most likely withdrawal symptoms rather than a return of depression. She was also told she was clinically depressed and could “be like that for the rest of her life” – a total absence of hope.
Yet another danger. Citalopram, escitalopram, and amitriptyline are associated with increased risk for modest QT prolongation, according to a BMJ study. Researchers assessed the records of nearly 40,000 patients treated with at least one antidepressant who also underwent electrocardiogram 14 to 90 days after the prescription. Increasing doses of citalopram, escitalopram, and amitriptyline were associated with QT prolongation, but the other drugs studied did not show a similar risk. Bupropion, on the other hand, was associated with QT shortening. Even modest QT lengthening can cause heart block and sudden death.
http://www.bmj.com/highwire/filestream/627924/field_highwire_article_pdf/0/bmj.f288
The above link also stated that Citalopram was the most widely prescribed antidepressant in the US, with 37.8 million prescriptions in 2011. Is there any question of manipulated positive clinical trial results that may have steered prescribers towards this medication? Have Forest Laborotories and Lundbeck proved to be more trustworthy than GSK and Pfizer? I think this may have some bearing on our GPs assurance that Cipramil was a completely safe medication for my 17 year old daughter.
Chris – Forest and Lundbeck have been no more honest in their handling of clinical trial data than GSK or Pfizer. The hazards of citalopram, especially its cardiac effects, have been buried.
Cisapride was not a psychotropic drug. It was one of the most effective drugs for treatment of gastroesophageal reflux. It caused a number of deaths by prolonged Q-T interval. Because of the potential risk for arrhythmias, particularly when used with interacting drugs, mainly one class of antibiotics, Janssen stopped marketing cisapride in the United States in July 2000. It is now available only through the manufacturer’s limited-access protocol. Its use is restricted to those patients unable to tolerate or resistant to standard therapies and requires intensive monitoring.
The prolonged Q-T interval with antipsychotics has been recognized for years but now we also have information on its existence with Celexa and probably all SSRIs and some tricyclic antidepressants yet we can’t get BigPharma to follow Janssen’s example?
The escitalopram curve on last page, 11, of the BMJ paper “QT interval and antidepressant use” is so clearly VERY concerning, why have we not had warnings re: dosages above 20mg, which are common here in Australia and i daresay elsewhere, in the same way we’ve had warnings of citalopram above 40mg. Is escitalopram still being on patent related? I cannot help but think so.
These cardiac problems are much more common than suspected and more often than not are missed. More than 50 medications, many of them common, can lengthen the Q-T interval in otherwise healthy people and cause drug-induced long QT syndrome. Medications that can lengthen the Q-T interval include certain antibiotics ( e.g. Avelox), antidepressants, antihistamines, diuretics, heart medications, statins, diabetes medications, as well as some antifungal and antipsychotic drugs. People who develop drug-induced long QT syndrome may also have some subtle genetic defects in their hearts, making them more susceptible to disruptions in heart rhythm from taking drugs that can cause prolonged Q-T intervals.
People at risk of long QT syndrome include: Children, teenagers and young adults with unexplained fainting, unexplained near drownings or other accidents, unexplained seizures, or a history of cardiac arrest. First-degree relatives of people with known long QT syndrome
People taking medications known to cause prolonged Q-T intervals
People with low potassium, magnesium or calcium blood levels.
Long QT syndrome often goes undiagnosed or is misdiagnosed as a seizure disorder. However, long QT syndrome may be responsible for some otherwise unexplained deaths in children and young adults. Prolonged Q-T intervals may never cause any problems. However, physical or emotional stress may block a heart susceptible to prolonged Q-T intervals and cause the heart’s rhythm to spin out of control, triggering life-threatening, irregular heart rhythms including Torsades de pointes — ‘twists of the points.’ This arrhythmia is characterized by the heart’s two lower chambers (ventricles) beating fast, making the waves on an ECG monitor look twisted. When this arrhythmia occurs, less blood is pumped out so less blood then reaches the brain, causing sudden fainting and, often, without any warning. If a torsades de pointes episode is short — lasting less than one minute — the heart can correct itself seconds later, and consciousness returns with no after effects. This is different from a typical seizure. However, if a torsades de pointes episode persists, it can lead to a life-threatening arrhythmia called ventricular fibrillation a condition that causes the ventricles to beat so fast that the heart quivers and effectively ceases pumping blood. Unless shocked back into a normal rhythm by a defibrillator, ventricular fibrillation can lead to brain damage and death. It’s thought that long QT syndrome may explain some cases of sudden death in young people who otherwise appear healthy.
These facts are among the many that require either a complete physical examination or a full knowledge of the patient’s history before prescribing psychotropic medications. Deaths resulting from these situations are rarely, if ever, identified as drug-induced although the information has been available for many years and is not only dosage related.